Dizziness and imbalance can be more than simple inconveniences. They can severely restrict movement, affect day-to-day functioning and cause falls, which can have severely debilitating consequences. The new Center for Balance and Dizziness (CDB), based in the Center for Rehabilitation Medicine, offers state-of-the-art technology and treatment for these problems.
According to statistics from the National Institutes of Health, 90 million Americans in all age groups suffer dizziness, imbalance or both in their lifetimes. Fifty percent of people over the age of 75 are affected.

Neurologist Ronald Tusa, director of the Emory center, has worked in the field for more than 20 years. With proper diagnosis, according to Tusa, almost all patients can experience relief. “Dizziness is a very broad area and is due to a lot of common diseases,” Tusa said. “We advocate that, no matter what the cause is, it can be treated.”

Tusa holds joint appointments in neurology, ophthalmology and otolaryngology, and is the founder and former director of the University of Miami’s Dizziness and Eye Movement Center. Earlier, he spent 13 years at Johns Hopkins University, where he began his research in vision and eye movement. He is the author of two books and numerous chapters and articles for professional journals concerning movement disorders and disorders of the eyes and ears.

Dizziness can affect any age group from babies to the elderly, Tusa explained. It may come from a variety of causes such as eye movement disorders, diseases of the inner ear and migraines. Accurate diagnosis of the root cause of the dizziness is key to effective treatment.
The CDB uses a multidisciplinary approach that includes neurology, ophthalmology, physical therapy and dietetics, as needed, in both diagnosis and treatment. Specialized equipment is used to track eye movements, body position as patients stand erect, and to provide other key information that aids in proper diagnosis.

Treatment varies according to the diagnosis. For example, one of the most common diagnoses of the condition called vertigo, or “spinning,” is benign paroxysmal positional vertigo (BPPV). The condition occurs when crystals that form in the inner ear break free over time or due to head trauma. As they float, certain head movements will then induce vertigo.

If a patient has been diagnosed with BPPV, he or she can be treated in the office, often with immediate results. Other causes of vertigo include disruptions of the “balance center” in the inner ear due to a variety of causes, including Meniere’s Disease, viral infections or side effects of certain antibiotics.

Dizziness and balance problems are often misdiagnosed or overlooked entirely by doctors, Tusa said. Patients are sometimes told they must simply live with the condition or are prescribed medications which may not be effective.

Rather than be put on medication, CDB patients are more often treated with a customized program of physical therapy and, if needed, diet and lifestyle modifications. The program has three physical therapists on staff who work only with patients with dizziness and imbalance. One of these therapists, Susan Herdman, is the author of the nation’s most utilized textbook on vestibular rehabilitation. Physical therapy plays a key role in treatment.

In the case of balance disorders, which often affect the elderly, the cause may turn out to be disuse or “disequilibrium,” Tusa said. “As we get older, muscles atrophy; we develop arthritis; our range of motion diminishes,” he said. “People often develop a fear of falling. They then become more sedentary. It’s a vicious cycle. With an exam, testing and then physical therapy, we can usually turn this around in about a month, primarily with a home therapy program.”

The new center is focusing on a three-pronged program: patient care; research devoted toward improving the ability to diagnose and treat patients; and education of physicians and the general public about the causes and effective treatments for problems with dizziness and balance.