Tuesday, July 7, 2009

Ear to the ground

Inner ear problems that cause dizziness may have serious consequences for the elderly

Eveline Gan, eveline@mediacorp.lcom.sg

Inner-ear problems affect the balance of the elderly.

Nausea and giddiness accompanied by a loss of balance. By all accounts, it seemed that my grandfather - who felt so ill two weeks ago that he could hardly move or speak - was displaying pre-stroke symptoms.

We rushed him to the nearest A&E department. Fortunately, the doctor assured us that his illness was not as grave as we had imagined.

What my 73-year-old grandfather experienced were the unpleasant effects of vestibular dysfunction, or inner ear balance disorder in layman-speak.

While vestibular dysfunction may not seem as serious as other medical conditions - say, a stroke - a new study has found that it may lead to equally catastrophic consequences in the elderly.

According to a report published in May's issue of medical journal Archives of Internal Medicine, those with the condition are more likely to fall down. For the elderly, falls often lead to serious injuries and are one of the leading causes of death.

Of the 5,086 adults surveyed, 26.8 per cent who showed symptoms of vestibular dysfunction such as dizziness and spinning sensations had an eight-fold increase risk of falling, the study found.

A balancing act

Maintaining our sense of balance is a complex process that involves the vestibular system - organs in the inner ear that keep us upright by sending messages to the brain about our orientation - what we see and touch, as well as the strength of our muscles, explained Dr Yuen Heng Wai, an ear, nose and throat (ENT) consultant at Alexandra Hospital's department of otolaryngology.

People who have vestibular disorders may find it tough to maintain equilibrium because information necessary for balance is not sent to the brain.

As such, they will have symptoms that are similar to those my grandfather experienced. These include giddiness and spinning sensations when they move their body or head. Sweating, nausea and vomiting may also occur.

Dr Yuen said that although inner ear balance disorders also afflict young adults, they have more serious consequences for those advanced in years.

On average, over half of the patients he sees at the hospital are above the age of 50.

"If a young man feels dizzy, he can still use his eyes or his muscular power to maintain balance. The ability to use sensory cues to compensate for giddiness is diminished in the elderly," explained Dr Yuen.

For the elderly, the ability to stay balanced is a big deal.

A simple fall can be catastrophic, said Dr Noor Hafizah, a senior consultant at Tan Tock Seng Hospital's (TTSH) department of geriatric medicine.

According to Dr Hafizah, up to 20 per cent of the elderly in Singapore fall accidentally each year. At TTSH's A&E department, more than half - about 60 per cent - of this group require hospitalisation.

"Compared to young adults, the elderly are more frail. Their reflexes are also slower. So when they lose their balance, they have a higher risk of sustaining serious injuries," said Dr Hafizah, adding that there is also an increased risk of death.

In spite of the research findings, Dr Hafizah said falls among the elderly aren't only caused by inner ear balance problems.

"Falling should not be considered as a normal part of ageing. It could also be an early warning sign that the person has a more serious underlying medical condition such as arthritis or a neurological illness," she said.

While an inner ear balance disorder cannot be prevented, it can be easily diagnosed after a careful physical examination by an ENT doctor. The remedy will depend on what the problem is. With prompt treatment - which includes medication and therapy - most recover eventually, said Dr Yuen.

Who's at risk?

According to ENT consultant Dr Yuen Heng Wai, the elderly have a higher risk of getting inner ear balance disorders. So do those who have had head injuries or who position their heads in uncommon ways.

Said Dr Yuen: "It's been found that people who put their heads in abnormal positions, such as those who practice yoga regularly, are more prone to getting inner ear balance problems."

From TODAY, Health – Tuesday, 07-Jul-2009