Balance problems can disrupt daily activities, making it difficult to walk or move without feeling unsteady. These problems often arise from issues in the inner ear or brain or from having low blood pressure. Symptoms can include dizziness, a spinning sensation, or feeling light-headed.
While many balance issues are harmless and temporary, persistent problems require medical attention to identify underlying causes and appropriate treatments.
This article discusses potential causes, symptoms, and treatment of balance problems.
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How Does the Sense of Balance Work?
The ear plays a key role in hearing and balance. The vestibular system in the inner ear is crucial for maintaining equilibrium. This system includes three semicircular canals and two otolith organs located beneath the canals. Each semicircular canal is filled with fluid and ends in the ampulla, which contains sensory hair cells.
When the head moves, the fluid in these canals moves too, but a bit slower. This movement bends the sensory hair cells, telling the brain which way your head is moving—up or down, left or right, or turning around.
The otolith organs, embedded with sensory hair cells in a gel-like membrane with small crystals, detect movements like falling, riding an elevator, or accelerating in a car. One otolith organ senses forward, backward, or sideways movement, while the other detects up and down movements.
The brain processes this information and sends it to other organs, like the eyes and muscles, helping us maintain balance and understand our body's position. Sometimes, conflicting messages from the vestibular system and other senses, like vision, can cause dizziness or nausea.
Symptoms of Balance Problems
If you have a balance disorder, you may experience one or more of the following symptoms.
Neurological and Inner Ear Issues
Balance problems often manifest as dizziness or vertigo. These symptoms can be caused by conditions affecting the brain or inner ear, such as:
- Vertigo: A sensation of spinning or moving, even when you're still
- Meniere’s disease: A disorder of the inner ear causing severe dizziness, ringing of the ears, and hearing loss
- Vestibular neuritis: Inflammation of the vestibular nerve, leading to vertigo and imbalance
- Labyrinthitis: Inflammation of the inner ear, often due to infection, causing dizziness and loss of balance
Physical Injuries
Injuries to the body can also affect balance. Common examples include broken bones in the feet, legs, back, or neck. Concussions or other traumatic brain injuries can disrupt the brain's ability to process balance information.
In addition, medications you take for pain management of your injuries could also lead to balance issues.
Potential Causes of Balance Problems
The following are potential causes of balance problems:
Vertigo
Vertigo is one of the most common causes of balance problems, characterized by a spinning sensation. There are two main types: peripheral and central.
Peripheral Vertigo
Peripheral vertigo arises from issues within the inner ear's balance-control mechanisms, such as the vestibular labyrinth and semicircular canals. This type of vertigo can be triggered by various factors, including:
- Benign paroxysmal positional vertigo (BPPV)
- Certain medications like aminoglycoside antibiotics or diuretics that affect inner ear structures
- Head injuries leading to vestibular nerve inflammation or irritation
- Labyrinthitis
- Meniere's disease
- Noncancerous tumors
Central Vertigo
Central vertigo results from problems within the brain, particularly in regions like the brain stem or cerebellum. Causes of central vertigo are:
- Blood vessel diseases affecting brain circulation in the brain
- Certain medications like anticonvulsants or aspirin
- Neurological conditions such as multiple sclerosis (MS) that lead to nerve damage
- Seizures (bursts of uncontrolled electrical activity between cells in the brain)
- Strokes (blocked blood supply to the brain or a burst blood vessel in the brain) affecting brain function
- Tumors (both cancerous and noncancerous) impacting brain areas related to balance
- Vestibular migraine, a specific type of migraine headache characterized by vertigo episodes
Brain Injury
Traumatic brain injuries, such as concussions, can impair the brain's ability to coordinate balance, leading to dizziness and unsteadiness.
Dizziness, or a sense of imbalance, is common following a brain injury due to disruptions to the vestibular system. Trained physical therapists who specialize in evaluating balance issues can tailor a rehabilitation plan based on your symptoms. If your symptoms persist, your healthcare provider can prescribe medications to relieve discomfort and improve your condition.
Spinal Cord Injury
Damage to the spinal cord can disrupt the transmission of signals between the brain and the body, affecting balance and movement.
Spinal cord injury can cause several symptoms that affect balance, including:
- Paralysis
- Weakness in any part of the body
- Walking difficulties
- Unnatural spinal or head positions
- Pain or pressure in the head, neck, or back
Chronic Medical Conditions
Conditions like Parkinson's disease, MS, and diabetes can affect the nervous system and lead to balance problems.
Parkinson's disease is a neurodegenerative disorder that affects movement and motor control. One of its hallmark symptoms is postural instability. With Parkinson's, individuals may experience difficulty maintaining their balance while standing or walking. This instability can increase the risk of falls and impact daily activities.
Multiple sclerosis is an autoimmune condition that targets the central nervous system, including the brain and spinal cord. MS can cause damage to the nerves responsible for coordinating movement and balance. As a result, people with MS may encounter issues with balance, coordination, and gait (manner in which a person walks), affecting their mobility and stability.
Diabetes, especially when poorly managed, can lead to peripheral neuropathy, a condition characterized by nerve damage, often in the extremities such as the feet and legs. Peripheral neuropathy can disrupt the sensory feedback necessary for maintaining balance and can also affect muscle strength and coordination, causing balance problems.
Stroke
A stroke can damage parts of the brain responsible for balance and coordination, resulting in dizziness and difficulty walking.
