A balance disorder may be caused by viral or bacterial infections in the ear, a head injury, or blood circulation disorders that affect the inner ear or brain. Many people experience problems with their sense of balance as they get older. Balance problems and dizziness also can result from taking certain medications.
In addition, problems in the visual and skeletal systems and the nervous and circulatory systems can be the source of some posture and balance problems. A circulatory system disorder, such as low blood pressure, can lead to a feeling of dizziness when we suddenly stand up. Problems in the skeletal or visual systems, such as arthritis or eye muscle imbalance, also may cause balance problems. However, many balance disorders can begin all of a sudden and with no obvious cause.
What are some types of balance disorders?
There are more than a dozen different balance disorders. Some of the most common are:
- Benign paroxysmal positional vertigo (BPPV) or positional vertigo is a brief, intense episode of vertigo that occurs because of a specific change in the position of the head. If you have BPPV, you might feel as if you're spinning when you look for an object on a high or low shelf or turn your head to look over your shoulder (such as when you back up your car). You also may experience BPPV when you roll over in bed. BPPV is caused when otoconia tumble from the utricle into one of the semicircular canals and weigh on the cupula. The cupula can't tilt properly and sends conflicting messages to the brain about the position of the head, causing vertigo. BPPV sometimes may result from a head injury or just from getting older.
- Labyrinthitis is an infection or inflammation of the inner ear that causes dizziness and loss of balance. It frequently is associated with an upper respiratory infection such as the flu.
- Meniere's disease is associated with a change in fluid volume within parts of the labyrinth. Meniere's disease causes episodes of vertigo, irregular hearing loss, tinnitus (a ringing or buzzing in the ear), and a feeling of fullness in the ear. The cause of this disease is unknown. For more information, read the NIDCD fact sheet Meniere's Disease.
- Vestibular neuronitis is an inflammation of the vestibular nerve and may be caused by a virus. Its primary symptom is vertigo.
- Perilymph fistula is a leakage of inner ear fluid into the middle ear. It can occur after a head injury, drastic changes in atmospheric pressure (such as when scuba diving), physical exertion, ear surgery, or chronic ear infections. Its most notable symptom, besides dizziness and nausea, is unsteadiness when walking or standing that increases with activity and decreases with rest. Some babies may be born with perilymph fistula, usually in association with hearing loss that is present at birth.
- Mal de debarquement syndrome (MdDS) is a balance disorder in which you feel as if you're continuously rocking or bobbing. It generally happens after an ocean cruise or other sea travel. Usually, the symptoms will go away in a matter of hours or days after you reach land. However, severe cases can last months or even years.
How is a balance disorder diagnosed?
Diagnosis of a balance disorder is difficult. There are many potential causes—including medical conditions and medications.
To help evaluate a balance problem, your doctor may suggest you see an otolaryngologist. An otolaryngologist is a physician and surgeon who specializes in the ear, nose, and throat. An otolaryngologist may request tests to assess the cause and extent of the balance problem depending on your symptoms and health status.
The otolaryngologist may request a hearing examination, blood tests, an electronystagmogram (which measures eye movements and the muscles that control them), or imaging studies of your head and brain. Another possible test is called posturography. For this test, you stand on a special movable platform in front of a patterned screen. The doctor measures how your body moves in response to movement of the platform, the patterned screen, or both.
How is a balance disorder treated?
The first thing a doctor will do to treat a balance disorder is determine if your dizziness is caused by a medical condition or medication. If it is, your doctor will treat the condition or suggest a different medication.
Your doctor also may describe ways for you to handle daily activities that increase the risk of falling and injury, such as driving, walking up or down stairs, and using the bathroom. If you have BPPV, your doctor might prescribe a series of simple movements, called the Epley maneuver, to help dislodge the otoconia from the semicircular canal. You begin the Epley maneuver by sitting upright, with the help of a trained therapist, then quickly lie down on your back, turn your head to one side, and wait for a minute or two before sitting back up again. For some people, one session will be all that is needed. Others might need to repeat the procedure several times at home to relieve their dizziness.
If you are diagnosed with Meniere's disease, your doctor may recommend changes in your diet, such as reducing the use of salt in your food and limiting alcohol and caffeine. Not smoking also may help. Some anti-vertigo or anti-nausea medications may relieve your symptoms, but they can also make you drowsy. Other medications, such as the antibiotic gentamicin or corticosteroids, may be injected behind the eardrum to reach the inner ear. Although gentamicin helps reduce dizziness, it occasionally destroys sensory cells in the cochlea and causes permanent hearing loss. The risk of hearing loss can be lowered if small doses of gentamicin are given off and on until your symptoms decrease. Corticosteroids don't cause hearing loss; however, research is underway to determine if they are as effective as gentamicin. Surgery on the vestibular organ may be necessary if you have a severe case of Meniere's disease.
