Remaining Balance

I'm not sure, VikingMan. I'm unaware of any method which quantifies balance, as a result of vestibular function alone, outside of medical testing. Alas, within the rigorous walls of medical standards, I'm still unaware of any test, whether commonplace or yet to be established, which can calculate the vestibular systems ability to dictate balance within a single unit of precise measurement. Hence the reason why medical professionals generally describe balance as 'yeah good', 'umm poor', 'hmm average' or 'err nonexistent' et cetera, rather than 76.65% vs 77.3% of optimum vestibular function.

… I could however be wrong. Hopefully I am.

&, of course, this isn't a jab at medical professionals, it's simply the terminology we resort to when science has yet conquered a specific area of study. Hereby known as the terminology of the gaps.

If I'm reading your question correctly, I'm wondering how this could be done at home, per se, without testing, when concerning those who have lost, or experience vestibular dysfunction, considering it would be difficult to isolate which of the peripheral sources were responsible for the balance input calculated.

For instance, I know closing the eyes isolates both the vestibular source - the utricle, saccule, & the three semicircular canals - & the proprioceptive source from the bodies balance system as a whole, however I'm unaware of any method that can be employed in the comfort of your home which can further isolate one of the remaining two sources, so to quantify vestibular ability alone.

Regarding your second question, there is a correlation between the two, though the coefficient value is somewhat moderate & short of absolute.

This, however, isn't my area of expertise. Corrections are appreciated & information corroding my ignorance promptly welcomed.

Hopefully someone knows more than I do & provides the both of us with a more knowledgeable answer.

 

Well this is definitely in the category of medical testing but when I was seen in denver last fall I learned through the VNG that my balance in my bad ear was at 40%. This number can fluctuate day-to-day though -- I remember that was a particularly bad balance day for me.

I'd had an audiogram done a couple weeks prior and although I don't remember the exact numbers I know my hearing wasn't down 60%. Maybe 20% at most. At that time my MM was affecting balance way more than hearing and when I asked the doctor why my hearing wasn't as bad as balance she said "dumb luck".

 

Hi

here in the uk caloric tests are common

http://www.dizziness-and-balance.com/testing/ENG/caloric_test.htm

At appointments I've done Unterberger test (marching on the spot with eyes closed) and there is also something called the Fukuda stepping test which came up when I was looking how to spell 'unterberger'!

baloo

 

If I'm reading your question correctly, I'm wondering how this could be done at home, per se, without testing, when concerning those who have lost, or experience vestibular dysfunction, considering it would be difficult to isolate which of the peripheral sources were responsible for the balance input calculated.

For instance, I know closing the eyes isolates both the vestibular source - the utricle, saccule, & the three semicircular canals - & the proprioceptive source from the bodies balance system as a whole, however I'm unaware of any method that can be employed in the comfort of your home which can further isolate one of the remaining two sources, so to quantify vestibular ability alone.

My experience, I had lost my hearing in my mm ear but still had good balance. I am assuming it was because the vestibular source had not been affected and also I was in excellent physical condition, i.e. triathlete, and yoga. Due to vertigo and drop attacks I had a gent shot. This is when my balance system was throne out of whack and perfectly normal considering the gent shot. Once my brain adjusted I was back to my old self. Then I advanced to the laby and once again I had to wait until my brain adjusted. As you say Nathan, eyes close and dark rooms are not a good situation for me. But prior to the gent/laby my balance was not affected when I lost my hearing.

 

Interesting. Thank you, Redwing. Did you experience vertigo & drop attacks during the time you "still had good balance"? If so, would this not imply that your vestibular system was indeed affected, & your balance system sporadically out of whack, prior to your gent shot, though elaborated by it?

I'm aware of VNGs, their ability to decipher between bilateral & unilateral loss, to test motor & inner ear function, & to determine the causes of dizziness & balance problems, though I'm ignorant as to how they isolate proprioceptive from vestibular input & quantify vestibular ability to these precise degrees.

I propose a number of questions to anyone kind enough to answer them, as the google machine has yet supplied the information I'm looking for.

How does a VNG distinguish vestibular input from proprioceptive input?

How have we quantified irregular eye movements, so to calculate the degree of vestibular dysfunction? For instance, while attempting to follow a visual object with their eyes, as required of the patient during a VNG, how irregular must eye movement be to grant a diagnosis of such accuracy?

For example, is it based on the number of eye jumps? Is the value of one eye jump equivalent to 10% vestibular dysfunction, or 5%? How have we determined these values? Or is it based on the amount of time the eye wanders - if the eye were to wander 40% of the total time attempting to follow the visual, does this then conclude 40% vestibular disfunction? What is the relationship value between eye movement & vestibular dysfunction?

