About balance disorders

What is balance disorders?

A balance disorder is a condition that makes you feel unsteady or dizzy, as if you are moving, spinning, or floating, even though you are standing still or lying down. Balance disorders can be caused by certain health conditions, medications, or a problem in the inner ear or the brain.

Our sense of balance is primarily controlled by a maze-like structure in our inner ear called the labyrinth, which is made of bone and soft tissue. At one end of the labyrinth is an intricate system of loops and pouches called the semicircular canals and the otolithic organs, which help us maintain our balance. At the other end is a snail-shaped organ called the cochlea, which enables us to hear. The medical term for all of the parts of the inner ear involved with balance is the vestibular system.

How does the vestibular system work?

Our vestibular system works with other sensorimotor systems in the body, such as our visual system (eyes) and skeletal system (bones and joints), to check and maintain the position of our body at rest or in motion. It also helps us maintain a steady focus on objects even though the position of our body changes. The vestibular system does this by detecting mechanical forces, including gravity, that act upon our vestibular organs when we move. Two sections of the labyrinth help us accomplish these tasks: the semicircular canals and the otolithic organs.

The semicircular canals are three fluid-filled loops arranged roughly at right angles to each other. They tell the brain when our head moves in a rotating or circular way, such as when we nod our head up and down or look from right to left.

Each semicircular canal has a plump base, which contains a raindrop-shaped structure filled with a gel-like substance. This structure, called the cupula, sits on top of a cluster of sensory cells, called hair cells. The hair cells have long threadlike extensions, called stereocilia, that extend into the gel. When the head moves, fluid inside the semicircular canal moves. This motion causes the cupula to bend and the stereocilia within it to tilt to one side. The tilting action creates a signal that travels to the brain to tell it the movement and position of your head.

Between the semicircular canals and the cochlea lie the otolithic organs, which are two fluid-filled pouches called the utricle and the saccule. These organs tell the brain when our body is moving in a straight line, such as when we stand up or ride in a car or on a bike. They also tell the brain the position of our head with respect to gravity, such as whether we are sitting up, leaning back, or lying down.

Like the semicircular canals, the utricle and the saccule have sensory hair cells. These hair cells line the bottom of each pouch, and their stereocilia extend into an overlying gel-like layer. On top of the gel are tiny grains made of calcium carbonate called otoconia. When you tilt your head, gravity pulls on the grains, which then move the stereocilia. As with the semicircular canals, this movement creates a signal that tells the brain the head's position.

Our visual system works with our vestibular system to keep objects from blurring when our head moves and to keep us aware of our position when we walk or when we ride in a vehicle. Sensory receptors in our joints and muscles also help us maintain our balance when we stand still or walk. The brain receives, interprets, and processes the information from these systems to control our balance.

The vestibular structures of the inner ear are the vestibule (which is made up of the utricle and saccule) and the three semicircular canals. These structures work somewhat like a carpenter's level (a tool used to show how "level" a horizontal or vertical surface is). That is, they work by way of the vestibulocochlear nerve with the vestibular center in the brain to deal with body balance and position. (The rest of the inner ear, that is, the cochlea, is concerned with hearing.) Thus, the vestibular system includes the vestibule, the semicircular canals, the vestibular branch of the vestibulocochlear nerve, and the vestibular center in the brain.

The vestibular system measures linear and rotational movement. A number of disorders can cause this system to stop working or provide inappropriate information. These disorders include Ménière syndrome, labyrinthitis, benign paroxysmal positional vertigo, ear infections, tumors, or trauma. Each of these conditions is discussed below.

What are the symptoms for balance disorders?

Signs and symptoms of balance problems include:

  • Sense of motion or spinning (vertigo)
  • Feeling of faintness or lightheadedness (presyncope)
  • Loss of balance or unsteadiness
  • Falling or feeling like you might fall
  • Feeling a floating sensation or dizziness
  • Vision changes, such as blurriness
  • Confusion

What are the causes for balance disorders?

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 positions and move elsewhere in the inner ear. BPPV is the most common cause of vertigo in adults. You might experience a spinning sensation when turning in bed or tilting your head back to look up.
  • 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 without treatment. This is a common disorder second to BPPV in adults.
  • 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. This is the third most common disorder in adults.
  • 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 40.
  • Migraine. Dizziness and sensitivity to motion (vestibular migraine) can occur due to migraine. 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.
  • Ramsay Hunt syndrome. Also known as herpes zoster oticus, this condition occurs when a shingles-like infection affects the facial, auditory and vestibular nerves near one of your ears. You might experience vertigo, ear pain, facial weakness 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. Motion sickness is common in people with migraines.

