Balance Disorders

Types of balance disorders

The most common types of balance disorders include:

• Benign paroxysmal positional vertigo (BPPV) — BPPV, or positional vertigo, is a sudden, severe vertigo episode that occurs when you change the position of the head.
• Labyrinthitis — labyrinthitis occurs when the inner ear becomes infected or inflamed and causes dizziness or loss of balance.
• Meniere’s disease — Meniere’s disease occurs when the fluid volume within the labyrinth changes; Meniere’s is typically associated with tinnitus, vertigo and hearing loss.
• Vestibular neuritis — vestibular neuritis occurs when the vestibular nerve becomes inflamed, typically by a virus.
• Perilymph fistula — perilymph fistulas occur when fluid from the inner ear leaks into the middle ear.
• Mal de debarquement syndrome (MdDS) — mal de debarquement syndrome is a balance problem that typically occurs after a cruise or sea travel; you feel like you are continuously rocking or bobbing.

Causes of balance disorders

Balance disorders may be caused by the following:

• Medications
• Problems in the inner ear or brain
• Head injury
• Health conditions such as arthritis or eye muscle imbalance

In many patients, balance problems occur suddenly with no apparent cause.

Risk factors for balance disorders

Risk factors that increase your likelihood of developing balance issues include:

• Age — balance problems are more common as you age; approximately 75 percent of Americans over the age of 70 are diagnosed with abnormal balance.
• Gender — women are at greater risk of developing balance problems than men.
• Ethnicity — in Americans, Mexican-Americans have the highest prevalence of balance problems.

Symptoms of balance disorders

If you have a balance problem, you may have symptoms such as:

• Dizziness
• Vertigo (spinning sensation)
• Trouble walking or staggering when walking
• Lightheadedness
• Blurry vision
• Disorientation or feeling confused
• Nausea
• Vomiting
• Diarrhea
• Fluctuations in heart rate and blood pressure
• Anxiety
• Fatigue
• Depression

Your symptoms may last for long periods or come and go over short periods of time.

Diagnosis of balance disorders

It is difficult to diagnose balance problems. If your primary care doctor suspects you have a balance disorder, he or she may refer you to a ENT specialist for further testing. An ENT specialist, also known as an otolaryngologist, is a doctor who specializes in diseases of the ears, nose, neck and throat.

During a physical exam, your doctor may perform any of the following tests:

• Hearing examination — many patients who have hearing difficulties also have a balance disorder.
• Blood pressure tests — will help determine if changes in your blood pressure are causing your balance problems.
• Video nystagmogram — uses a camera to test eye movements; eye movements can play a role in balance and vestibular function.
• Imaging studies of the head and brain — if you have a medical condition that is causing your balance problem, an MRI or CT scan may be able to help diagnose it.
• Posturography test — will determine what parts of the balance system you rely on most.
• Chair testing — during a rotary chair test, your eye movements will be analyzed as your chair moves around in a circle.

Treatment for balance disorders

Treatment for balance issues will vary based on what is causing your symptoms. Treatments may include:

• Vestibular rehabilitation — also known as balance retraining exercises, is therapy to help you adjust to your balance problems and maintain physical activity.
• Lifestyle and nutrition changes — nutritional changes can help relieve symptoms from balance problems caused by migraine headaches or Meniere’s disease.
• Medical management — severe vertigo can be treated with medication that may relieve your symptoms.
• Surgery — patients with Meniere’s disease may need surgery such as stereotactic radiosurgery.
• Positioning techniques — may be used to remove particles out of the inner ear.