What are the common causes of balance disorders. How do balance problems affect daily life. What treatment options are available for balance disorders. Can balance issues be prevented or managed effectively.

Understanding Balance Disorders: An Overview

Balance disorders are conditions that can make you feel unsteady, dizzy, or as if you’re moving when you’re actually standing still. These disorders can significantly impact your quality of life, affecting your ability to perform daily activities and potentially leading to psychological and emotional distress.

According to recent statistics, approximately 15% of American adults, or 33 million people, experienced balance or dizziness problems in 2008. This prevalence highlights the importance of understanding these disorders and their implications.

What exactly is a balance disorder?

A balance disorder is a condition that disrupts your body’s ability to maintain equilibrium. It can manifest in various ways, including:

• Feeling unsteady while standing, sitting, or lying down
• Experiencing a sensation of movement, spinning, or floating
• Suddenly feeling as if you’re tipping over while walking

It’s important to note that while everyone may experience occasional dizziness, persistent or severe symptoms could indicate an underlying balance disorder.

Recognizing the Symptoms of Balance Disorders

Balance disorders can present with a wide range of symptoms, varying in intensity and duration. Recognizing these symptoms is crucial for early diagnosis and treatment.

What are the common symptoms of balance disorders?

The symptoms of balance disorders can include:

• Dizziness or vertigo (a spinning sensation)
• Falling or feeling like you’re going to fall
• Staggering while walking
• Lightheadedness or a floating sensation
• Blurred vision
• Confusion or disorientation
• Nausea and vomiting
• Changes in heart rate and blood pressure
• Fear, anxiety, or panic

These symptoms may come and go over short periods or persist for extended durations. Prolonged balance issues can lead to fatigue and depression, further impacting an individual’s overall well-being.

Exploring the Causes of Balance Disorders

Balance disorders can stem from various factors, ranging from medical conditions to environmental influences. Understanding these causes is essential for proper diagnosis and treatment.

What are the primary causes of balance disorders?

Balance disorders can be triggered by:

1. Medications: Certain drugs can affect the inner ear or brain, leading to balance issues.
2. Ear infections: Infections in the inner ear can disrupt the vestibular system.
3. Head injuries: Trauma to the head can affect the brain’s ability to process balance-related information.
4. Low blood pressure: This can cause dizziness, especially when standing up quickly.
5. Skeletal or visual system problems: Conditions like arthritis or eye muscle imbalance can contribute to balance disorders.
6. Age-related changes: The risk of balance problems increases with age.

It’s worth noting that many balance disorders can occur suddenly and without an obvious cause, making diagnosis challenging in some cases.

The Intricate Mechanisms of Balance in the Human Body

Maintaining balance is a complex process involving multiple systems in the body. Understanding how these systems work together can provide insight into why balance disorders occur and how they can be treated.

How does the body maintain balance?

Your sense of balance relies on a series of signals sent to your brain from various organs and structures in your body, including:

• Eyes: Visual input helps orient you in space.
• Ears: The vestibular system in the inner ear plays a crucial role in balance.
• Muscles and touch sensors: These provide information about body position and movement.

The vestibular system, or labyrinth, is a maze-like structure in your inner ear composed of bone and soft tissue. It contains several key components:

1. Semicircular canals: Three fluid-filled ducts that detect head rotation.
2. Cupula: A gelatin-like structure in each canal that flexes with head movement.
3. Otolithic organs (utricle and saccule): These detect linear movements and head position relative to gravity.

When you move, these structures work together to send signals to your brain, allowing you to maintain stable posture and balance.

The Impact of Balance Disorders on Daily Life

Balance disorders can significantly affect an individual’s ability to perform everyday tasks and maintain their quality of life. Understanding these impacts is crucial for both patients and caregivers.

How do balance disorders affect daily activities?

Balance disorders can impact daily life in numerous ways:

• Mobility challenges: Difficulty walking, climbing stairs, or navigating uneven surfaces.
• Increased fall risk: Higher likelihood of falls, which can lead to injuries.
• Work limitations: Reduced ability to perform certain job tasks or maintain employment.
• Social isolation: Reluctance to participate in social activities due to symptoms or fear of falling.
• Emotional distress: Anxiety, depression, or frustration related to the condition.
• Sleep disturbances: Difficulty sleeping due to symptoms or worry.

These impacts underscore the importance of early diagnosis and effective management of balance disorders.

Diagnosing Balance Disorders: Tests and Procedures

Accurately diagnosing balance disorders is crucial for developing an effective treatment plan. Healthcare providers use a variety of tests and procedures to identify the underlying causes of balance issues.

What diagnostic tests are used for balance disorders?

Diagnostic procedures for balance disorders may include:

1. Hearing tests: To check for problems in the ear that could affect balance.
2. Eye movement tests: To evaluate how well your eyes and inner ears work together.
3. Posturography: A test that measures how your body moves in response to various conditions.
4. Rotary chair testing: To assess the function of your inner ear balance system.
5. Videonystagmography (VNG): A test that records eye movements to evaluate inner ear and central motor functions.
6. Imaging tests: Such as MRI or CT scans to check for structural abnormalities.
7. Blood tests: To check for underlying medical conditions that might be causing balance problems.

These tests help healthcare providers determine the specific type of balance disorder and its underlying cause, enabling them to develop a tailored treatment plan.

Treatment Options for Balance Disorders

Treatment for balance disorders varies depending on the underlying cause and severity of symptoms. A comprehensive approach often involves a combination of therapies and lifestyle modifications.

What are the main treatment options for balance disorders?

Treatment options for balance disorders may include:

• Vestibular rehabilitation therapy: Exercises to help the brain compensate for inner ear problems.
• Medications: To treat specific conditions or alleviate symptoms like vertigo or nausea.
• Dietary changes: Reducing salt, caffeine, or alcohol intake if these contribute to symptoms.
• Balance retraining exercises: To improve stability and reduce fall risk.
• Canalith repositioning maneuvers: Specific head movements to treat certain types of vertigo.
• Surgery: In rare cases, for conditions that don’t respond to other treatments.
• Lifestyle modifications: Such as using assistive devices or making home safety improvements.

The effectiveness of these treatments can vary, and a healthcare provider may recommend a combination of approaches tailored to the individual’s specific condition and needs.

Living with Balance Disorders: Coping Strategies and Support

While balance disorders can be challenging, there are numerous strategies and support systems available to help individuals manage their condition and improve their quality of life.

How can individuals cope with balance disorders in daily life?

Coping strategies for living with balance disorders include:

1. Maintaining a safe home environment: Removing tripping hazards and installing grab bars or handrails.
2. Using assistive devices: Such as canes or walkers to improve stability.
3. Practicing relaxation techniques: To manage anxiety related to balance issues.
4. Joining support groups: To connect with others facing similar challenges.
5. Staying physically active: Engaging in appropriate exercises to improve balance and overall health.
6. Educating family and friends: Helping loved ones understand the condition and how they can provide support.
7. Planning ahead: Anticipating potential challenges in different environments and preparing accordingly.

By implementing these strategies and working closely with healthcare providers, individuals with balance disorders can often manage their symptoms effectively and maintain an active, fulfilling lifestyle.

Understanding balance disorders, their causes, symptoms, and treatment options is crucial for anyone experiencing these issues or supporting someone who does. With proper diagnosis, treatment, and management strategies, many individuals with balance disorders can significantly improve their quality of life and reduce the impact of symptoms on their daily activities. If you or someone you know is experiencing persistent balance problems, it’s important to consult with a healthcare provider for a thorough evaluation and personalized treatment plan.

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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