By Dr Ananya Mandal, MD
Balance problems are symptoms of an underlying condition rather than disease in itself. There are several different causes and varieties of disorders that may lead to balance problems. Thus treatment of balance disorders is also wide ranging and varied.
For example, balance problems caused by ear infections are treated using antibiotics and anti-inflammatory agents while those due to side effects of medications are treated with stopping the suspected drug or medication. Some of the treatment options include:-
Treatment for a disease or disorder that is leading to balance problems. This could be an ear infection, stroke, or multiple sclerosis. Other causes such as head injuries and disorders of the joints, high or low blood pressure and blood sugar are also treated specifically.
Diet and lifestyle changes – in patients of Ménière's disease, dietary changes such as reducing intake of sodium or salt may help in reducing the symptoms of dizziness. In most patients avoidance of alcohol, caffeine and nicotine is advised.
Treatment of inflammation within the inner ear. This includes labyrinthitis or vestibular neuroninitis. These are treated using anti-inflammatory agents including corticosteroids.
Some aminoglycoside antibiotics, such as gentamicin and streptomycin may be used in treatment of balance problems caused by Ménière's disease. Streptomycin injections and application of gentamicin directly into the inner ear are useful for their ability to affect the hair cells of the balance system. Gentamicin also can affect the hair cells of the cochlea leading to hearing loss.
Certain drugs may be used in some balance disorders. For example, in Ménière's disease Beta-histine can ease symptoms. Diuretics like hydrochlorthiazide may also be used.
Other drugs include sedatives for dizziness including lorazepam that does not ease symptoms but helps patients cope with the sensation. Some drugs that work on motion sickness may be used. This includes drugs belonging to the classes antihistaminics and anticholinergics.
Some calcium channel blockers like Verapamil and Nimodipine and GABA modulators like gabapentin and Baclofen may also help. Neurotransmitter reuptake inhibitors such as antidepressants SSRIs (Selective Serotonin Reuptake Inhibitors) including Fluoxetine, Escitalopram and trycyclic antidepressants including imipramine etc. may be useful in some patients.
Balance retraining exercises (vestibular rehabilitation) – these exercises involve specific movements of the head and body. This helps in promotion of the compensation for the disorder. These are usually performed under the guidance of professionals with knowledge and understanding of the vestibular system and its association with other organs of the body.
Those with Benign Paroxysmal Positional Vertigo (BPPV) suffer from dizziness due to misplaced crystals within the ear. Treatment involves moving these crystals out of areas that may trigger dizziness. This is achieved by head and neck positional exercises.
In addition there may be counselling and cognitive behavioral therapy that is useful in persons with anxiety and depression.
Surgery is necessitated in some severe causes of balance disorders. For example, in severe cases of Ménière's disease, surgery is the last resort. Surgical methods for Ménière's disease include Vestibular neuronectomy and Labyrinthectomy.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)
Last Updated: May 26, 2013