Feeling of faintness or lightheadedness

Lightheadedness can be associated with:

  • Hemodynamic 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 feeling lightheaded or faint.
  • 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 lightheadedness or a fainting feeling.

Loss of balance or unsteadiness

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 unsteadiness.
  • Medications. Loss of balance or unsteadiness can be a side effect of medications.
  • Certain neurological conditions. These include cervical spondylosis and Parkinson's disease.


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.

What are the treatments for balance disorders?

The first thing a doctor will do to treat a balance disorder is determine if your dizziness is caused by a medical condition or medication. If it is, your doctor will treat the condition or suggest a different medication.

Your doctor also may describe ways for you to handle daily activities that increase the risk of falling and injury, such as driving, walking up or down stairs, and using the bathroom. If you have BPPV, your doctor might prescribe a series of simple movements, called the Epley maneuver, to help dislodge the otoconia from the semicircular canal. You begin the Epley maneuver by sitting upright, with the help of a trained therapist, then quickly lie down on your back, turn your head to one side, and wait for a minute or two before sitting back up again (see Figure 3). For some people, one session will be all that is needed. Others might need to repeat the procedure several times at home to relieve their dizziness.

If you are diagnosed with Ménière's disease, your doctor may recommend changes in your diet, such as reducing the use of salt in your food and limiting alcohol and caffeine. Not smoking also may help. Some anti-vertigo or anti-nausea medications may relieve your symptoms, but they can also make you drowsy. Other medications, such as the antibiotic gentamicin or corticosteroids, may be injected behind the eardrum to reach the inner ear. Although gentamicin helps reduce dizziness, it occasionally destroys sensory cells in the cochlea and causes permanent hearing loss. The risk of hearing loss can be lowered if small doses of gentamicin are given off and on until your symptoms decrease. Corticosteroids don't cause hearing loss; however, research is underway to determine if they are as effective as gentamicin. Surgery on the vestibular organ may be necessary if you have a severe case of Ménière's disease.

Some people with a balance disorder may not be able to fully relieve their dizziness and will have to develop ways to cope with it on a daily basis. A vestibular rehabilitation therapist can help by developing an individualized treatment plan that combines head, body, and eye exercises to decrease dizziness and nausea.

To reduce your risk of injury from dizziness, avoid walking in the dark. You also should wear low-heeled shoes or walking shoes outdoors and use a cane or walker if necessary. If you have handrails in the home, inspect them periodically to make sure they are safe and secure. Modifications to bathroom fixtures can make them safer. Conditions at work may need to be modified or restricted, at least temporarily. Driving a car may be especially hazardous. Ask your doctor's opinion about whether it's safe for you to drive.

What are the risk factors for balance disorders?

Balance Disorders are conditions where one may feel unsteady or light-headed. It gives you the sensation that floating and spinning usually does, but all while you’re on your feet. The way our balance is effective is due to a maze-like structure present in the inner ear termed as the labyrinth. It is made up of bone and self-tissue. Evidence of disturbance in this part of the ear or the brain will lead to one of several balance disorders.

Risk Factors of Balance Disorders:

1. Benign paroxysmal positional vertigo
2. Vestibular neuritis
3. Persistent postural-perceptual dizziness
4. Meniere’s disease
5. Migraine
6. Acoustic neuroma
7. Ramsay hunt syndrome
8. Head injury
9. Motion sickness
10. Hemodynamic orthostatic hypotension
11. Cardiovascular disease
12. Vestibular problems
13. Nerve damages to the legs
14. Joint, muscle or vision issues
15. Medications
16. Specific neurological conditions
17. Psychiatric disorders
18. Hyperventilation

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
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

Is there a cure/medications for balance disorders?

Cure/medications for Balance Disorders
One of the first steps in the diagnosis of these diseases is to determine if the cause of it is a medical condition or a side-effect of a certain medication itself. Once this is cleared, your doctor will illustrate examples of careful ways you can handle your daily activities along with medication in some cases.

1. Antibiotic gentamicin: It is injected behind the eardrum so that it can reach the inner ear. While it helps in reducing dizziness, it should be given on and off in low doses to prevent hearing loss.

2. Corticosteroids: Unlike gentamicin, Corticosteroids don’t cause the destruction of sensory cells in the cochlea. However, the research on whether it is as efficient as gentamicin is still ongoing.

3. Anticholinergics: These drugs include Scopolamine, traditionally treated for seasickness.

4. Antiemetics: A combination of Decadron and Zofran is used to treat dizziness and nausea.

5. Antihistamines: Antivert, Benadryl and Phenegran reduce the effects of motion sickness.

6. Benzodiazepines: Valium, Klonopin and Xanax help manage anxiety, acute motion sickness and vertigo.

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
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

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