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The solution to your balance problems

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Have you ever felt dizzy, lightheaded, or as if the room is spinning around you? If the feeling happens often, it could be a sign of a balance problem. Balance problems can make you feel unsteady. You may also have blurred vision, confusion, and disorientation. They are one cause of falls and fall-related injuries, such as a hip fracture.
Some balance problems are due to problems in the inner ear. Others may involve another part of the body, such as the brain or the heart. Aging, infections, head injury, certain medicines, or problems with blood circulation may also cause balance problems.
It is important to see your doctor about balance problems. They can be a sign of other health problems, such as an ear infection or a stroke. Your doctor may send you to a specialist for a diagnosis. You may need a hearing test, blood tests, or imaging studies of your head and brain. Other possible tests look at your eye movements, and how your body responds to movement.
In some cases, treating the illness that is causing the disorder will help with the balance problem. Exercises, a change in diet, and some medicines also can help.
What causes balance disorders?
There are many causes of balance problems, such as medications, ear infections, a head injury, or anything else that affects the inner ear or brain. Low blood pressure can lead to dizziness when you stand up too quickly. Problems that affect the skeletal or visual systems, such as arthritis or eye muscle imbalance, can also cause balance disorders. Your risk of having balance problems increases as you get older.
Unfortunately, many balance disorders start suddenly and with no obvious cause.
How does my body keep its balance?
Your sense of balance relies on a series of signals to the brain from several organs and structures in the body, which together are known as the vestibular system. The vestibular system begins with a maze-like structure in your inner ear called the labyrinth, which is made of bone and soft tissue.
Within the labyrinth are structures known as semicircular canals. The semicircular canals contain three fluid-filled ducts, which form loops arranged roughly at right angles to one another. They tell your brain when your head rotates or moves up or down. Inside each canal is a gel-like structure called the cupula [KEW-pyew-lah], stretched like a thick drumhead across its duct. The cupula sits on a cluster of sensory hair cells. Each hair cell has tiny, thin extensions called stereocilia that protrude into the cupula.
When you turn your head, fluid inside the semicircular canal moves, causing the cupula to flex, which bends the stereocilia. This bending creates a nerve signal to the brain to tell it which way your head has turned.

mage Structures of the balance system inside the inner ear. (Graphic: NIH Medical Arts)

mage Structures of the balance system inside the inner ear. (Graphic: NIH Medical Arts)

