Balance disorders

Balance disorders are conditions that make you feel unsteady or dizzy. If you are standing, sitting or lying down, you may feel as if you are moving, spinning or floating. If you are walking, you may suddenly feel as if you are tipping over.

The neurosciences experts at Edward-Elmhurst Health diagnose and treat balance disorders such as vertigo, labyrinthitis and Ménière's disease.

Causes of balance disorders

Everyone has a dizzy spell now and then, but the term “dizziness” can mean different things to different people. For one person, dizziness might mean a fleeting feeling of faintness, while for another it could be an intense sensation of spinning (vertigo) that lasts a long time.

There are many causes of balance problems, such as medications, ear infections, a head injury, or anything else that affects the inner ear or brain. Low blood pressure can lead to dizziness when you stand up too quickly. Problems that affect the skeletal or visual systems, such as arthritis or eye muscle imbalance, can also cause balance disorders.

Your risk of having balance problems increases as you get older. Unfortunately, many balance disorders start suddenly and with no obvious cause.

Common 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: A brief, intense episode of vertigo triggered by a specific change in the position of the head. You might feel as if you're spinning when you bend down to look under something, tilt your head to look up or over your shoulder, or roll over in bed. BPPV occurs when loose otoconia tumble into one of the semicircular canals and weigh on the cupula. The cupula doesn't flex properly and sends wrong information about your head’s position, causing vertigo. BPPV can result from a head injury, or can develop just from getting older.
  • Labyrinthitis: An infection or inflammation of the inner ear that causes dizziness and loss of balance. It is often associated with an upper respiratory infection such as the flu.
  • Ménière's disease: Episodes of vertigo, hearing loss, tinnitus (a ringing or buzzing in the ear), and a feeling of fullness in the ear. It may be associated with a change in fluid volume within parts of the labyrinth, but the cause or causes are still unknown.
  • Vestibular neuronitis: An inflammation of the vestibular nerve that can be caused by a virus, and primarily causes vertigo.
  • Perilymph fistula: A leakage of inner ear fluid into the middle ear. It causes unsteadiness that usually increases with activity, along with dizziness and nausea. Perilymph fistula can occur after a head injury, dramatic changes in air pressure (such as when scuba diving), physical exertion, ear surgery, or chronic ear infections. Some people are born with perilymph fistula.
  • Mal de Debarquement syndrome: A feeling of continuously rocking or bobbing, typically after an ocean cruise or other sea travel. Usually the symptoms go away a few hours or days after you reach land. Severe cases, however, can last months or even years, and the cause remains unknown.

Symptoms of a balance disorder

If you have a balance disorder, you may stagger when you try to walk, or teeter or fall when you try to stand up. You may experience other symptoms, such as:

  • Dizziness or vertigo (a spinning sensation)
  • Falling or feeling as if you are going to fall
  • Lightheadedness, faintness, or a floating sensation
  • Blurred vision
  • Confusion or disorientation

Other symptoms of a balance disorder may include nausea and vomiting, diarrhea, changes in heart rate and blood pressure, and fear, anxiety or panic. Symptoms may come and go over short time periods or last for a long time, and can lead to fatigue and depression.

Diagnosing balance disorders

Diagnosis of a balance disorder is difficult. To find out if you have a balance problem, your doctor may suggest that you see an otolaryngologist. An otolaryngologist is a physician and surgeon who specializes in diseases and disorders of the ear, nose, neck and throat.

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Treatment for balance disorders

The first thing your doctor will do if you have a balance problem is determine if another health condition or a medication is to blame. If so, your doctor will treat the condition, suggest a different medication, or refer you to a specialist if the condition is outside his or her expertise.

If you have BPPV, your doctor might may recommend a series of simple movements, such as the Epley maneuver, which can help dislodge the otoconia from the semicircular canal. In many cases, one session works. Other people need the procedure several times to relieve their dizziness.

If you are diagnosed with Ménière's disease, your doctor may recommend that you make some changes to your diet and, if you are a smoker, that you stop smoking. Anti-vertigo or anti-nausea medications may relieve your symptoms, but can also make you drowsy.

Some people with a balance disorder may not be able to fully relieve their dizziness and will need to find ways to cope with it. A vestibular rehabilitation therapist can help you develop an individualized treatment plan.

Source: National Institutes of Health

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