Are all neurological influences ruled out prior to this calculation?

Would the unterberger & fukuda (sounds like an insult in Hindi, does it not? Wot a fukuda. Stop being such a fukuda) test not be problematic to determine vestibular input alone, considering said exercise observes both vestibular & proprioceptive input?

Regarding the caloric test, eye movement or lack thereof &/or according nystagmus measures vestibular ability generally - i.e. as weak or strong. Though a valuable test no doubt, I'm wondering if it can produce more than ball park results, so to confidently conclude, for instance, 87% vs 89% optimum vestibular function.

I'm curious as to how we determine these values so precisely.

 

I had the caloric test done last year, mainly to test that I did not have any problems with my 'good ear' which is my right. As I have a grommet in my left ear it had to be the air caloric test and I remember the audiologist telling me that the balance in my 'good ear' was within the normal range (he didn't explain that) but the balance function in my left ear 'bad ear', 96% had been destroyed (I've had gent treatment). The caloric test is a bit rough so I didn't press for explanations but if I get a chance I will ask how they can be so precise.

I'd had Menieres-like attacks for quite a while (maybe 7 or 8 years) but they were very occasional, maybe once or twice a year if that and I could go for years without any. In 2011 the attacks started up again and became pretty regular, and after a while Menieres was diagnosed. A month or two before, I had seen a sports physiotherapist because of a running injury and he got me to do some balance exercises (standing on one leg and going up and down on tip toe) and he was really shocked by how bad my balance was. So I always wondered if somehow that was an indicator that things weren't OK.

Baloo

 

Interesting. Thank you, Redwing. Did you experience vertigo & drop attacks during the time you "still had good balance"? If so, would this not imply that your vestibular system was indeed affected, & your balance system sporadically out of whack, prior to your gent shot, though elaborated by it?

Yes, I did have vertigo and drop attacks during this time. So yes I believe during those attacks my vestibular system most of been affected. But after an attack my balance was never affected until the gent and laby.

 

Cool. Will be interesting to know how they calculate so precisely. Thank you, Baloo.

Welcome to the forum, btw.

I can relate to this. Though I've never received a gent shot or a laby, while I was experiencing drop attacks & random, though frequent episodes of vertigo, like you, my balance between these occurrences remained essentially normal. It wasn't until my vertigo & drop attacks ceased, that I then began to experience a ever so slight degree of disequilibrium 24/7.

 

Nathan did you experience natural burnout with your mm? Are you symptom free now? I don't know too many mm folks who have "burnout". Lucky you if you did!

 

I was actually tempted to mention burnout in my response to you, though it's a complicated disease as we are all aware of, & difficult to determine with absolute certainty if my mm's entered burnout or a surprisingly elongated period of remission.

I'm not symptom free, no. While I no longer experience drop attacks, nor episodes of vertigo, I still experience rare, slight & very much manageable short lived episodes of Mal de debarquement, & minor though fluctuating periods of tinnitus, aural fullness & hyperacusis. & of course disequilibrium as I mentioned earlier.

I've regained, how I'm unaware, much of the hearing I lost during the first 3 - 4 years after I was diagnosed. I no longer require hearing aids for instance, however struggle at times while attempting to follow conversation in noisy environments, especially here in AU as Aussies tend to mumble. Despite experiencing that which I've mentioned above, & though my hearing & balance remains compromised, the severity of my symptoms now border trivial the majority of the time. Particularly when compared to the degree I once suffered form them.

I hope it is burnout, & would be inclined to place my money on burnout rather than remission, though I'm not discarding the possibility that the perdition I once experienced may return sometime in the future.

 

I was actually tempted to mention burnout in my response to you, though it's a complicated disease as we are all aware of, & difficult to determine with absolute certainty if my mm's entered burnout or a surprisingly elongated period of remission.

You are correct Nathan. I asked my OTO about burnout hoping I was close to the end. Unfortunately he told me exactly what you stated. There is no absolute way of knowing. I really hope you have entered burnout.

 

Hello,
My vestibular nerve is what was the cause of my poor balance. A rotory chair test is what determined that my vestibular nerve is only working 5%.

 

I think I remember a post on this board during the past few months where someone posted that their recent testing showed limited/no vestibular function remaining in the bad ear. And that dr told them that because there is no remaining function that he/she would not ever have the vertigo attacks again. It does not change the fullness or ringing but that vertigo would not be an issue in the future. So perhaps that is what "burnout" actually is - not that Menieres "stops" but that once it has destroyed all function it can no longer react.