In Syndromes & Disorders

A Balance Disorder and a Whole Family of Issues

Balance disorder is a general phrase used to label many different conditions that end up looking like the same thing. At least three systems in the body are involved with maintaining balance. If you, or someone you care about, no matter their chronological age, starts to:

  • have trouble controlling how quickly or slowly they walk,
  • bump into things,
  • stumble,
  • stagger, especially when going around corners,
  • fall,
  • generally have trouble standing,
  • trip when going up or down stairs,
  • have trouble changing position (like standing up, sitting down, rolling from side to side),
  • feel dizzy, nauseous, or throw up after quick or sudden head movement,

some kind of balance issue could be at the root of it all.

Balance problems can be a warning of a serious health problem. They can be blood pressure issues, brain problems, circulatory issues, and aftereffects from head injuries. In 2008, according to the National Institute of Health  an estimated 33.4 million American adults reported a balance or dizziness problem during the previous twelve months. A number of things can cause these signs to appear.


Many balance disorders are temporary. In children, they can be simply be an outward sign of learning to walk or manage a rapidly-growing body. Most children’s balance issues, even those with a medical origin, often resolve themselves without medical intervention.

The more permanent types of balance problems are not common. Here’s a list of types and causes of balance issues that are found in the adult population:

  1. Temporary condition due to alcohol consumption, drug use, medication interaction, disease, or motion (usually of a car or boat).
  2. Aftermath of a head injury, often a concussion or blunt-force trauma.
  3. Aging. Simply growing older can create balance challenges for some people.
  4. Side effect of a stroke, migraine headache, or seizure.
  5. Sudden change in blood pressure, often from changing position (like standing up or bending over) too quickly.
  6. Middle or inner ear infection, which can cause vestibular neuronitis (inflammation of the vestibular nerve), labyrinthitis (inflammation of the labyrinth, an inner ear part), and affect the vestibular system, the body’s primary balance system.
  7. Meniere’s Disease, usually affects the balance mechanism in one ear by causing problems with the inner ear fluid. Symptoms include vertigo (dizziness), tinnitus (ringing in the ears), partial hearing loss that comes and goes, and a sensation of ear congestion and ear pressure. It can occur in anyone, but usually appears in persons 40 – 60 years old. The cause of this disease is unknown.
  8. Benign Paroxysmal Positional Vertigo (BPPV), caused by inner ear issues.
  9. Eye problems – most notably nystagmus, which are involuntary eye movements that can wreak havoc with an individual’s sense of balance.
  10. Skeletal and/or muscle problems.
  11. Unknown origins – balance problems starting suddenly and having no apparent cause.

Common Symptoms

  1. Vertigo symptoms – a sense of immediate surroundings spinning. This unpleasant, unsteady feeling is often accompanied by nausea and vomiting.
  2. Dizziness – feeling giddy, having the sensation that everything is spinning around you.
  3. Disequilibrium – feeling physically off-balance, and falling down in the same general direction. Nausea and vomiting usually do not occur with this symptom.
  4. Lightheadedness – a sense of faintness, but not necessarily fainting.
  5. Blurred vision, or involuntary eye movements (nystagmus).
  6. Feelings of confusion or disorientation.
  7. Fatigue – tiredness from the effort of accommodating and adapting to the imbalance. This tiredness is often out of proportion to the amount of effort expected to be expended in an activity.
  8. Fear, anxiety, and depression – psychological states that can arise from not knowing one has a balance disorder and as a result not being able to function in expected ways.

Issues with physical balance can occur with no warning. They can occur once or a number of times, and can be short episodes or last for months or years.

Balance is a function of several different body subsystems cooperating. For convenience, it is called the Vestibular System, but keeping our balance is a complex interaction of the inner ear, vision, and musculoskeletal subsystems. Correct diagnosis of a balance disorder is equally as complex.

