What are the most common balance disorders. How do balance problems affect daily life. What treatments are available for balance disorders. Can balance issues be prevented. When should you see a doctor for balance problems. How is a balance disorder diagnosed. What lifestyle changes can help manage balance issues.

Understanding Balance Disorders: An Overview

Balance disorders are conditions that make individuals feel unsteady, dizzy, or as if they are in motion when they are actually still. These disorders can significantly impact a person’s quality of life, affecting their ability to perform daily activities and potentially leading to psychological distress.

The prevalence of balance problems is noteworthy, with approximately 15% of American adults (33 million people) reporting balance or dizziness issues in 2008. As the population ages, this number is likely to increase, making it crucial to understand the nature, causes, and treatments of balance disorders.

Common Symptoms of Balance Disorders

Balance disorders can manifest in various ways, often causing discomfort and disruption to daily life. Some of the most common symptoms include:

• Dizziness or vertigo (a spinning sensation)
• Falling or feeling like you’re about to fall
• Staggering while walking
• Lightheadedness or a floating sensation
• Blurred vision
• Confusion or disorientation

Additionally, individuals may experience nausea, vomiting, diarrhea, changes in heart rate and blood pressure, and feelings of fear, anxiety, or panic. These symptoms can be intermittent or persistent, potentially leading to fatigue and depression if left untreated.

How do balance disorders affect daily activities?

Balance disorders can have a profound impact on a person’s ability to perform routine tasks. Simple activities like walking, climbing stairs, or even standing up from a seated position can become challenging and potentially dangerous. This can lead to a loss of independence and a reduced quality of life, as individuals may become hesitant to engage in activities they once enjoyed due to fear of falling or experiencing dizziness.

The Intricate Balance System of the Human Body

To understand balance disorders, it’s essential to grasp how the body maintains balance under normal circumstances. The human balance system is a complex network of organs and structures working in harmony to keep us stable and oriented.

What are the key components of the balance system?

The balance system relies on signals from several organs and structures in the body:

1. Eyes: Visual input helps orient us in space
2. Ears: The vestibular system in the inner ear detects head position and movement
3. Muscles and touch sensors: Proprioception provides information about body position

The vestibular system, located in the inner ear, plays a crucial role in maintaining balance. It consists of the labyrinth, a maze-like structure made of bone and soft tissue, which houses the semicircular canals and otolithic organs.

How do semicircular canals contribute to balance?

The semicircular canals are three fluid-filled ducts arranged at roughly right angles to each other. They detect rotational movements of the head. Within each canal is a structure called the cupula, which contains sensory hair cells with stereocilia. When the head turns, fluid movement in the canals causes the cupula to flex, bending the stereocilia and generating nerve signals that inform the brain about head rotation.

What role do otolithic organs play in balance?

The utricle and saccule, collectively known as otolithic organs, are responsible for detecting linear acceleration and head position relative to gravity. These organs contain sensory hair cells and otoconia (tiny calcium carbonate crystals). The movement of these crystals in response to gravity or acceleration stimulates the hair cells, sending signals to the brain about head position and movement.

Common Causes of Balance Disorders

Balance disorders can arise from various factors, some of which are easily identifiable while others remain elusive. Understanding these causes is crucial for proper diagnosis and treatment.

What medical conditions can lead to balance problems?

Several health conditions can contribute to balance disorders:

• Ear infections
• Head injuries
• Vestibular neuritis
• Ménière’s disease
• Benign paroxysmal positional vertigo (BPPV)
• Multiple sclerosis
• Stroke
• Brain tumors

Additionally, conditions affecting the skeletal or visual systems, such as arthritis or eye muscle imbalance, can also lead to balance issues.

Can medications cause balance problems?

Yes, certain medications can affect balance as a side effect. These may include:

• Antidepressants
• Anti-anxiety medications
• Blood pressure medications
• Anticonvulsants
• Sedatives
• Some antibiotics

It’s important to discuss any balance changes with your healthcare provider if you’re taking medications, as adjustments to dosage or alternative treatments may be necessary.

