by Neil Bauman, Ph.D.
An 80-year-old man wrote:
During the night if I have to walk in semi-darkness or on badly lit pavement, and especially if I have to look up and down (to avoid potholes in the street pavement), I develop imbalance and a staggering gait, which embarrasses me a lot. My ENT consultant told me I had age-related Vertigo, and prescribed a short medicinal course which has not really helped.
I can understand your embarrassment. You appear drunk, but you’re not. What has happened is that the balance system in your inner ears is damaged–but people looking at you don’t know that.
Furthermore, I disagree with the diagnosis your ENT made because you are not experiencing vertigo from your description of your problem. Basically, you don’t have problems in good light–just when the light is poor. This is not the way vertigo works. Thus I am not surprised that the medications he prescribed didn’t work.
What has happened is that your vestibular system (balance system in your inner ears) has been damaged. When the light is good, your eyes compensate for your poor vestibular function. However, when there is no light, or poor light, then your eyes aren’t of much use, and you have the balance problems, staggering gait, and the lack of a steady horizon (indicated by your problems when looking up and down–technically known as oscillopsia).
Let me explain how this all works. Your body has three separate balance systems, your ears, your eyes and your proprioceptive system (basically pressure sensors in your legs and feet that tell you when you are upright). Your ears are the most sensitive of these three systems, your eyes are next and your proprioceptive system trails a distant third.
You can function reasonably well with any two of these three systems working. That is why under good light you have reasonable balance–your eyes and proprioceptive systems are doing their jobs. However, when you lose the light, your eyes no longer help you much. Thus only your proprioceptive system is working properly and consequently you have balance problems.
If this vestibular damage is permanent (and it may be), you have to learn how to live with it. As you can see, one of the secrets is to do your moving around during the day and limit where you go at night. Under poor light conditions, you would do well to have a companion to lean on and steady you. In the house, use night lights in the hallways so you can see well enough to go to the bathroom at night. Also, holding on to the walls helps.
Something obviously damaged your vestibular system. Perhaps it was from taking one or more of the many drugs that can damage your ears (ototoxic drugs). One strong indication of this would be any medication you started taking in the days or weeks before you began to notice your balance problems.
To learn more about this, read Part I of my article on Ototoxic Drugs at Ototoxicity—The Hidden Menace. Part I: Lives in Upheaval. Also, my book Ototoxic Drugs Exposed reveals most of the drugs that can damage your vestibular system.