New Technology Helps Doctors Diagnose
and Treat Balance Disorder

by Debbe Geiger, Duke University Medical Center
March 2010

Complaints of dizziness, loss of balance and vertigo prompt more than seven million visits to doctors each year, yet many patients don’t get the relief they seek.

Now, doctors at Duke University Medical Center in Durham, NC, can pinpoint the cause and tailor the appropriate treatment using highly sophisticated diagnostic equipment available at only a handful of sites nationwide. It maps weaknesses in the vestibular system where many balance problems lie.

There are four main types of balance problems — vertigo (a false sense of spinning), presyncope (faintness), disequilibrium (feeling off balance), and light-headedness. Several conditions cause them, from migraines to meniere’s disease. The challenge lies in figuring out which is the culprit.

Doctors aren’t always trained to ask the right questions. They don’t always have access to the right tools to make the correct diagnosis. Patients often find themselves bumped from specialist to specialist in their quest for answers. And they make it harder on themselves by offering vague descriptions of the symptoms they’re experiencing.

A battery of tests try to determine where the balance problems originate, but not all are accurate. An MRI rules out whether a tumor or stroke is to blame. Then a medication like Antivert (meclivine) may be prescribed, but it has side effects and doesn’t always work. As a result, frustrated patients are often told to live with what ails them. Sometimes that makes patients second-guess themselves.

"So many patients tell me, ‘I was starting to think I was crazy,’" says David Kaylie, MD, an otolaryngologist at Duke. "You go to so many doctors and you start to wonder if it’s all in your head."

Kaylie says balance disorders can be treated successfully with the right tools. And that’s where this complex diagnostic system comes in.

The central components are a rotating chair housed in a dark chamber, infrared goggles mounted with an internal video camera, microphones, and intricate computer programs. The goal is to pinpoint whether the balance problems reside in the inner ear or the brain.

The eyes hold many of the answers. That’s because the eyes are a window to the inner ear; they depend on each other for good balance and clear vision. Head movements and other stimulation send signals from the inner ear to the eyes via the central nervous system. And by tracking eye movement, doctors can see what’s going on behind the closed doors.

"The dark chamber, the rotating chair, the lights, the sounds, and the infrared goggles help us stimulate the senses," explains Kaylie. "By monitoring the eyes’ movements we can track the way the vestibular system is responding. If someone has a vestibular weakness, the brain tries to compensate. The diagnostics tells us what stage of compensation the brain is in, and helps us figure out how we can retrain the brain to compensate correctly for the balance loss."

Being able to interpret the test is difficult and requires a specially trained audiologist. And while it’s covered by most insurance, the equipment is expensive to install. That’s why so few places have it, and why few people with balance disorders are able to reap its benefits.

In the right hands, however, it puts patients on the path to better balance and overall good health. Once the doctors accurately identify the cause of the balance loss using this sophisticated armamentarium of tests, they can prescribe the right treatment. That may take the form of physical therapy, changes in activity levels, medication, dietary adjustments, and sometimes surgery.

"When you can have one of these tests and it can show concretely and objectively that something is wrong, that alone makes people start to feel better," Kaylie says.

For more information about treating balance disorders and vestibular testing at Duke, call 919.684.3834 or visit visit Duke's Vestibular Clinic online.

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