Degenerative Changes of the Vestibular Receptors as Underlying Mechanism

Dizziness and Unstable Gait in Old Age—Etiology, Diagnosis and Treatment by Prof. Dr. med. Klaus Jahn, Prof. Dr. med. Reto W. Kressig, Dr. med. Stephanie A. Bridenbaugh, Prof. Dr. med. Thomas Brandt, Dr. med. Roman Schniepp in issue 23/2015

The authors mention the occurrence of specific balance disorders in the elderly (for example, Menière’s disease, which has a prevalence of 0.1% in the general population) (1), but they do not sufficiently explain the sequential degeneration of the vestibular receptor (hair) cells (in that order: semicircular canal receptors → saccule → utricle) (2), which determines the clinical picture of vestibular disorders in the elderly—which the Berlin Aging Study (3) has demonstrated for the first time over a time period of 30 years (first longitudinal study so far). This study also showed that the determinants correlating the most with psychosocial well-being, social interactions, and cognitive-motor functions are primarily the sensory systems hearing and balance/equilibrium. Since falls usually occur out of a movement, the tests for balance assessment suggested by the authors (Romberg’s test, for instance, has a sensitivity of only 30% for detecting vestibular deficits) are possibly suitable for screening, but not to determine the extent and quality of a vestibular deficit and/or the need for therapy. Modern posturographic approaches (4) using standardized standing and walking tests that reflect the everyday life conditions of the elderly can be quickly and easily used to assess the postural stability and the risk of falls, which in turn can then be used to decide on a specific intervention (for example, the so-called neurofeedback balance training). A further important aspect is optimizing a patient’s hearing by means of hearing aids/implants, because fewer falls occur in those with good spatio-temporal orientation as supported by optimized hearing. Substituting all sensory functions is of crucial importance for a self-sustained life at old age—which the authors explicitly stressed for vision.

DOI: 10.3238/arztebl.2016.0058b

Prof. Dr. med. Arneborg Ernst

HNO-Klinik im ukb, Berlin

Conflict of interest statement

The author declares that no conflict of interest exists.

References

1. Jahn K, Kressig RW, Bridenbaugh SA, Brandt T, Schniepp R: Dizziness and unstable gait in old age—etiology, diagnosis and treatment. Dtsch Arztebl Int 2015; 112: 387–93

2. Agrawal Y, Zuniga MG, Davalos-Bichara M, et al.: Decline in semicircular canal and otolith function with age. Otol Neurotol 2012; 832–39

3. Baltes PB, Mayer KU: The Berlin Aging Study—aging from 70 to 100. Cambridge University Press 2001

4. Basta D, Rossi-Izquierdo M, Soto-Varela A, et al.: Efficacy of a vibrotactile neurofeedback training in stance and gait conditions for the treatment of balance deficits: A double-blind, placebo-controlled multicenter study. Otol Neurotol 2011; 32: 1422–99