Care & Treatment
Physical and occupational therapists and other professionals who specialize in rheumatology physical medicine, rehabilitation can help with these types of problems. Physical therapists will design exercises to strengthen the large muscles that are used for walking, standing and changing position. Occupational therapists can work to improve activities of daily living to maintain or improve independence.
Inner ear problems
Benign Positional Paroxysmal Vertigo (BPPV)
The Epley maneuver (also called canalith repositioning procedure) is a series of slow head and body movements. This simple and painless 15-minute office procedure is designed to reposition any loose calcium crystals in your inner ears. It may need to be done a couple of times.
After returning home, the person must keep the treated ear above shoulder level for the rest of the day and avoid lying flat. The head must be slightly elevated on pillows the night of the procedure. By the next day, symptoms should be gone and restrictions on head positioning are no longer needed.
Your BPPV will most likely resolve itself within a few days or weeks at most. Medications are not recommended for BPPV.
Your healthcare professional may prescribe:
- Motion-sickness medications such as meclizine (Antivert) to relieve the acute feelings of vertigo and dizziness. However, avoid long-term use of this drug because it can cause negative side effects in older adults and make dizziness worse.
- Methylprednisolone or an antibiotic to reduce inner ear inflammation. Prednisone should only be used for a short time to avoid side effects.
This condition can resolve without any medications, so a person may choose to “wait it out” if symptoms are not severe.
Your healthcare professional may recommend you go to vestibular rehabilitation (exercises to help manage dizziness and balance problems).
Symptoms of this chronic disease can be minimized with:
- Meclizine (Antivert) to reduce the sensation of vertigo. However, avoid long-term use of this drug because it can cause negative side effects in older adults and make dizziness worse.
- Diuretics (water pills) and salt restriction to reduce the fluid build-up in the inner ear. About 1,500 mg of salt per day is the limit.
- Avoid monosodium glutamate (MSG), a meat tenderizer and flavor enhancer. MSG may cause fluid retention.
- Vestibular rehabilitation to help with symptoms.
- Meals spread evenly throughout the day so the person eats and drinks similar amounts several times each day. This can help regulate fluids in the body. Five or six small meals may be better than three large ones.
Sudden Low Blood Pressure (orthostatic hypotension)
Steps a healthcare provider may recommend:
- Changing medications to ensure proper blood pressure
- Changing diet to avoid a drop in blood pressure after eating. For example, increasing the amount of salt in your food, if blood pressure is not normally high. Reducing or eliminating alcohol may be another suggestion.
- Avoiding sudden shifts in positions, especially after:
- Being in bed all night
- Sitting for a long time
- Having just used the bathroom
- Having just finished a large meal
Be sure to get up slowly and wait a few minutes until any dizziness has passed before beginning to walk.
A physical therapist can show a person how to pump their ankles and calves and clench their fists and forearms before standing. This encourages blood flow to the heart and upper body. Moving slowly and keeping your head elevated when lying down are all simple ways to avoid a sudden drop in blood pressure after a change in position.
Other Steps You Can Take
- Wear over-the-knee pressure stockings. which will help to prevent blood pooling in the feet and lower legs.
- Avoid walking or exercising in hot weather.
- Take medications to treat orthostatic hypotension:
- Fludrocortisone increases the amount of blood in the body.
- Midodrine can raise blood pressure when the person is standing.
- Pyridostigmine, nonsteroidal anti-inflammatory drugs (NSAIDs), and caffeine may also help. But each of these medications run the risk of undesirable side effects, such as nausea, diarrhea and sweating.
Medication-related Balance Problems
After reviewing a person’s medications, the healthcare professional may recommend changes and dosage adjustments to avoid side effects such as dizziness and unsteadiness.
Medical Conditions and Sensory Deficits
Healthcare professionals must review a person’s health problems to ensure that they are being treated appropriately to avoid balance problems.
Eyesight and hearing need to be checked and corrected with glasses or hearing aids if needed. Eye diseases like cataracts, glaucoma, and macular degeneration can be treatable.
Last Updated January 2023