Dizziness Can Be a Drag Coping with Balance Disorders

August 2012

National Institutes of Health • Department of Health and Human Services • newsinhealth.nih.gov

Inside News: 3 Understanding Rosacea... 4 Food Allergy in Kids... Hip Replacement... Alcohol Abuse and Alcoholism

Imagine reaching for something on balance-related signals to a grocery shelf and suddenly feel- the brain. The brain receives ing unsteady. Or looking over your and coordinates information shoulder to back up the car and from all these different body having things start whirling around systems. Balance disorders you. Most people feel dizzy now and can arise when any of these then. But if that feeling persists or signals malfunction. interferes with your daily life, it could Because balance be a sign of a balance disorder. is so complex, it can A balance disorder makes you be hard to figure out feel as if you’re moving, spinning or the underlying cause floating, even though you’re quite of certain problems. still. More than 4 in 10 Americans will Some balance dis- experience an episode of dizziness orders can begin sometime during their lives that’s suddenly. They might significant enough to send them to arise from an ear a doctor. infection, a head Dizziness can range from feeling injury or certain lightheaded to woozy to disoriented. medications. Low Feeling that you or your surround- blood pressure can ings are spinning is called vertigo. lead to dizziness Any of these sensations can be when you stand up extremely distressing. quickly. Disorders “Balance is a multisystem function,” related to vision, explains NIH hearing and balance muscles, bones or expert Dr. Daniel Sklare. It begins joints can also con- with a series of signals within the tribute to balance tiny balance organs of the inner ear. problems. These organs work with your brain’s “As America gets older, many vertigo that might arise with an visual system to give you a sense people with imbalance have a abrupt change in the position of the of your body’s position. They also collection of these problems,” says head, like when you bend over to keep objects from blurring when Dr. Gordon Hughes, NIH clinical trials tie your shoes. Technically known as your head moves. Sense receptors director for hearing and balance. benign paroxysmal positional vertigo in skin, joints and muscles also send “They might have aging of the ear, (BPPV), this condition can result from aging of vision, cataracts, muscle continued on page 2 weakness from losing some muscle Definitions mass or arthritis in the hips, plus other problems like diabetes.” Vertigo Researchers have identified more @ The feeling that you, or the things than a dozen different balance Subscribe around you, are spinning. disorders. The most common is a sudden, often harmless burst of newsinhealth.nih.gov 2 August 2012 http://newsinhealth.nih.gov/issue/Aug2012 continued from page 1 intense vertigo, hearing loss, nausea, a head injury or simply from getting tinnitus (a ringing or buzzing in the Web Links older. BPPV sometimes occurs when ear) and a feeling of fullness in the tiny calcium crystals in the inner ear ear. Ménière’s disease usually affects For more information about become displaced. In that case, your only one ear. balance disorders, see our links online: doctor can treat BPPV by carefully Some people with Ménière’s http://newsinhealth.nih.gov/issue/Aug2012/Feature1 moving the head and body to disease have single attacks of reposition these particles. An NIH- dizziness separated by long periods supported clinical trial showed that of time. Others may experience a heart or blood condition. If an inner this treatment works well for BPPV. many attacks closer together over ear balance disorder is likely, you Another common balance disorder a number of days. Some affected may be referred to a specialist such is known as Ménière’s disease. It people have vertigo so extreme that as an otolaryngologist, a doctor with can develop at any age, but most they lose their balance and fall. These expertise in the ear, nose and throat. often strikes adults between 40 and episodes are called “drop attacks.” You might receive a hearing test, a 60 years of age. Symptoms include An attack of Ménière’s symptoms, balance test and possibly an imaging while not life-threatening, can feel study of the brain. completely overwhelming. The Work with your doctor to figure out symptoms arise because of a change how to cope with your dizziness on Wise Choices in fluid volume within the inner ear. a daily basis and reduce your risk of Tell Your Doctor But its underlying cause remains injury. For example, wear low-heeled unknown. Scientists estimate that shoes or walking shoes outdoors. You Discuss your symptoms with a 6 in 10 people either get better on might decide to try using a cane or health care provider if: their own or can control their vertigo walker. Safe, secure handrails in stair- n You often feel unsteady. with diet, drugs or devices. In severe wells and grip handles in bathrooms cases, surgical therapies can end the can help make your home safer. Driv- n You feel as if the room is spin- dizziness but might affect hearing. ing a car may be especially hazard- ning around you. NIH-funded researchers at the ous, so ask your doctor if it’s safe for n You feel as if you’re moving University of Washington are now you to drive. when you know you’re stand- exploring a new treatment option to A specialized rehabilitation thera- ing or sitting still. stop a Ménière’s attack. An implant pist can give you a set of head, body n You lose your balance and fall. behind the ear is designed to control and eye exercises to help reduce diz- abnormal electrical activity in the ziness and nausea. n You feel as if you’re falling. nerve that sends balance information Meanwhile, researchers continue to n You feel lightheaded, or as if to the brain, bringing the sensation work to develop new, more effective you might faint. of spinning to a halt. The device is approaches. In one experimental n Your vision becomes blurred. now being tested in clinical trials. rehabilitation strategy, now in clinical If you think you may have a bal- trials, scientists have created a “virtual n You sometimes feel disoriented, ance disorder, talk with your health reality” grocery store. It allows people losing your sense of time, place care provider. Your doctor can assess with balance disorders to walk safely or identity. whether your symptoms might be on a treadmill through computer- caused by a serious disorder, such as generated store aisles. While holding onto a grocery cart, they can look up and down, turn their heads and NIH News in Health (ISSN 1556-3898) reach for items on virtual shelves. By National Institutes of Health Managing Editor Harrison Wein, Ph.D. doing this, they safely learn how to Office of Communications Editor Vicki Contie navigate an environment that can & Public Liaison Contributors Vicki Contie, Alan Defibaugh be challenging for someone with a Building 31, Room 5B64 (illustrations), Heather Dolan, Belle Waring and balance problem. Bethesda, MD 20892-2094 Harrison Wein [email protected] “The key for people looking for Tel: 301-435-7489 Fax: 301-496-0019 newsinhealth.nih.gov treatment is to go to the best team of clinical experts that they can Attention Editors Reprint our articles and gain access to,” says Dr. Sklare. illustrations in your own publication. Our material For more health information from NIH, visit is not copyrighted. Please acknowledge NIH News “It’s very important to get that in Health as the source and send us a copy. http://health.nih.gov level of assessment.” n http://newsinhealth.nih.gov/issue/Aug2012 August 2012 3

