Balance is essential
By: Mary-Ellen Phelps Deily
Washington Post, October 16, 2001
Dizzy Spells Are Common and Treatable at 60-Plus -- But
Not to Be Ignored.
In December 1997, Richard
L. Moyer's world started spinning.
The 72-year-old was on the golf course "just
standing talking to somebody," he said. Then, "all of a sudden,
I started to sway." Moyer, who had spent 20 years in the Navy and
never experienced even a twinge of motion sickness, feared a heart attack
– until, seconds later, the harrowing sensation passed.
But his problems had just
begun. Over the following three years, Moyer experienced dizzy spells that
grew in intensity and duration. Some lasted for hours.
"I really couldn't do
anything I wanted to do," he recalled. "I never knew when [the
dizziness] was going to hit. . . . You can't believe how miserable that
Today, the Shermans Dale,
Pa., resident is feeling fine, and he credits his recovery to treatment at
Johns Hopkins Hospital for Meniere's disease, an inner-ear condition that
can trigger severe dizziness. "I plan to do things now," Moyer
said. "I don't have to fear getting dizzy."
Harry Weiss, an
86-year-old who lives in a Bethesda retirement community, has suffered
brief, less severe bouts of dizziness. He is "occasionally and
distressingly" dizzy, and he has no idea why. "I think I've been
stopped by dizziness for many, many years now," Weiss said. "The
doctors never seem to know how to deal with it. Their eyes seem to glaze
over when you say you're dizzy."
Weiss and Moyer are among
the many seniors who suffer from dizziness and balance problems. While
these conditions can strike at any age, they fall disproportionately on
older people. According to an analysis by the National Institute on
Deafness and Other Communication Disorders (NIDCD), about 6.2 million
Americans report chronic dizziness or balance problems, about half of them
seniors. Nationally, around 9 percent of the 65-and-over population report
suffering from balance problems.
And it's not just
prevalence that makes balance an important issue for seniors. Older people
are more likely to hurt themselves seriously if they fall – and to
suffer greater disability afterward.
"Usually a fall in an
older person is going to impair their functioning," said Sandra
Sewell, a registered nurse and clinical specialist in geriatrics who
serves as the program manager for community care management at Suburban
Hospital in Bethesda. Particularly for frail elderly individuals with
other health issues, she said, falls can be devastating.
Brain Tumor or Allergy?
Unfortunately, the symptom
of dizziness can be a sign of a bewildering range of underlying
conditions, from the relatively benign to the potentially fatal: low blood
pressure, brain tumors, vision problems, stroke, allergies, head trauma,
nutritional deficiencies and many more. Still, doctors and patients agree
that seeking out medical attention early is crucial, and not only to rule
out or treat serious conditions. Balance problems of more benign origin
can often be treated easily – but if they are not, older people with
problems that should be only mild and correctable may suffer reduced
quality of life unnecessarily.
"When the nurse says
you have a 75-year-old patient with dizziness, you don't know which of 20
different ways you're going to be going," said Robert Dobie, director
of NIDCD's Division of Extramural Research. NIDCD, part of the National
Institutes of Health, studies hearing, balance, smell, taste, voice,
speech and language.
Dobie's first priority is
understanding what the patient is experiencing. He begins by barring the
word "dizzy" from all discussions. "We banish it from our
conversation because it's too vague," he said.
Dobie gets patients to
describe their symptoms in more specific terms and then usually can assign
the case to one of four categories, all relatively common among older
people. "Getting it narrowed down" is crucial, Dobie said.
"The majority of patients . . . have symptoms that can be
If they feel as if things
around them are moving or that they're moving when they're not, that's
vertigo, a condition typically related to the inner ear. Vertigo can be
caused by ear infection, ear trauma or the loosening of calcium crystals
within the ear due to aging.
If they feel as if they're
going to fall down, disequilibrium. This type of dizziness can be
associated with inner-ear problems, medication side effects, arthritis or
neurological problems, to name a few possibilities. The drugs most likely
to cause disequilibrium are ones that affect the brain, including
sedatives, painkillers, anti-seizure medications and antidepressants.
Drinking alcohol while on medication can also trigger the sensation.
If they feel as if they're
going to faint, that's presyncope, which may indicate a heart, medication
or blood vessel problem. Often, blood pressure medicines are the culprit.
In some cases, they'll lower a patient's blood pressure too much and bring
on the fainting feeling.
Unfortunately, many cases
fall into a fourth, unspecified category. Dobie refers to patients in this
group as having "lightheadedness" or "nonspecific
dizziness." Although the lack of a clear diagnosis can be troubling
to the patient, generally the people in this category don't have anything
seriously wrong, Dobie said.
At the Extremes
Probably the most common
cause of vertigo is something called benign paroxysmal positional vertigo,
or BPPV. People with BPPV experience vertigo – or nausea or
lightheadedness – when they turn their heads or just roll over in bed.
To understand how BPPV affects people, imagine feeling as if you've just
stepped off a very fast merry-go-round – when you haven't.
The attacks are brought on
by loose calcium crystals or debris in a person's ear. In the case of
younger people, a head injury can be the cause. With older people,
degeneration of the ear's vestibular system may be to blame.
