Balance

Approximately 40% of the United States population will experience a form of dizziness or balance problem over the course of their life (National Institute on Deafness and Other Communication Disorders [NIDCD], 2014). Balance problems are disorders which can cause you to feel unstable. If you are sitting still, you may feel as if you are spinning, moving, or floating. If you are walking, you might feel as if you are going to tip over or veer to one side.

There are many aspects of your body which contribute to your balance: your bones, joints, muscles, vision, inner ear, heart, nerves, and brain. There are three systems which are the most important for balance. These are: somatosensory (how you feel the ground beneath you), vision (ability to see where you are and orient yourself to objects), and vestibular (inner ear organ which controls balance). When one of these systems is not functioning properly, you may experience balance problems and have a greater risk of falling. About one in three adults aged 65 and older fall each year and 10% of falls result in major injuries (Agrawal, Y., Ward, B.K., & Minor, L.B. [2013]. Vestibular dysfunction: Prevalence, impact and need for targeted treatment.  Journal of Vestibular Research, 23[3]).

There are various symptoms you may experience which can help determine the cause of your balance problems.

Symptoms:

  • Sensation that the room is spinning (vertigo)
  • Lightheadedness or fainting
  • Unsteadiness or loss of balance
  • Faintness/Lightheadedness (presyncope)
    • Orthostatic hypotension: You may experience a sudden drop in blood pressure after sitting or standing up too quickly, which can result in lightheadedness.
    • Cardiovascular disease: Any heart disease (heart arrhythmia, blocked blood vessels, thickened heart muscle) can cause reduced blood flow and result in lightheadedness.
  • Loss of balance
    • Vestibular problems: Disorders of your inner ear can cause unsteadiness while walking or with head movement, especially in dark environments.
    • Nerve damage to legs (neuropathy): You may experience difficulty walking and unsteadiness due to weakness and reduced sensation in your legs.
    • Joint, muscle, or vision problem: Weak muscles and unstable joints may increase difficulty walking and result in unsteadiness. Vision problems which cause double vision or blurry vision can result in imbalance.
    • Medications: Certain medications may have unsteadiness as a side effect.
    • Various neurologic conditions

Testing

Based on the nature of your balance problems, your physician may refer you to a variety of specialists:

  • ENT physician: ear, nose, and throat conditions
  • Audiologist: hearing and balance system of the inner ear
  • Physical therapist
  • Neurologist: brain and nervous system
  • Cardiologist: heart and blood vessels

When you visit the audiologist, there are a variety of tests which can be performed to determine if the cause of your symptoms is due to your vestibular system (inner ear):

  • Hearing Evaluation: Some balance disorders can affect hearing since both the hearing and balance organs are located in the inner ear.
  • Electronystagmography/Videonystagmography: This test records your eye movements using either electrodes placed under your eyes (electronystagmography) or goggles with small video cameras (videonystagmography). Your eyes are recorded in order to evaluate the neural pathways between your eyes and vestibular system. The test will also involve following a target with your eyes and moving into different body positions. It evaluates the functioning of the vestibular system in each ear.
  • Vestibular Evoked Myogenic Potentials: The test involves putting surface electrodes on your neck and face to evaluate the muscle responses and neural pathways which connect to the vestibular system. During the test, you will be asked to move your neck and eyes in response to a loud sound.
  • Video Head Impulse Test: You will be wearing a pair of goggles with a small video camera, which will measure your eye movements when your head is turned from left to right and up and down.

Treatment

Balance problems can cause people to limit their activities and restrict their movement. It is important to stay active, but to do so safely. After you have been diagnosed with a balance disorder, there are various treatment options which may be recommended.

Vestibular Rehabilitation (balance retraining exercises):  A physical therapist trained in vestibular rehabilitation provides an individualized balance retraining program to help you compensate for imbalance and maintain your activities of daily life. They can also provide exercises and tools to help prevent falls.

Positioning procedures: A therapist may perform a maneuver (canalith repositioning) which moves the crystals in your inner ear, which have become dislodged, into a different area of your inner ear. This maneuver is used to treat BPPV.