How does aging affect balance?

As we age, our risk of experiencing balance problems increases. This is due to several factors:

1. Deterioration of sensory systems (vision, proprioception, vestibular function)
2. Decreased muscle strength and flexibility
3. Slower reflexes and reaction times
4. Increased susceptibility to chronic health conditions that can affect balance

While some degree of balance decline is normal with aging, severe or sudden changes should be evaluated by a healthcare professional.

Diagnosing Balance Disorders

Accurate diagnosis of balance disorders is crucial for effective treatment. Healthcare providers use a combination of methods to identify the underlying cause of balance issues.

What tests are used to diagnose balance disorders?

Diagnostic tests for balance disorders may include:

• Hearing tests
• Eye movement tests
• Posturography
• Rotary chair testing
• Videonystagmography (VNG)
• Vestibular evoked myogenic potentials (VEMP) test
• Imaging studies (CT scan or MRI)

These tests help evaluate the function of the vestibular system, identify any structural abnormalities, and assess how well the different components of the balance system work together.

When should you seek medical attention for balance problems?

It’s important to consult a healthcare provider if you experience:

• Persistent or severe dizziness
• Recurring episodes of vertigo
• Frequent falls or near-falls
• Significant difficulty with daily activities due to balance issues
• Balance problems accompanied by other symptoms like hearing loss, vision changes, or neurological symptoms

Early intervention can help prevent complications and improve outcomes for many balance disorders.

Treatment Options for Balance Disorders

The treatment of balance disorders depends on the underlying cause and may involve a combination of approaches. The goal is to alleviate symptoms, improve balance, and enhance overall quality of life.

What are the main treatment approaches for balance disorders?

Treatment options for balance disorders include:

1. Medications: To treat underlying conditions or manage symptoms
2. Vestibular rehabilitation therapy: Exercises to improve balance and reduce dizziness
3. Canalith repositioning procedures: For treating BPPV
4. Lifestyle modifications: Including dietary changes and stress management
5. Balance aids: Such as canes or walkers for added stability
6. Surgery: In rare cases, for conditions like acoustic neuroma

The choice of treatment depends on the specific diagnosis, severity of symptoms, and individual patient factors.

How effective is vestibular rehabilitation therapy?

Vestibular rehabilitation therapy (VRT) is a highly effective treatment for many balance disorders. This specialized form of physical therapy aims to retrain the brain to process balance information more effectively. VRT typically involves:

• Gaze stabilization exercises
• Balance training
• Habituation exercises
• Gait training

Studies have shown that VRT can significantly improve balance, reduce dizziness, and enhance overall function in patients with various vestibular disorders.

Living with Balance Disorders: Coping Strategies and Lifestyle Modifications

While medical treatments are crucial, there are several strategies individuals can employ to manage balance disorders and improve their quality of life.

What lifestyle changes can help manage balance issues?

Implementing the following lifestyle modifications can be beneficial:

• Regular exercise: To improve strength, flexibility, and balance
• Home safety modifications: Such as removing tripping hazards and installing handrails
• Stress reduction techniques: Like meditation or yoga
• Dietary adjustments: Reducing salt intake for Ménière’s disease, limiting alcohol and caffeine
• Adequate sleep: To support overall health and balance function
• Vision correction: Ensuring proper eyewear to optimize visual input for balance

These changes, combined with medical treatments, can significantly improve daily functioning and reduce the risk of falls.

How can individuals prevent falls related to balance disorders?

Preventing falls is crucial for individuals with balance disorders. Some effective strategies include:

1. Using assistive devices like canes or walkers when necessary
2. Wearing appropriate footwear with good support and non-slip soles
3. Improving lighting in the home, especially in hallways and stairwells
4. Practicing caution when changing positions, such as standing up slowly
5. Engaging in balance-specific exercises under professional guidance
6. Staying physically active to maintain overall strength and coordination

By implementing these strategies, individuals can reduce their risk of falls and maintain greater independence.

