Balance problems

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

Many body systems — including your muscles, bones, joints, vision, the balance organ in the inner ear, nerves, heart and blood vessels — must work normally for you to have normal balance. When these systems aren’t functioning well, you can experience balance problems.

Many medical conditions can cause balance problems. However, most balance problems result from issues in your balance end-organ in the inner ear (vestibular system).

Symptoms and causes

Symptoms

Signs and symptoms of balance problems include:

• Sense of motion or spinning (vertigo)
• Feeling of faintness (presyncope)
• Loss of balance (disequilibrium)
• Dizziness

Causes

Balance problems can be caused by several different conditions. The cause of balance problems is usually related to the specific sign or symptom.

Sense of motion or spinning (vertigo)

Vertigo can be associated with many conditions, including:

• Benign paroxysmal positional vertigo (BPPV). BPPV occurs when calcium crystals in your inner ear — which help control your balance — are dislodged from their normal position and move elsewhere in the inner ear. BPPV is the most common cause of vertigo. You might experience a spinning sensation when turning in bed or tilting your head back to look up.
• Meniere’s disease. In addition to sudden and severe vertigo, Meniere’s disease can cause fluctuating hearing loss and buzzing, ringing or a feeling of fullness in your ear. The cause of Meniere’s disease isn’t fully known. Meniere’s disease is rare and typically develops in people who are between the ages of 20 and 60.
• Migraine. Dizziness and sensitivity to motion (vestibular migraine) can occur due to migraine headache. Migraine is a common cause of dizziness.
• Acoustic neuroma. This noncancerous (benign), slow-growing tumor develops on a nerve that affects your hearing and balance. You might experience dizziness or loss of balance, but the most common symptoms are hearing loss and ringing in your ear. Acoustic neuroma is a rare condition.
• Vestibular neuritis. This inflammatory disorder, probably caused by a virus, can affect the nerves in the balance portion of your inner ear. Symptoms are often severe and persistent, and include nausea and difficulty walking. Symptoms can last several days and gradually improve on their own.
• Ramsay Hunt syndrome. Also known as herpes zoster otitis, this condition occurs when a shingles infection affects the facial nerve near one of your ears. You might experience vertigo, ear pain and hearing loss.
• Head injury. You might experience vertigo due to a concussion or other head injury.
• Motion sickness. You might experience dizziness in boats, cars and airplanes, or on amusement park rides.
• Persistent postural-perceptual dizziness. This disorder occurs frequently with other types of vertigo. Symptoms include unsteadiness or a sensation of motion in your head. Symptoms often worsen when you watch objects move, when you read, or when you are in a visually complex environment such as a shopping mall.

Feeling of faintness (presyncope)

Presyncope can be associated with:

• Orthostatic hypotension (postural hypotension). Standing or sitting up too quickly can cause some people to experience a significant drop in their blood pressure, resulting in presyncope.
• Cardiovascular disease. Abnormal heart rhythms (heart arrhythmia), narrowed or blocked blood vessels, a thickened heart muscle (hypertrophic cardiomyopathy), or a decrease in blood volume can reduce blood flow and cause presyncope.

Loss of balance (disequilibrium)

Losing your balance while walking, or feeling imbalanced, can result from:

• Vestibular problems. Abnormalities in your inner ear can cause a sensation of a floating or heavy head, and unsteadiness in the dark.
• Nerve damage to your legs (peripheral neuropathy). The damage can lead to difficulties with walking.
• Joint, muscle or vision problems. Muscle weakness and unstable joints can contribute to your loss of balance. Difficulties with eyesight also can lead to disequilibrium.
• Medications. Disequilibrium can be a side effect of medications.
• Certain neurologic conditions. These include cervical spondylosis and Parkinson’s disease.

Dizziness

A sense of dizziness or lightheadedness can result from:

• Inner ear problems. Abnormalities of the vestibular system can lead to a sensation of floating or other false sensation of motion.
• Psychiatric disorders. Depression (major depressive disorder), anxiety and other psychiatric disorders can cause dizziness.
• Abnormally rapid breathing (hyperventilation). This condition often accompanies anxiety disorders and may cause lightheadedness.
• Medications. Lightheadedness can be a side effect of medications.

Diagnosis

Your doctor will start by reviewing your medical history and conducting a physical and neurological examination.

To determine if your symptoms are caused by problems in the balance function in your inner ear, your doctor is likely to recommend tests. They might include:

• Hearing tests. Difficulties with hearing are frequently associated with balance problems.
• Posturography test. Wearing a safety harness, you try to remain standing on a moving platform. A posturography test indicates which parts of your balance system you rely on most.
• Electronystagmography and video nystagmography. Both tests record your eye movements, which play a role in vestibular function and balance. Electronystagmography uses electrodes and video nystagmography uses small cameras to record eye movements.
• Rotary chair test. Your eye movements are analyzed while you sit in a computer-controlled chair that moves slowly in one place in a circle.
• Dix-Hallpike maneuver. Your doctor carefully turns your head in different positions while watching your eye movements to determine if you have a false sense of motion or spinning.
• Vestibular evoked myogenic potentials test. Sensor pads attached to your neck and forehead and under your eyes measure tiny changes in muscle contractions in reaction to sounds.
• Imaging tests. MRI and CT scans can determine if underlying medical conditions might be causing your balance problem.
• Blood pressure and heart rate tests. Your blood pressure might be checked when sitting and then after standing for 2 to 3 minutes to determine if you have significant drops in blood pressure. Your heart rate might be checked when standing to help determine if a heart condition is causing your symptoms.

Treatment

Treatment depends on the cause of your balance problems. Your treatment may include:

• Balance retraining exercises (vestibular rehabilitation). Therapists trained in balance problems design a customized program of balance retraining and exercises. Therapy can help you compensate for imbalance, adapt to less balance and maintain physical activity. To prevent falls, your therapist might recommend a balance aid, such as a cane, and ways to reduce your risk of falls in your home.
• Positioning procedures. If you have BPPV, a therapist might conduct a procedure (canalith repositioning) that clears particles out of your inner ear and deposits them into a different area of your ear. The procedure involves maneuvering the position of your head.
• Diet and lifestyle changes. If you have Meniere’s disease or migraine headaches, dietary changes are often suggested that can ease symptoms. If you experience orthostatic hypotension, you might need to drink more fluids or wear compressive stockings.
• Medications. If you have severe vertigo that lasts hours or days, you might be prescribed medications that can control dizziness and vomiting.
• Surgery. If you have Meniere’s disease or acoustic neuroma, your treatment team may recommend surgery. Stereotactic radiosurgery might be an option for some people with acoustic neuroma. This procedure delivers radiation precisely to your tumor and doesn’t require an incision.

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