Chronic Balance Disorders


Jeff Ballinger

Patients with chronic balance disorders receive a wider range of services with faster diagnoses since the launch two years ago of a comprehensive balance center at Columbia.

“Balance is a complex sense,” says Lawrence R. Lustig, MD, the Howard W. Smith Professor of Otolaryngology/Head & Neck Surgery and department chair. “The public has a nebulous definition of what ‘dizzy’ entails. You’ll often hear people use the words vertigo, dizzy, or lightheaded synonymously. And yet, each person could be talking about very different things.”

According to the National Institute on Deafness and Other Communication Disorders, four out of 10 Americans at some point in their lives will experience an episode of imbalance significant enough to send them to a doctor. Symptoms of chronic vertigo, disequilibrium, and presyncope can have a significant impact on the ability to perform activities of daily living, such as bathing, dressing, or simply moving around the home.

J. Kirk Roberts, MD, associate professor of neurology, director of the general neurology program at NewYork-Presbyterian/Columbia, and a member of the balance center, became interested in vertigo and imbalance 15 years ago. “About three-quarters of my practice is focused on vertigo, dizziness, and balance, in addition to a variety of other neurological conditions,” says Dr. Roberts. “A lot of patients with benign positional vertigo will be treated by their local physicians—either primary care doctors or an ENT—and they’ll get better and everything is fine. The patients that don’t benefit from those initial therapies are the ones that we really need to see.”

Dr. Lustig describes a typical scenario when patients present to their primary care physician with issues of dizziness and balance problems. “The general practitioner will put them on meclizine for a while. When that doesn’t work they are sent to an ENT doctor. The ear doctor will say that their ears are fine and then they are sent to a neurologist. The neurologist says their brain is fine. Meanwhile, there are six or eight weeks, even months, that pass between each of these visits. In fact, a research study showed that on average a patient will have seen three or four subspecialists before getting a correct diagnosis.”

The concept of the comprehensive balance center is to shortcut the process of getting to the right subspecialist and appropriate care, says Dr. Lustig. “We’re going to provide high quality, state-of-the-art diagnosis for patients with complex balance problems that to date have not been adequately treated.”

The center brings together specialists in otolaryngology, audiology, neurology, and physical and rehabilitation medicine. “We can also draw on orthopedic surgery, ophthalmology, and cardiology, which would be a little bit more peripheral in the process but definitely important because issues arise in those systems that impact balance as well,” says Dr. Lustig. “Our goal is for the patient to have the neurology and the otolaryngology evaluation on the same day. Ultimately, having each of the specialists confer with one another is much more efficient for patients. They don’t have to waste months of trying out therapies that may not work before being sent on to someone else.”