Whenever a doctor is presented with a patient who complains of a balance disorder, the first order of business is to rule out any external physical cause. This includes (but is not limited to):

  • Falls, accidents, or injuries, especially anything affecting the head
  • Medications and possible interactions. This includes over-the-counter medications, herbal preparations, pain relievers, and sleep aids
  • Ototoxic medications, which are drugs intended for other uses (like antibiotics or chemotherapy) that damage the inner ear
  • Chronic infections
  • Substance abuse, such as alcohol or drugs
  • Recent new activities
  • Environmental factors, such as a new living or work space, new carpeting or drapes, any change in any surroundings
  • Allergies, such as pets, plants, clothing, food, or fragrances

A doctor may consult with other professionals before making a diagnosis. This can take the form of a formal presentation at a specialists’ meeting, a more informal conversation with another doctor, or going to research sources only available to medical professionals. Based on the results of these fact-finding activities, the next step may be:

  • Referral to an audiologist, an otolaryngologist (ear-nose-throat doctor, also called an ENT), and/or a neurolotologist (a specialist in ear disorders)
  • MRI scan – magnetic resonance imaging, a technology that uses magnets for seeing what is going on inside the body without performing any invasive procedures
  • CT scan – computerized tomography, which is an x-ray procedure that takes x-ray photos in ‘slices’ in order to build up a three-dimensional picture of that part of the body
  • Electronystagmography – testing eye movements, since a major component of balance is the interaction of eyes and ears
  • Posturography – testing how the body responds to movement or presented patterns
  • Other diagnostic tests

Balance disorders are much more than a feeling of dizziness or vertigo. They also have far-reaching effects on those stricken with the condition. Balance disorders do not have simple solutions. They are complex conditions that need to be addressed on more than one level.

Physical Aspects of Treatment

Most of the time, the body needs to be retrained to deal with the changes in the vestibular system. Vision, hearing, and proprioception (knowing where your body is and how it’s oriented in space without looking at it) need to learn to work together again. A physical therapist has training and experience in working with people with balance disorders. Physical therapy can help:

  • Lessen the impact of balance issues on daily activities
  • Teach how to adapt to changes in the world of an individual with balance challenges

Different balance disorders have different approaches to deal with what look like similar conditions. For example, doctors perform the Epley maneuver with individuals who have been diagnosed with BPPV to relieve symptoms of vertigo and help the vestibular system return to proper functioning. Those who are dealing with Meniere’s Disease usually work with their treatment team to relieve symptoms only, because this condition has no cure.

All balance challenges benefit from:

  • High-quality nutrition
  • Low-sodium intake
  • Enough fluid intake to prevent dehydration
  • Stronger abdominal and spinal erector muscle groups
  • Enough rest, which translates to not getting too tired
  • Stability aids, such as stable footwear, canes, and walkers, which helps prevent falls

Psychological Aspects of Treatment

Regardless of the type of balance issue an individual has, a counselor or psychotherapist can help a person recognize and come to terms with the life changes a balance disorder can cause. Even though the treatment team has implemented and everyone is working the treatment plan, it may take more time than the patient likes before he or she sees any physical improvements. The fear, anxiety, and depression that may arise after such a radical change in functioning are real issues, not products of the imagination. It is just as important to pay attention to and address the psychological as well as the physical issues.

As soon as possible after the diagnosis is made, a mental health professional needs to become part of the treatment team. Waiting for signs of psychological distress to appear before acting to deal with that distress robs people, both patients and those in their support systems, of tools they could have been using to lessen or prevent its negative effects. It is more than possible only one or two visits with a mental health professional will be needed. Preventing the mental anguish that may arise from such a sudden change in the ability to function is much more effective than trying to cure it.

Support groups are another tool available for the person dealing with balance challenges. They can be used by some people instead of, or before starting to work with, or at the same time they are working with, a mental health professional. Meeting others who are dealing with similar issues helps emphasize to them that they are not alone. Support groups provide the chance to speak with people who live with balance issues and gain non-medical perspectives, insights, and observations.

Group members who have lived and dealt with balance issues for a longer time than the newcomer can offer practical tools for dealing with some of the unique challenges that come up, bring a sense of humor to the situation, and suggest resources the newcomer may not know exist. Support groups also provide a venue in which to frankly talk about personal experiences and issues without having to feel it necessary to ‘put on a happy face.’

An important thing to keep in mind is that balance disorders in and of themselves are not fatal. Some, especially those that appear in childhood, resolve themselves in time and go away on their own. Those that appear during adulthood, though, require adaptation to the condition. Sometimes, changes in nutrition, types of exercise, and awareness of surroundings can have a dramatically positive effect.

An overwhelming amount of information about balance disorders is available from doctors and pharmacists, on the Internet, in libraries, and through professional associations. This article touches on the basics of what is quite a complex group of conditions that can appear out of nowhere and stay for the rest of a person’s life. Doing more research is a crucial piece of the peace of mind puzzle.

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