The Future of Balance Disorder Research and Treatment

As our understanding of balance disorders continues to evolve, researchers are exploring new avenues for diagnosis and treatment. These advancements hold promise for improving outcomes and quality of life for individuals affected by balance disorders.

What emerging technologies are being developed for balance disorders?

Several innovative technologies are being researched and developed:

• Virtual reality-based rehabilitation programs
• Wearable devices for continuous balance monitoring
• Implantable vestibular prostheses
• Gene therapy for certain genetic balance disorders
• Advanced imaging techniques for more precise diagnosis

These technologies aim to provide more personalized and effective treatments for balance disorders.

How might future treatments improve outcomes for balance disorder patients?

Future treatments have the potential to:

1. Offer more targeted therapies based on individual patient characteristics
2. Provide earlier intervention through improved diagnostic tools
3. Enhance rehabilitation outcomes with technology-assisted training
4. Restore vestibular function in cases previously considered untreatable
5. Improve long-term management of chronic balance disorders

As research progresses, individuals with balance disorders can look forward to more effective and less invasive treatment options, potentially leading to better overall outcomes and improved quality of life.

Balance Disorders — Causes, Types & Treatment

What is a balance disorder?

A balance disorder is a condition that makes 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.

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.

About 15 percent of American adults (33 million) had a balance or dizziness problem in 2008. Balance disorders can be caused by certain health conditions, medications, or a problem in the inner ear or the brain. A balance disorder can profoundly affect daily activities and cause psychological and emotional hardship.

What are the symptoms of a balance disorder?

If you have a balance disorder, your symptoms might include:

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

Other symptoms might 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.

What causes balance disorders?

Causes of balance problems include medications, ear infection, 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.

How does my body keep its balance?

Your sense of balance relies on a series of signals to your brain from several organs and structures in your body, specifically your eyes, ears, and the muscles and touch sensors in your legs. The part of the ear that assists in balance is known as the vestibular system, or the labyrinth, a maze-like structure in your inner ear made of bone and soft tissue.

Structures of the balance system inside the inner ear

Source: NIH/NIDCD

Within the labyrinth are structures known as semicircular canals. The semicircular canals contain three fluid-filled ducts, which form loops arranged roughly at right angles to one another. They tell your brain when your head rotates. Inside each canal is a gelatin-like structure called the cupula [KEW-pyew-lah], stretched like a thick sail that blocks off one end of each canal. The cupula sits on a cluster of sensory hair cells. Each hair cell has tiny, thin extensions called stereocilia that protrude into the cupula.

When you turn your head, fluid inside the semicircular canals moves, causing the cupulae to flex or billow like sails in the wind, which in turn bends the stereocilia. This bending creates a nerve signal that is sent to your brain to tell it which way your head has turned.

Between the semicircular canals and the cochlea (a snail-shaped, fluid-filled structure in the inner ear) lie two otolithic [oh-toe-LITH-ic] organs: fluid-filled pouches called the utricle [YOU-trih-cull] and the saccule [SACK-kewl]. These organs tell your brain the position of your head with respect to gravity, such as whether you are sitting up, leaning back, or lying down, as well as any direction your head might be moving, such as side to side, up or down, forward or backward.

The utricle and the saccule also have sensory hair cells lining the floor or wall of each organ, with stereocilia extending into an overlying gel-like layer. Here, the gel contains tiny, dense grains of calcium carbonate called otoconia [oh-toe-CONE-ee-ah]. Whatever the position of your head, gravity pulls on these grains, which then move the stereocilia to signal your head’s position to your brain. Any head movement creates a signal that tells your brain about the change in head position.

When you move, your vestibular system detects mechanical forces, including gravity, that stimulate the semicircular canals and the otolithic organs. These organs work with other sensory systems in your body, such as your vision and your musculoskeletal sensory system, to control the position of your body at rest or in motion. This helps you maintain stable posture and keep your balance when you’re walking or running. It also helps you keep a stable visual focus on objects when your body changes position.

