Are Serious Vestibular Problems a Wheelchair Sentence?

by Neil Bauman, Ph.D.

A man wrote,

I am very interested in hearing and balance and was looking for your thoughts—I know you are not an MD, but would appreciate your views.

If someone is having vertigo from a serious disease such as bilateral Meniere’s disease, is such a person better off without a vestibular system in the long run as his eyes and proprioceptive system will eventually take over for the loss of his ears?

Also, I know falls are a leading cause of death due to bad balance. As a result, are people who have vestibular loss/damage better off using wheelchairs outside where fast moving objects and other stimuli could cause them to fall over and seriously injure themselves?

Does someone without any vestibular function in either ear require a wheelchair for safety, independence and to compensate for poor balance?

I congratulate you on your wanting to know more about ears and balance and how people with poor balance can effectively cope with their balance problems.

As you know, your body contains not just one, but three separate balance systems—the vestibular system in your inner ears, your eyes, and the proprioceptive system in your lower legs and feet. You need two of these three systems working in order to maintain your balance.

There is no cut and dried answer to whether a person with Meniere’s disease is better off without a faulty vestibular system or not. Much of it boils down to personal choice. Some people choose to kill off all their remaining vestibular function in an attempt to end intractable vertigo. Other people choose not to. I think much depends on just how bad their vertigo is.

However, of all the people I know with bad balance (and I know a good number), I can’t think of any that use a wheelchair solely for reasons of bad balance.

Perhaps this is because typically Meniere’s disease occurs in mid-life while a person still has a reasonably active lifestyle, rather than in elderly, frail people.

Furthermore, sitting in a wheelchair is actually counterproductive. You see, the truth is, the more you exercise your remaining balance organs, the better your brain can maintain your balance. Let me give you some examples.

I’m thinking of three men—one plays golf every day to keep his balance working. The second one goes hiking all over the world—but he typically takes two walking sticks with him on rough or dangerous trails. I’ve been out hiking with the third man. He lurches and staggers around like the proverbial “drunken sailor”, but doesn’t fall down. He typically uses a hiking stick. He also has a big service dog which is trained as both a hearing ear and a balance dog.

So does a person without any vestibular function require a wheelchair? Generally I’d say “no”. Walking sticks—yes, but wheelchairs—no. Of course there are exceptions depending on the person’s age, frailty, health, etc.

Typically, people need to maintain an active lifestyle for optimal health and balance. Thus, those still vigorous enough need to walk and to do other exercise in order to keep their balance systems working as well as possible.

However, at night, it is prudent to have another person with you to lean on as necessary as your eyes don’t help much with balance in dim light and do nothing to help you in the dark.

If you have no useable vestibular function, you should follow these guidelines.

1. Walk on firm surfaces when you are “working”. When you walk on uneven or soft surfaces you negate your proprioceptive system. Save walking on soft or uneven surfaces for times when you are actively working on strengthening your balance systems and it is safe to do so.

2. Move around in the light. In the dark you lose the balance assistance your eyes provide.

3. Especially avoid walking on soft or uneven surfaces at night as you basically have no functioning balance systems left to help you.

4. Avoid visually “busy” scenes. For some people walking down aisles in the supermarket is too much. They need to focus on the floor to maintain their balance. And if the floor has a busy pattern, even that won’t work.

5. When riding in a vehicle, sit on the driver’s side in the back seat, or half way back on a bus. That way you can’t see the visually busy road out the windshield and can’t see the fence posts, poles, etc. whizzing by on the side of the road that can make you dizzy and upset your balance.

As you can see, there are a number of effective coping strategies people can employ to help themselves get around even though their vestibular systems are shot. How much better to employ these strategies and remain independent rather than give up and live in wheelchairs.