From: American Academy of Neurology
Sudden falls for elderly may be caused by overlooked ear disorder
Sudden fall attacks among the elderly can be related to an overlooked inner ear disorder. However, with proper diagnosis, available treatments are often successful in curing the problem, according to a study presented during the American Academy of Neurology's 52nd Annual Meeting in San Diego, CA, April 29.
"In older patients, an inner ear cause for sudden fall attacks or recurrent vertigo (dizziness) is often overlooked and many of the patients are misdiagnosed," said Gail Ishiyama, MD, a neurologist at the UCLA School of Medicine in Los Angeles, CA, and lead author of the study. "Once the correct diagnosis is made, we found that physicians and patients alike are hesitant to consider surgery, even in the cases of disabling and dangerous sudden fall attacks. Our experience is that the surgical success rate in these older individuals is excellent."
The study included eight patients -- five men and three women -- with sudden fall attacks that began after age 55. During the attacks the patients had the sensation of being pushed to the ground. They did not lose consciousness, had no accompanying neurological symptoms, and were able to rise immediately after the attack. Prior to the study, one participant with sudden falls had been put on long-term seizure medications despite three negative seizure tests, and another patient had a cardiac pacemaker placed that did not end the fall attacks.
Three of the patients were diagnosed with Meniere's disease, a disorder of the inner ear usually resulting in recurrent attacks of dizziness, tinnitus (ringing in the ear) and deafness. The disease also causes swelling in the ear's endolymphatic system, which contains the organs for hearing and balance.
Five patients had delayed endolymphatic hydrops, a disorder similar to Meniere's but the symptoms, including dizziness or falls, may occur years after a profound hearing loss. All patients had at least partial hearing loss in one ear and a decrease in eye movement related to the ear's balance function.
"Often times, the vertigo or falling spells are unaccompanied by symptoms usually associated with the ear in patients with delayed endolymphatic hydrops," said Ishiyama. "If a disorder of the inner ear is suspected, a hearing test and a test that records eye movements following stimulation of the inner ear's balance organs can usually confirm the diagnosis."
To diagnose an inner ear disorder patients should be asked about the length and quality of the vertigo or sudden fall attacks, associated symptoms, whether or not there is a loss of consciousness, hearing loss, ringing in the ears or ear fullness.
"Sodium and water retention have long been associated with worsening Meniere's disease, but it is still unknown why," Ishiyama stated. "Although a low salt diet is known to reduce the severity and frequency of dizziness and stabilize progressive hearing loss in many of these patients, fall attacks often do not lessen." Five of the patients failed conservative medical treatment and underwent surgery to remove diseased sensory organs in the ear or had medication injected directly into the middle ear through the eardrum. All five have been free of vertigo and sudden falls since surgery (a range of two to ten years).
For patients with complete hearing loss, the surgery includes removal of the sensory organs in the diseased ear. The hour-long procedure is successful in more than 95 percent of cases. A procedure in which the hearing can be preserved is available for patients with only partial hearing loss. Patients who are not candidates for surgery may opt for the injections, as general anesthesia is not required. However, this procedure may need to be repeated and has a higher failure rate.
The American Academy of Neurology, an association of more than 16,500 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research.
For more information about the American Academy of Neurology, visit its Web site at http://www.aan.com. For online neurological health and wellness information, visit NeuroVista at http://www.aan.com/neurovista.
EDITOR'S NOTE: Dr. Ishiyama will present the study at the American Academy of Neurology's 52nd Annual Meeting in San Diego, CA, during a scientific platform presentation on Wednesday, May 3, 2000, at 2:30 pm, in Room 8 of the San Diego Convention Center.