When the signals from any of these sensory systems malfunction, you can have problems with your sense of balance, including dizziness or vertigo. If you have additional problems with motor control, such as weakness, slowness, tremor, or rigidity, you can lose your ability to recover properly from imbalance. This raises the risk of falling and injury.

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: 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 affect how the cupula works. This keeps the cupula from flexing properly, sending incorrect information about your head’s position to your brain, and 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. For more information, read the NIDCD fact sheet Ménière’s Disease.
• 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 (MdDS): A feeling of continuously rocking, swaying, or bobbing, typically after an ocean cruise or other sea travel, or even after prolonged running on a treadmill. Usually the symptoms go away within a few hours or days after you reach land or stop using the treadmill. Severe cases, however, can last months or even years, and the cause remains unknown.

How are balance disorders diagnosed?

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

Dislodging otoconia using the Epley maneuver.

Source: NIH/NIDCD

You may be asked to participate in a hearing examination, blood tests, a video nystagmogram (a test that 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.

Posturography measures how well you can maintain steady balance during different platform conditions, such as standing on an unfixed, movable surface. Other tests, such as rotational chair testing, brisk head-shaking testing, or even tests that measure eye or neck muscle responses to brief clicks of sound, may also be performed. The vestibular system is complex, so multiple tests may be needed to best evaluate the cause of your balance problem.

How are balance disorders treated?

The first thing an otolaryngologist 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 otolaryngologist or audiologist might perform a series of simple movements, such as the Epley maneuver, to 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 otolaryngologist 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 they can also make you drowsy. Other medications, such as gentamicin (an antibiotic) or corticosteroids may be used. Although gentamicin may reduce dizziness better than corticosteroids, it occasionally causes permanent hearing loss. In some severe cases of Ménière’s disease, surgery on the vestibular organs may be needed.

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.

Talk to your doctor about whether it’s safe to drive, and about ways to lower your risk of falling and getting hurt during daily activities, such as when you walk up or down stairs, use the bathroom, or exercise. To reduce your risk of injury from dizziness, avoid walking in the dark. Wear low-heeled shoes or walking shoes outdoors. If necessary, use a cane or walker and modify conditions at your home and workplace, such as adding handrails.

When should I seek help if I think I have a balance disorder?

To help you decide whether to seek medical help for dizziness or balance problems, 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, even for a very brief time?
• 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—losing my sense of time or location?

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:
   • Is there a spinning sensation, and if so, which way does the room spin?
   • Is the dizziness/spinning caused by any specific motion or does it occur even when sitting or lying still?
   • Are there any other symptoms that occur at the same time as the dizziness/spinning, such as hearing loss, tinnitus, a feeling of pressure in one or both ears, or a headache?
   • Does anything seem to help the dizziness/spinning?
2. How often do I feel dizzy or have trouble keeping my balance? How long do the dizziness or spinning episodes last (seconds, minutes, hours, days)?
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 all prescription medications; all over-the-counter medicine, such as aspirin, antihistamines, or sleep aids; and all vitamin supplements and alternative or homeopathic remedies:
   • Name of medicine or supplement: ______________________.
   • How much (milligrams) _____ and how often (times) ______ per day.
   • The condition I take this medicine for is: __________________________.

What research is being done on balance disorders?

Scientists supported by the National Institute on Deafness and Other Communication Disorders (NIDCD) are studying animal ears to learn if inner-ear structures that help with balance but are destroyed by aging, medications, infections, or trauma can someday be regrown in people with balance problems. Other NIDCD-supported scientists are testing vestibular prostheses—miniature devices that may be worn outside the body or implanted into the ear to regulate the function of balance organs in the inner ear and ease dizziness. Some of these devices are being tested on volunteers in clinical trials, and others are still being developed. Visit the NIH Clinical Research Trials and You website to read about these and other clinical trials that are recruiting volunteers.

