What are vertigo and balance disorders?
Vertigo and balance disorders are a group of diseases that result from failures that occur at the level of the movement sensors that we have at the inner ear and brain level. The set of sensors that allow us to orient ourselves in space. The word vertigo, which is the most classic and characteristic form of these diseases, means spinning because the most common form of vertigo attacks is the one in which the patient has a very intense sensation of movement, with a spinning sensation associated with nausea and vomiting.
What are the symptoms?
As I said, the most frequent form is vertigo, with a spinning sensation. It is usually associated also with a very important difficulty when walking, when moving, because not having an adequate perception of our location in space, we have completely anomalous responses in relation to the movements we make. We have difficulty walking, we are unable to stand on our feet and when this becomes chronic, when the patient has a more sustained clinical condition over time, what persists is basically this limitation in the performance of movements during walking, adequate, a very important insecurity during movements and a risk of falls which, above all, will affect older people very significantly.
How does it affect the patient?
The degree of affectation that vestibular pathology produces in the patient is very high. Only those who have suffered from it know to what extent vertigo can alter our quality of life. Fundamentally we lose something that differentiates us from animals, which is our ability to stay in season, when that fails, everything fails. We have two important lines of functional alteration. On the one hand, vertigo crises, in which the patient does not know if tonight he will be able to go to dinner or if next week he will be able to go to work normally, because they are crises that appear very abruptly and totally incapacitate him in a very acute way. And on the other hand, we have the limitation generated by chronic instability. Patients who have suffered recurrent vertigo or in some cases chronic pathology in the alterations of balance, produces a chronic and maintained residual instability that makes us have a functional limitation, a limitation in our ability to move that makes us feel bad, persistently over weeks.
What are the treatments? What advances have there been in recent years?
The advances that have taken place in recent years, above all, have been at the diagnostic level. This is where we have taken very important steps forward in two aspects: first, our diagnostic capacity and, secondly, in our capacity to obtain data from the patient, from the patient’s examination, causing the least possible discomfort.
Two pieces of equipment have revolutionized the way of analyzing vertigo, which are the computerized dynamic posturography, which is a machine that allows us to analyze the patient’s balance capacity. It is a sophisticated machine, they are large machines that require a very high investment in space and equipment, but they allow us to really measure what the patient tells us when he/she is unstable. When the patient tells us, I have a bad balance, nowadays we can measure it. And secondly, the cephalic impulse test, which is a technological development that has been implemented on a regular basis for less than 15 years, has allowed us to analyze the speed of response of the balance system in a very perfect way. These two factors allow us today, together with experience and knowledge of the pathology, to arrive at a very sure, very accurate analysis of the patient’s pathology.
As far as treatment is concerned, we are making great progress in surgical techniques that allow us to apply the most appropriate treatment to the inner ear to solve the problems, especially in the case of vertigo crises. There are some very important lines of research worldwide, which will probably soon make it possible to place implants, just as we do in the case of hearing, but to restore the patients’ balance. And a line of treatment that in Europe is already being implemented in a very consolidated way and in Spain, more and more, is the fact of multidisciplinary vestibular rehabilitation teams. In other words, teams in which ENT specialists, neurologists, physical rehabilitators and physiotherapists work together, and which make it possible to recover the patient’s chronic imbalance in two fundamental areas. On the one hand, patients with vertigo who have been left with chronic instability and, on the other hand, the chronic instability of the elderly with the associated risk of falling, with the risk of fractures and with the very high mortality rates associated with falls in the elderly.