PT on the Net Research

Hearing and Balance Impairments


Question:

My client told me that about a year or so ago, he lost all hearing because the hairs in his ear died and could no longer pick up sound waves. He has gone through surgery to have a special hearing aid implanted into his skull and can hear now, but his balance is a little off. He doesn't have trouble walking, etc. but things like balancing on one foot are difficult for him. I suspect this is partly because he doesn't balance on one foot often, but I was curious if the lack of hairs in his ear would have an effect on his balancing ability. I know the fluid in the ear has quite a lot to do with balance. I wondered if the hairs would have anything to do with balancing and what I might be able to do to help this client safely acquire increased balance and proprioceptive abilities.

Answer:

My first concern would be that this client has been cleared for any tumor, cancer or compressive pathology of the eighth cranial nerve. In hopes that this is the case, and in light of the fact that the damage you report is done, I will make the following suggestions as to ways of improving balance in your client:

  1. There are very strong neurological connections between the eyes, vestibular system and upper cervical spine. The upper cervical spine tells the head where the body is,; the vestibular system tells the body where the head is (so to speak), and the eyes contribute to overall proprioception through both focal and peripheral vision. The vestibular system is a major player in maintaining target acquisition and therefore tracking of the eyes. You can test the function of the vestibular system by simply performing what is called "The Doll's Head Manouver." This is done by having the seated patient look at the tip of your nose as you passively rotate his head left and right and then flex and extend his craniocervical junction. During these movements, his eyes should stay in binocular vision and focused equally on your nose. If he has a vestibular dysfunction effecting the tracking of the eyes, he will display a nystagmus (a darting away of the eye relative to the other eye that is still on your nose or both). If this test is positive, there are only two methods that may alter the function I know of and since only one is appropriate for exchange in this forum, we will focus on it. You need to make sure he is drinking at least half his body weight in ounces of water daily. I do know of incidences in the literature and clinical cases where poor balance was caused by dehydration, which thickens the endolymph so much it would not effectively activate the celia in the semicircular canals, and balance may therefore be disrupted. If I remember correctly, I site a research article to this effect in my series titled "Scientific Balance Training," which is available to PTN members.
  2. The upper cervical complex is commonly subluxed in people, and altered balance is a frequent complaint in this case. The atlas/axis region is the most unstable region of the spinal column due to the fact that the atlas has the least ligamentous support of all spinal vertebra and the greatest range of motion, not to mention that a human head weights approximately eight percent of your body weight and its riding atop a very flexible column (for which the mobile atlas serves as a juncture). Research by the National Upper Cervical Chiropractic Association shows that a displacement of less than one degree can cause significant symptoms, which can and often do include decreased balance and proprioceptive changes. To clear this region, find a CHEK Level III practitioner by checking the locator system on my web page (www.chekinstitute.com) or find a physio, osteopath or chiropractor that has spent time getting special training with this region of the spine. Corrections here are complex, and many use manipulation to treat the atlas, which is like tuning a Swiss watch with a sledge hammer!
  3. Frequently, trigger points in the sternocleidomastoid muscles, pteragoids, dygastrics, anterior and posterior suboccipitals, deep cervical flexors or levator scapula cause vertigo or loss of balance. This is because of referred pain/sensation causing dyscoordination of vestibular, ocular and proprioceptive inputs to the brain, confusing data interpretation such that loss of balance results. I'm sure if you studied the book "Myofascial Pain and Dysfunction" by Travell and Simons, you will find plenty on this topic.
  4. The hyoid bone has been found by George Goodheart to influence balance. If you are looking at a lateral view X-ray, the hyoid bone should sit directly in front of the third cervical vertebra. In those with an elevated or depressed hyoid, the chances of impaired balance secondary to pathology in cervical and cranial muscles and upper cervical mechanical dysfunction escalate.

I have covered many of the important pathways in my above sited article. In addition, you can purchase my chapter "Posture and Craniofacial Pain" (which was originally published by Williams and Wilkins in the 1994 publication titled "Chiropractic Approach to Head Pain") from my office. This chapter gets heavy into many of these issues.

Once you have cleared these areas, simply work forward by assuring core function and progressively increasing the balance challenges as he adapts. You may find any good book on treating neurological/brain disorders such as CP helpful in how to go about introducing and progressing exercises that improve integration of the body-head and head-body reflexes. The book "The Swiss Ball" by B. Carrier could be of use to you if you can locate it. It was only available for a short time but very useful.