Some people with a balance disorder may not be able to fully relieve their dizziness and will have to develop ways to cope with it on a daily basis. A vestibular rehabilitation therapist can help by developing an individualized treatment plan that combines head, body, and eye exercises to decrease dizziness and nausea.
To reduce your risk of injury from dizziness, avoid walking in the dark. You also should wear low-heeled shoes or walking shoes outdoors and use a cane or walker if necessary. If you have handrails in the home, inspect them periodically to make sure they are safe and secure. Modifications to bathroom fixtures can make them safer. Conditions at work may need to be modified or restricted, at least temporarily. Driving a car may be especially ha
How do I know if I have a balance disorder?
Everyone has a dizzy spell now and then, but the term “dizziness” may mean something different to different people. For some people, dizziness might be a fleeting sensation of spinning, while for others it's intense and lasts a long time. Experts believe that more than four out of 10 Americans will experience an episode of dizziness significant enough to send them to a doctor.
To help you decide whether or not you should seek medical help for a dizzy spell, ask yourself the following questions. If you answer “yes” to any of these questions, talk to your doctor.
- Do I feel unsteady?
- Do I feel as if the room is spinning around me?
- Do I feel as if I'm moving when I know I'm sitting or standing still?
- Do I lose my balance and fall?
- Do I feel as if I'm falling?
- Do I feel “lightheaded” or as if I might faint?
- Do I have blurred vision?
- Do I ever feel disoriented, such as losing my sense of time or where I am?
How can I help my doctor make a diagnosis?
You can help your doctor make a diagnosis and determine a treatment plan by answering the questions below. Be prepared to discuss this information during your appointment.
1. The best way I can describe my dizziness or balance problem is:
2. How often do I feel dizzy or have trouble keeping my balance?
3. Have I ever fallen?
When did I fall?
Where did I fall?
Under what conditions did I fall?
How often have I fallen?
4. These are the medicines I take:
(Include prescription medications and over-the-counter medicine, such as aspirin, antihistamines, or sleep aids.)
Name of medicine:
How much (milligrams) and how often (times) per day:
The condition I take this medicine for is:
At your appointment, take a minute to write down any instructions your doctor has given you. Be sure to ask any questions you have before you leave the office.
What research is being done for balance disorders?
BPPV is the most common balance disorder. Because the source of the problem—displaced otoconia—is located deep within the ear, doctors have had to rely mainly on observation and a medical history to make a diagnosis. Researchers supported by the National Institute on Deafness and Other Communication Disorders (NIDCD) now have created a head-mounted apparatus that uses 3-D animation to map the location of otoconia in the inner ear. The apparatus is built around a pair of infrared video goggles that gather data from eye and head movements and then sends it to a computer program for mapping. A second computer program uses the data to develop a step-by-step guide for repositioning maneuvers to dislodge the otoconia from the semicircular canals. If shown to be effective in clinical trials, the apparatus and its software programs will help doctors more accurately diagnose BPPV and guide repositioning maneuvers to ensure the best possible treatment.
Other NIDCD-supported scientists are looking at the molecular mechanisms that regulate the development of the inner ear. One research team has identified a gene that encodes a protein that helps in the formation of the semicircular canals and their related sensory tissue. Another team has identified a family of genes, called the otopetrins, which help form otoconia in mice. Findings from the mouse study could help researchers determine if otoconia destroyed by aging, medications, infections, or trauma can someday be regenerated in humans with balance problems.
NIDCD-supported scientists also are experimenting with several types of vestibular prostheses, or replacement parts, in balance-impaired animals. Researchers hope these devices will one day be used to compensate for vestibular system loss in people.
One prosthesis uses a head-mounted motion sensor to mimic the ear and brain's natural signaling system. The sensor measures the head's rotation and sends the information to a microprocessor. The microprocessor then converts the signals into electrical impulses and sends them to an electrode implanted in the ear. The electrode stimulates the vestibular nerve, creating a signal that helps the brain move the eyes to compensate for the head's rotation.
A second prosthesis is designed to simulate the movement of fluid within the semicircular canal. In a normal ear, fluid changes help the brain understand the movement and position of the head. The device combines microcontroller circuitry with a tiny mechanical device that increases normal fluid movement to provide a stronger vestibular signal to the brain.
Researchers also are studying the effectiveness of different types of rehabilitative exercises as a treatment option for balance disorders. In one NIDCD-funded study, researchers have used virtual reality technology to simulate the aisles of a grocery store. Using a real cart attached to a custom-built treadmill in front of a projection screen, patients “walk” down aisles, scanning virtual store shelves for items on their list. Researchers are testing whether practicing in the virtual store will lessen episodes of dizziness in the real world, especially in visually complex environments.