A lot of people will experience a balance disturbance at some time in their life. Many patients will come to an ENT physician with a complaint of vertigo. The role of the ENT doctor in the evaluation of patients with a balance disturbance is to determine if the balance problem is because of an abnormality of the ear. What is vertigo? The term vertigo generally means a sensation of spinning; whether the patient feels like they are spinning or the environment is spinning. Often movement makes the sensation worse.
The System of Balance
There are four parts of the nervous system that play a role in balance. The eyes, ears, peripheral nervous system, and the brain. The eyes generally relay information to the brain where our body is relation to the world around us. The ears tell the brain where the body is in relation to rotary, linear and vertical motion. The peripheral nervous system sends information about the position of our body from various receptors in the muscles, bones, and joints. The brain then acts as the super computer that puts all the information together and regulates how our body responds to the stimulus. Anything that affects any part of the previous systems can cause our balance to be disturbed.
The Vestibular System
The human ear has two parts the cochlea and the vestibular system. The cochlea is the mechanism of hearing. The vestibular system is the mechanism of balance. When the vestibular system is not functioning normally the symptom the patient describes is usually one of spinning. Either they are spinning or the environment is spinning. Usually movement makes the symptom worse. Being motionless and keeping the eyes open generally decreases the symptoms. Onset of symptoms may be quite sudden, or sometimes it can be a gradual increase in frequency and severity.
Evaluating the vestibular system
Because the vestibular system and the cochlea are one sensory organ patients that come to an ENT physician with a complaint of vertigo will always get a thorough evaluation of the ear, nose and throat, and the cranial nerves. They will also be examined for beating of the eyes called nystagmous. Their peripheral balance system will also be checked with tests of movement and gait. A hearing test will be performed. If indicated, further test may include test of the , vestibular system, cochlea, auditory nerve, and possibly blood test. Fortunately, none of these test are painful, they include an electronystagmogram, (ENG), electrocochleography (ECOG), and an auditory brainstem response (ABR). Some clinics even perform test of posturography.
Other evaluations of balance
If indicated the ENT physician may make a referral to an ophthalmologist or a neurologist if testing indicates that the peripheral nervous system, eyes, or brain are abnormal. Sometimes an MRI of the brain and auditory nerve may be performed.
Treatment of vertigo
Once the source of the balance disturbance is determined and if it is confirmed to be vestibular in origin there are several treatments that the ENT doctor may use to treat vertigo. These can include vestibular suppressants, antivirals, steroids, dietary changes, diuretics, physical therapy, and possibly intratympanic injections or even surgery.