Between the semicircular canals and the cochlea lie two otolithic [oh-toe-LITH-ic] organs: fluid-filled pouches called the utricle [YOU-trih-cull] and the saccule [SACK-kewl]. These organs tell your brain the position of your head with respect to gravity, such as whether you are sitting up, leaning back, or lying down, as well as when your head is moving in a straight line, such as up, forward, or sideways.
The utricle and the saccule also have sensory hair cells lining the floor or wall of each organ, with stereocilia extending into an overlying gel-like layer. Here, the gel contains tiny, dense grains of calcium carbonate called otoconia [oh-toe-CONE-ee-ah]. Whatever the position of your head, gravity pulls on these grains, which then move the stereocilia to signal your head’s position to your brain. Any head movement creates a signal that tells your brain about the change in position.
When you move, the vestibular system detects mechanical forces, including gravity, that stimulate the semicircular canals and the otolithic organs. These organs work with other sensory systems in your body, such as your vision and your musculoskeletal sensory system, to control the position of your body at rest or in motion. This helps you maintain stable posture and keep your balance when you’re walking or running. It also helps you keep a stable visual focus on objects when your body changes position.
When the signals from any of these sensory systems malfunction, you can have problems with your sense of balance. If you have additional problems with motor control, such as weakness, slowness, tremor, or rigidity, you can lose your ability to recover properly from imbalance. This raises the risk of falling and injury.
What are some types of balance disorders?
There are more than a dozen different balance disorders. Some of the most common are:
• Benign paroxysmal positional vertigo (BPPV) or positional vertigo: A brief, intense episode of vertigo triggered by a specific change in the position of the head. You might feel as if you’re spinning when you bend down to look under something, tilt your head to look up or over your shoulder, or roll over in bed. BPPV occurs when loose otoconia tumble into one of the semicircular canals and weigh on the cupula. The cupula doesn’t flex properly and sends wrong information about your head’s position, causing vertigo. BPPV can result from a head injury, or can develop just from getting older.
• Labyrinthitis [lab-buh-rinth-EYE-tiss]: An infection or inflammation of the inner ear that causes dizziness and loss of balance. It is often associated with an upper respiratory infection such as the flu.
• Ménière’s [main-YEHRZ] disease: Episodes of vertigo, hearing loss, tinnitus (TIN-nih-tuss, a ringing or buzzing in the ear), and a feeling of fullness in the ear. It may be associated with a change in fluid volume within parts of the labyrinth, but the cause or causes are still unknown. Read the NIDCD fact sheet Ménière’s Disease for more information.
• Vestibular neuronitis [new-ron-EYE-tiss]: An inflammation of the vestibular nerve that can be caused by a virus, and primarily causes vertigo.
• Perilymph fistula [PERRY-limf FIS-tew-lah]: A leakage of inner ear fluid into the middle ear. It causes unsteadiness that usually increases with activity, along with dizziness and nausea. Perilymph fistula can occur after a head injury, dramatic changes in air pressure (such as when scuba diving), physical exertion, ear surgery, or chronic ear infections. Some people are born with perilymph fistula.
• Mal de Debarquement [dee-BARK-ment] syndrome (MdDS): A feeling of continuously rocking or bobbing, typically after an ocean cruise or other sea travel. Usually the symptoms go away a few hours or days after you reach land. Severe cases, however, can last months or even years, and the cause remains unknown.
How are balance disorders diagnosed?
Diagnosis of a balance disorder is difficult. To find out if you have a balance problem, your doctor may suggest that you see an otolaryngologist. An otolaryngologist is a physician and surgeon who specializes in diseases and disorders of the ear, nose, neck, and throat.
The otolaryngologist may ask you to have a hearing examination, blood tests, an electronystagmogram (a test that measures eye movements and the muscles that control them), or imaging studies of your head and brain. Another possible test is called posturography. For this test, you stand on a special movable platform in front of a patterned screen. The doctor measures how your body responds to movement of the platform, the patterned screen, or both.
How are balance disorders treated?
The first thing a doctor will do if you have a balance problem is determine if another health condition or a medication is to blame. If so, your doctor will treat the condition, suggest a different medication, or refer you to a specialist if the condition is outside his or her expertise.
If you have BPPV, your doctor might recommend a series of simple movements, such as the Epley maneuver, which can help dislodge the otoconia from the semicircular canal. In many cases, one session works; other people need the procedure several times to relieve their dizziness.
If you are diagnosed with Ménière’s disease, your doctor may recommend that you make some changes to your diet and, if you are a smoker, that you stop smoking. Anti-vertigo or anti-nausea medications may relieve your symptoms, but they can also make you drowsy. Other medications, such as gentamicin (an antibiotic) or corticosteroids may be used. Although gentamicin may reduce dizziness better than corticosteroids, it occasionally causes permanent hearing loss. In some severe cases of Ménière’s disease, surgery on the vestibular organs may be needed.
Some people with a balance disorder may not be able to fully relieve their dizziness and will need to find ways to cope with it. A vestibular rehabilitation therapist can help you develop an individualized treatment plan.
Talk to your doctor about whether it’s safe to drive, as well as ways to lower your risk of falling and getting hurt during daily activities, such as when you walk up or down stairs, use the bathroom, or exercise. To reduce your risk of injury from dizziness, avoid walking in the dark. You should also wear low-heeled shoes or walking shoes outdoors. If necessary, use a cane or walker and modify conditions at your home and workplace, such as by adding handrails.
When should I seek help if I think I have a balance disorder?
To help you decide whether to seek medical help for a dizzy spell, ask yourself the following questions. If you answer “yes” to any of these questions, talk to your doctor:
• Do I feel unsteady?
• Do I feel as if the room is spinning around me?
• Do I feel as if I’m moving when I know I’m sitting or standing still?
• Do I lose my balance and fall?
• Do I feel as if I’m falling?
• Do I feel lightheaded or as if I might faint?
• Do I have blurred vision?
• Do I ever feel disoriented–losing my sense of time or location?
Having good balance is important for many everyday activities, such as going up and down the stairs. It also helps you walk safely and avoid tripping and falling over objects in your way.
Each year, more than 2 million older Americans go to the emergency room because of fall-related injuries. A simple fall can cause a serious fracture of the arm, hand, ankle, or hip. Balance exercises can help you prevent falls and avoid the disability that may result from falling. You can do balance exercises almost anytime, anywhere, and as often as you like as long as you have something sturdy nearby to hold on to for support. Try these balance exercises: stand on one foot, walk heel to toe, and walk in a straight line with one foot in front of the other. A number of lower-body exercises – especially those that strengthen your legs and ankles – also can help improve your balance. These include the back leg raise, side leg raise, knee curl, and toe stand exercises, which can be found on the Go4Life website.
As you progress in your exercise routine, try adding the following challenges to help your balance even more: l Start by holding on to a sturdy chair with both hands for support. l When you are able, try holding on to the chair with only one hand. l With time, hold on with only one finger, then with no hands at all. l If you are really steady on your feet, try doing the balance exercises with your eyes closed. (-National Institute on Aging).


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