Strokes may also lead to one-sided body weakness, making balance difficult. This can affect sitting up, standing, and walking, causing foot drop and an increased risk of tripping. Fatigue may also contribute to feelings of instability.
Migraine
Vestibular migraine is a specific type of migraine that involves symptoms beyond the typical headache.
In addition to head pain, people with vestibular migraines experience episodes of vertigo and dizziness. Vertigo is characterized by a sensation of spinning or feeling off-balance, as if the environment is moving when it's not. This can also be accompanied by nausea, vomiting, and difficulty focusing or concentrating.
Age
As people age, natural changes in the vestibular system, vision, and muscle strength can lead to balance problems. People over the age of 75 tend to have higher rates of balance disorders than younger people.
Medication
Dizziness and balance problems are side effects of some medications, including:
- Antibiotics
- Sleeping pills
- Antidepressants
- Muscles relaxants
- Blood pressure medicines
- Pain medicines
- Sedatives
- Anticonvulsants (anti-seizure medications)
Who Is at Risk of Balance Problems?
Balance problems can affect anyone, but certain factors increase the risk, including:
- Older adults
- People with conditions like diabetes, cardiovascular disease, and neurological problems
- Those with past injuries to the head or spine
- People with low blood pressure
What Causes Loss of Balance While Walking?
Loss of balance while walking can be due to a variety of factors, including:
- Inner ear disorders: Conditions like benign paroxysmal positional vertigo, Meniere’s disease, and vestibular neuritis can disrupt balance.
- Neurological conditions: Diseases like Parkinson's or MS can impair coordination.
- Vision problems: Poor vision can make it difficult to navigate and maintain balance.
How Are Balance Problems Diagnosed?
Diagnosing balance problems often involves a series of specialized tests conducted by healthcare professionals trained in identifying and treating disorders of the ear. Depending on your symptoms and medical history, your primary care provider may refer you to an audiologist or an otolaryngologist (an ear, nose, and throat specialist, or ENT) for further evaluation.
ENG or VNG Tests
One common test is the electronystagmography (ENG) or videonystagmography (VNG) tests, which measure involuntary eye movements called nystagmus.
During these tests, you'll sit in a dark room and follow a light with your eyes while your head and body are moved into different positions. Electrodes or special goggles will record your eye movements, helping to identify any abnormal function in your inner ear.
Rotary Chair Test
Another test is the rotary test or rotary chair test, which evaluates how well your eyes and inner ear work together to maintain balance. You'll sit in a chair that moves back and forth while wearing goggles that track your eye movements.
Posturography
Posturography, or computerized dynamic posturography (CDP), assesses your ability to balance while standing on a platform. This test measures your balance under different conditions, such as with open or closed eyes and while viewing moving images on a screen.
Additional tests may include:
- Vestibular-evoked myogenic potentials (VEMP) tests, which measure specific parts of your inner ear's function
- Dix-Hallpike maneuver or the newer video head impulse test (vHIT) to evaluate how your eyes respond to head movements.
- Hearing evaluations
- Imaging tests of the head and brain
How Are Balance Problems Treated?
The following are treatment options for balance problems:
Home Care
For minor balance problems, home care can be effective. This includes:
- Maintaining a healthy weight
- Exercising
- Staying hydrated can prevent dizziness caused by dehydration or low blood pressure
- Not standing too quickly
- Avoiding alcohol
Medications
Medications can help manage balance problems caused by specific conditions. Medication usage and dosage will depend on the reason behind the balance issues. Medications that treat dizziness and balance problems include:
- Antihistamines
- Antidepressants
- Aminopyridines
- Benzodiazepines
- Anticonvulsants
- Anti-inflammatories
- Corticosteroids
Surgery
In some cases, surgery may be necessary to treat underlying causes of balance problems. Surgeries for balance problems caused by vestibular dysfunction include:
- Labyrinthectomy: Removal of the inner ear to control severe Meniere’s disease
- Vestibular nerve section: Cuts the vestibular branch to stop balance signals, and the brain compensates with the opposite ear
- Chemical labyrinthectomy: Uses an antibiotic called gentamicin to destroy vestibular cells, which stops balance signals to the brain
- Endolymphatic sac decompression: Relieves pressure in the cochlea (spiral-shaped part of the inner ear) and vestibular system (inner ear's balance system)
- Pneumatic equalization (PE) tubes: Equalizes air pressure across the eardrum with a tube inserted through the eardrum
- Microvascular decompression: Relieves abnormal pressure on the vestibulocochlear nerve (nerve responsible for carrying information to brain)
How to Improve Your Balance
Improving balance involves a combination of exercises and lifestyle changes:
- Mind-body practices like tai chi or yoga can enhance stability.
- Building muscle strength, especially in the legs, supports better balance.
- Stretching the muscles may help improve posture and balance.
It is also important to have regular checkups in which your healthcare provider might catch issues early.
When to Contact a Healthcare Provider
Contact a healthcare provider if you experience:
- Persistent feeling of unsteadiness
- Persistent dizziness or vertigo
- Difficulty walking or frequent falls
- Severe headaches or vision changes
Summary
Balance problems can arise from various causes, including inner ear disorders, neurological conditions, and physical injuries. Recognizing the symptoms and risk factors can help you seek appropriate treatment and manage your condition effectively.
Addressing balance issues through home care, medication, or surgery is crucial for maintaining quality of life and preventing falls. Regular checkups and proactive lifestyle changes can also enhance balance and overall health.