Red in the Face Things that cause flare-ups are Understanding Rosacea called triggers. Although they vary from person to person, common trig- Some people think of a rosy com- Rosacea symptoms can come and gers include hot foods or beverages, plexion as a sign of good health. But go, flaring up for weeks or months spicy foods, alcohol, extreme tem- red patches on the face may point to and then subsiding. Over time, the fa- peratures, sunlight, stress, exercise something more troubling—a long- cial redness can deepen and become and hot baths. lasting skin disorder called rosacea. more permanent. To identify and then avoid triggers, Rosacea (pronounced ro-ZAY- People are often embarrassed Gallo says, “take a very careful record she-ah) may start as redness on the by rosacea flare-ups. “The physical of the things that you eat and the cheeks, nose, chin or forehead. It appearance can be debilitating for things you are doing. Then also re- might even look like an outbreak of people, causing them to lose work cord when your rosacea is flaring, and pimples. But over time, the condition or to have low self-esteem,” says Dr. see if you can put the two together.” can worsen. Inflammationcan make Richard Gallo, a skin expert at the Because rosacea tends to worsen affected skin swollen and sensitive. University of California, San Diego. over time, early detection is criti- Red, thick, bumpy skin may appear “Many psychological problems are cal. There’s no test for rosacea, and on the face, causing discomfort and the consequence of having this red, several other conditions can have distress. Up to half of people with puffy face.” similar symptoms. Your doctor needs rosacea also develop eye problems. expertise and experience to make a Eyelids may become inflamed, and diagnosis. A dermatologist—a physi- vision impaired. cian who specializes in skin disor- Rosacea affects an estimated ders—can aid with rosacea detection 14 million Americans. The causes of and care. rosacea are unclear. The condition Although there’s no cure for rosa- tends to run in families, so genes cea, medical treatments and lifestyle likely play a role. changes can reduce symptoms. Anti- Although anyone can get rosa- biotics taken orally or applied to the cea, lighter-skinned populations are skin can lessen redness and bumps. at greater risk. People who blush For more serious cases, laser surgery frequently may also be more vulner- can remove visible blood vessels, able. It usually first strikes in middle reduce redness or correct thickened, age, when people are between 30 bumpy skin. and 60 years old. Women are 3 to NIH-funded scientists continue to 4 times more likely than men to search for new insights into rosacea. develop rosacea, especially during Gallo and his colleagues have found menopause. But rosacea symptoms that some people with rosacea have are generally more severe in men. high levels of inflammation-causing chemicals in their skin. The researchers are using this knowledge to develop experimental therapies that are Wise Choices now being tested in clinical trials. Signs of Rosacea If you have troubling facial redness, talk to a dermatologist or other n Frequent redness (flushing) on Definitions health care provider. Taking steps the face, especially on the fore- early on will help to control and re- head, nose, cheeks and chin. n Inflammation duce the symptoms of rosacea. n Small red lines under the skin. Heat, swelling and redness caused n Thickened skin or constant by the body’s protective response to redness along with sometimes- injury or infection. Web Links painful bumps. Genes n Inflamed eyes or eyelids. Stretches of DNA, a substance you For more information about rosacea, see our links online: n Swollen, red, bumpy nose, inherit from your parents, that define especially in men. characteristics such as eye color and http://newsinhealth.nih.gov/issue/Aug2012/Feature2 your risk for certain diseases. 4 August 2012 http://newsinhealth.nih.gov/issue/Aug2012