NIDCD-funded scientists are also working to develop much-needed tests to appropriately diagnose balance disorders. Standardized tests will help doctors determine the best way to help individuals restore their sense of balance and quality of life. These tests will also help us understand how many people suffer from balance disorders, and track whether the sense of balance is restored following treatment.

Where can I find additional information about balance disorders?

The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language.

For more information, contact us at:

NIDCD Information Clearinghouse
1 Communication Avenue
Bethesda, MD 20892-3456
Toll-free voice: (800) 241-1044
Toll-free TTY: (800) 241-1055
Email: [email protected]

NIH Pub. No. 00-4374
December 2017

Older Adults and Balance Problems

Have you ever felt dizzy, lightheaded, or as if the room were spinning around you? These can be troublesome sensations. If the feeling happens often, it could be a sign of a balance problem.

On this page:

Many older adults experience problems with balance and dizziness. Problems can be caused by certain medications, balance disorders, or other medical conditions. Balance problems are one reason older people fall. Maintaining good balance as you age and learning about fall prevention can help you get around, stay independent, and carry out daily activities.

Causes of balance problems

Read and share this infographic and help spread the word about how to help prevent falls.

People are more likely to have problems with balance as they grow older. In some cases, you can help reduce your risk for certain balance problems, but problems often can start suddenly and without obvious cause.

Balance problems can be caused by certain medications or medical conditions. The list below covers some common causes of balance problems.

• Medications. Check with your doctor if you notice balance problems while taking certain medications. Ask if other medications can be used instead, if the dosage can be safely reduced, or if there are other ways to reduce unwanted side effects.
• Inner ear problems. A part of the inner ear called the labyrinth is responsible for balance. When the labyrinth becomes inflamed, a condition called labyrinthitis occurs, causing vertigo and imbalance. Certain ear diseases and infections can lead to labyrinthitis.
• Alcohol. Alcohol in the blood can also cause dizziness and balance problems by affecting how the inner ear works.
• Other medical conditions. Certain conditions, such as diabetes, heart disease, stroke, or problems with your vision, thyroid, nerves, or blood vessels can cause dizziness and other balance problems.

Visit the NIH National Institute on Deafness and Other Communication Disorders website for more information on specific balance disorders.

Symptoms of balance disorders

If you have a balance disorder, you might experience symptoms such as:

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

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

Treatments for balance problems and disorders

Exercises that involve moving the head and body in certain ways can help treat some balance disorders. Patient-specific exercises are developed by a physical therapist or other professional who understands balance and its relationship with other systems in the body.

Balance problems due to high blood pressure may be managed by eating less salt (sodium), maintaining a healthy weight, and exercising. Balance problems due to low blood pressure may be managed by drinking plenty of fluids such as water; avoiding alcohol; and being cautious regarding your body’s posture and movement, such as never standing up too quickly. Consult with your doctor about making any changes in your diet or activity level.

Coping with a balance disorder

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 develop an individualized treatment plan.

Chronic balance problems can affect all aspects of your life, including your relationships, work performance, and your ability to carry out daily activities. Support groups provide the opportunity to learn from other people with similar experiences and challenges.

If you have trouble with your balance, talk to your doctor about whether it’s safe to drive, and about ways to lower your risk of falling during daily activities, such as walking up or down stairs, using the bathroom, or exercising. To reduce your risk of injury from dizziness, do not walk in the dark. Avoid high heels and, instead, wear nonskid, rubber-soled, low-heeled shoes. Don’t walk on stairs or floors in socks or in shoes and slippers with smooth soles. If necessary, use a cane or walker. Make changes to add safety features at your home and workplace, such as adding handrails.

Learn more about falls and falls prevention.

Read about this topic in Spanish. Lea sobre este tema en español.

For more information on balance problems

MedlinePlus
National Library of Medicine      
www.medlineplus.gov

Mayo Clinic
www.mayoclinic.org/patient-care-and-health-information

National Institute on Deafness and Other Communication Disorders
800-241-1044
800-241-1055 (TTY)
[email protected]
www.nidcd.nih.gov

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

Content reviewed:
September 12, 2022

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