Unsettling as the
condition is, it's often quite curable. In fact, doctors can perform a
series of gentle maneuvers that rotate a patient's head and body in such a
way that the crystals within the inner ear float back into place. In some
cases, doctors have the patient turn their heads themselves. In others,
patients are strapped to a table that rotates as they lie still. Either
way, the process is noninvasive, takes as little as 10 minutes and is
performed in doctor's offices rather than a hospital setting. With the
crystals back in place, the vertigo should stop. If crystals come loose
again, the treatment can be repeated.
Then there is dizziness
that indicates something really serious. For example, dizziness can
indicate stroke when it is paired with a number of neurological symptoms,
such as a loss of consciousness, difficulty talking, the inability to move
an arm or leg, or vision changes such as the appearance of blind spots.
Anyone with these symptoms should seek immediate medical attention, Dobie
Examining Past and Present
Of course, not every
diagnosis will be as straightforward as BPPV or stroke. So in many cases
physicians need to probe deeper. The patient's medical history is
essential, said John P. Carey, assistant professor of otolaryngology/head
and neck surgery at Johns Hopkins University in Baltimore. Carey generally
administers a range of hearing and balance tests. But he also wants to
know about medical problems patients have faced in the past. Even those
with no apparent connection to balance could make a difference, he said.
For instance, Carey
believes migraines can lead to balance problems long after the painful
headaches have stopped. Often, migraine-related dizziness can be treated
by adjusting a patient's diet, cutting out such things as caffeine,
chocolate and red wine. Regular aerobic exercise and a sleep schedule help
as well, Carie advised. If those treatments fail, medication may be
Equally important is
what's going on in a patient's life beyond the dizziness. Carey, who
treats Moyer and others with balance problems, recommends that patients
provide their doctors with a complete list of the medications they're
taking. The patient should indicate if they've just started or stopped
taking a particular drug.
Finally, Carey advised
that patients keep a dizziness diary where they jot down when and how
spells hit them. Documenting that attacks come when you're standing up or
reaching for something, for example, can make the doctor's job a lot
easier. "It's very important for patients to be very observant,"
As for treatments, they
can vary as much as diagnoses. For some, the cure may be as simple as the
elimination of a particular drug or a change in dosage. For others, a
special diet designed to cut salt intake and thereby reduce water
retention in the inner ear may help. Less frequently, doctors may
recommend medication. Very occasionally, surgery on the ear's balance
mechanism may be required.
Fear of Falling
It's not just the physical
aspect of dizziness that creates problems. Particularly among the elderly,
dizziness can pack a powerful psychological wallop.
"For someone who's
83, a fall is really frightening," said Sewell of Suburban Hospital.
"It can make them lose their confidence."
The hospital's community
care management program provides a variety of health and outreach services
to the elderly, and complaints of dizziness among its clientele are not
uncommon. Sewell said her organization takes a holistic approach to fall
prevention generally and to its causes, including dizziness. That entails
asking questions about a person's lifestyle and how dizziness has affected
it, and perhaps making a plan for how to cope with dizzy spells.
Sewell's staff is
interested in such mundane things as whether a person takes hot showers.
If the water's too hot, it could touch off a blood pressure problem that
brings on a feeling of dizziness or lightheadedness. Another common
irritant starts with the very common act of reaching over one's head to
get something. Sewell said she knows of many cases in which women, in
particular, have craned their necks back as they reached for something,
pinching off the blood supply in their neck momentarily and touching off a
What's important is
helping patients persevere and keeping their fears from getting the better
of them. "As we get older, we see the consequences of things,"
Sewell said. "Just think about it when you were 16 or in your early
twenties, all the things you did without thinking."
Sewell also advises her
clients to take it easy. Moving too fast can touch off a moment of low
blood pressure, when blood doesn't pump quite quickly enough to keep up
with the burst of activity, resulting in lightheadedness or dizziness. Her
advice: "You get up fast when somebody's at the end of the hall
handing you a $100 bill. [Otherwise,] you get there when you get
Richard Moyer knows what
it's like to have your life almost stolen away by dizziness. Although
Meniere's disease – the cause of his dizziness – frequently starts in
middle age, it didn't catch up with Moyer till he was in his late sixties.
But when it did get him, it hit him hard.
His troubles were so
severe that he feared driving and mostly kept close to home. He even
missed a reunion with Navy buddies that he'd been planning to attend.
Dizziness put "a clamp on everything," he said.
That's why he was so
relieved when his doctor got him an appointment at Johns Hopkins. The
physicians there determined that he was a good candidate for a treatment
involving injection of the antibiotic gentamicin into the inner ear.
Gentamicin essentially deadens the faulty balance mechanism in an ear
affected by Meniere's disease. The body compensates for the drug's effect
by relying on a person's one good ear for balance.
After the injection, Moyer
underwent physical therapy to improve his balance and learned exercises to
train his eyes to help steady him. For him, it's been a miracle cure.
"The help is great," he said. "I am just so pleased."
Today, Moyer, who runs his
own business making golf clubs, is an outspoken advocate for seeking
medical help as soon as dizziness strikes.
"Don't let it go," he advised. "Get help
as soon as you can."