For links to more information, see these stories online: Health Capsules http://newsinhealth.nih.gov/issue/Aug2012/Capsule1 the recommended treatment for Food Allergy Reactions in Kids severe reactions. In most cases, care- Young kids allergic to milk or eggs drug that reverses symptoms and can takers didn’t realize how severe the had allergic reactions to these and save lives. reaction was, didn’t have epinephrine other foods about once a year—even The researchers found that nearly available or feared giving the drug. though their families were taught 3 in 4 children had a food allergy “What is troubling is that in this how to avoid these foods, a new reaction during the study, and over study we found that a significant study reports. half had more than one reaction. number of young children received Food allergies are caused by an Most reactions were to milk (42%), allergenic foods from parents who abnormal immune system reaction egg (21%) and peanut (8%). In about were aware of the allergy,” says to food. Severe allergic reactions can 1 in 10 cases, the foods were given the study’s lead author, Dr. David lead to a life-threatening condition to the kids on purpose, even though Fleischer of National Jewish Health called anaphylaxis. their caretakers had learned how to in Denver. The findings suggest that To learn more about food allergies avoid the foods. parents need to be better educated in preschoolers, NIH-funded scientists Over 11% of the allergic reactions about the importance of avoiding followed 512 infants for 3 years. All were severe. But less than a third of allergy-triggering foods and treating had known or suspected allergies these were treated with epinephrine, severe reactions with epinephrine. n to milk or eggs. When the study began, the kids were 3 to 15 months old, and their parents or caretakers Definitions Featured Website were taught strategies for avoiding Alcohol Abuse and allergy-triggering foods. They also Immune System received written emergency plans The system that protects your body Alcoholism and prescriptions for epinephrine, a from harmful microbes. www.niaaa.nih.gov Considering Hip Replacement? This redesigned website for NIH’s Hip replacement is an operation in of any type involves risk,” says National Institute on Alcohol Abuse which a damaged hip joint is re- Dr. Stephen I. Katz, director of NIH’s and Alcoholism (NIAAA) offers a wealth moved and replaced with an artificial National Institute of Arthritis and of information about how alcohol use joint. If you or someone you know Musculoskeletal and Skin Diseases. affects human health. Learn about is considering hip replacement, you “But if less invasive treatments such ongoing research into treating and can learn more about this surgery at as medications and physical therapy preventing alcohol-related problems. NIHSeniorHealth.gov, a website for have not helped, hip replacement older adults. has proven to be an effective way to The new hip replacement topic relieve pain and restore function.” at http://nihseniorhealth.gov/hipreplacement/ The hip replacement topic on the whoneeds/01.html describes some of the NIHSeniorHealth site joins nearly 60 reasons for having the surgery, how other research-based health topics to prepare for and recover from it, of interest to older adults. Additional and ways to avoid complications. topics include physical activity, disor- Making a decision to have hip re- ders such as stroke and Alzheimer’s placement can be difficult. “Surgery disease and safe use of medicines. n How to get NIH News in Health Read it online. Get it by email. Get it in print. Visit newsinhealth.nih.gov Click the “Subscribe” button on Contact us (see page 2) to get free our home page to sign up for print copies for display in offices, email updates when new issues libraries or clinics within the U.S. are posted online. Subscribe NIH . . . Turning Discovery Into Health