In 1988, after a week’s vacation on the open seas, 20-year-old Randy Dictor stepped off her cruise ship into a world that kept on rocking. Nausea and unsteadiness lingered long after she returned home to New York City.
“I’d be afraid to walk on the street or down the stairs to the subway because I felt as if I was going to fall,” she recounts. “I’d stand on the subway platform letting trains pass until I saw one with an available seat.”
For the next five years, Dictor visited doctor after doctor, took drugs that offered only temporary relief, underwent MRI (magnetic resonance imaging)and CAT scans, and finally ended up at New York University’s Center for Balance Disorders, strapped inside a phone-booth-like contraption with a moving floor. Called the Equitest, it was a last-ditch effort to find what ailed her.
Every year more than 5 million people come to doctors with complaints of dizziness: sensations of spinning, lightheadness or disequilibrium-swaying as if drunk. These problems all fall under the heading of balance disorders.
Your brain maintains your sense of balance by relying on a constant stream of messages received from three parts of your body: eyes, inner ears and muscles and joints. Dizziness stems from sensory messages gone awry. A prime example is that familiar balance problem, seasickness.
If you’re on a ship’s deck, you can avoid seasickness by training your eyes on the horizon; that way your eyes, your inner ears and your legs all tell the brain you’re swaying. But venturing below can make you sick as a dog.
“Once you’re in your stateroom, your inner ears and your legs correctly inform your brain that you’re moving.” explains Dr. Ronald Hoffman, director of the Equilibrium Center at NYU. “But your eyes are looking at the wall swaying with you, so they say you’re standing still. You feel nauseated because your brain receives conflicting sensory information.” Seasick people recover when they reach solid ground. But for people with balance disorders, glitches in one or more of their body’s three monitors can result in months, or in rare cases, years of dizziness.
One common and easily treated balance disorder is a spinning sensation known as benign positional vertigo (BPV). Episodes are triggered by a change in position and usually last less than a minute.
“BPV is caused by tiny calcium deposits in the inner ear that have become dislodged,” explains UCLA neurologist Robert Baloh. Treatment takes just five minutes. The patient lies on his back on an examination table with his head hanging over the side-a position that generally brings on dizziness. The doctor then rotates the patient’s head until the renegade calcium deposits tumble out of the part of the inner ear where they’re causing problems.
A more serious balance disorder is Meniere’s disease, which usually strikes people between ages 20 and 50. It features sudden and recurrent attacks of dizziness that come without warning and typically last for several hours.
Meniere’s is caused by excess fluid that accumulates in the maze of passages (known as the labyrinth) that make up the inner ear. One approach to reducing the fluid buildup and pressure is to cut down on salt in the diet or take diuretic drugs. The drugs Bonine and Dramamine, often used to prevent seasickness, can help suppress the dizziness and nausea associated with balance disorders. Surgery is the treatment of last resort.
Many other problems can also spawn balance disorders: tumors pressing on nerves to the inner ear, side effects from certain antibiotics and blood-pressure medications, upper respiratory infections that damage the inner ear, and disorders such as diabetes that can cause numbness in the limbs.
Fortunately, the vast majority of patients with balance disorders recover on their own or can be successfully treated. But for patients like Dictor, perpetually dizzy for no apparent reason, the last chance to find what’s wrong is a ride on the Equitest.
Dictor fell forward when the platform began to move, a sign her balance problem was within one of her inner ears. The cause, her doctors concluded, was probably a viral infection that had injured her inner ear and sabotaged a reflex that allows the eyes to focus on objects when the head is moving. The treatment: physical therapy that would retrain her to maintain her balance while going through visual exercises.
Dictor’s nausea and rocking subsided after she worked with a physical therapist for eight months. “Now I’m fine, 100 percent,” she said recently. “It’s been a very strange experience, one other people have a hard time relating to. As with sight or hearing, I guess you don’t think about balance until it’s gone.”
