What Causes Balance Problems

Are you experiencing dizziness or feelings of being off balance? Remember when you were a kid and would roll down the hill, spin the merry-go-round fast, or play on anything that spins. The world starts to spin when you stop, you stumble around aimlessly and are unable to focus. You might even have feelings of wanting to throw up. These feelings can make you feel miserable.

In contrast, there are athletes that can spin in tight circles repeatedly on ice skates and then skate off in a straight line jumping along the way. How are some people susceptible to becoming dizzy with activities while others are not? Understanding this will help you understand what is causing you to have a disorder that affects your balance.

Your sense of balance or equilibrium is an important part of your daily life. Your ear plays a major role in you maintaining balance. The ear has two major functions: hearing and balance. Different parts of the ear allow for multiple roles. The main parts of the ear related to hearing include the outer ear, tympanic membrane, ossicles, cochlea, and the cochlear nerve.

While the ear is also related to our sense of balance, the structures involved differ from that of our sense of hearing. The vestibular system which includes your semicircular canals is responsible for your ability to balance. The semicircular canals have stones (otoliths) that float around the canals displacing a fluid, called endolymph, which causes cilia (hair-like structures) to move. The movement of the cilia causes a signal to be sent to the brain by the vestibular nerve. The brain then interprets the signal into what we feel as our balance.

The main symptoms related to balance disorders include:

• Dizziness
• Feeling a sensation of falling
• Feeling like you are about to faint (lightheaded)
• Nausea and/or vomiting
• Blurry vision

Many different causes can be related to balance disorders, and not all are related to the ears. Some of the causes include:

• Alcohol consumption
• Low blood pressure
• Side-effects of medications
• Arthritis
• Disorders affecting muscles of the eye

In relation to the ears, there are also many different reasons why you can develop a balance disorder. The list below identifies common disorders related to balance and a basic description of the cause:

• Benign paroxysmal positional vertigo (BPPV) - calcium stones that migrate into the semicircular canals
• Labyrinthitis and vestibular neuritis - inflammation of the inner ear (including the vestibular system)
• Meniere's disease - a vestibular fluid level imbalance
• Ear infection - inflammation of the inner ear
• Head trauma - damage to the inner ear or vestibular nerve
• Autoimmune inner ear disease

If you experience balance disturbances, you should see your physician. Most likely you will be referred to an ENT for a thorough workup. Your ENT will take a detailed history of how and when you experience vertigo as well as look in your ears. Following the exam, you will likely be referred for one or more tests to help identify the cause of your dizzy spells.

• Electronystagmography (ENG)
• Head impulse testing (HIT)
• Posturography

Because there are many reasons that you may develop a balance disorder, likewise there are many treatments for balance disorders. For more specific information related to treatments, please visit the links above related to specific diagnoses. However, the treatments may be categorized into the following main types of therapies for treating vertigo:

• Oral medications: antibiotics, steroids, anti-nausea, anti-vertigo
• Head positioning (i.e., Epley maneuver)
• Surgery
• Changing habits away from activities that make the symptoms worse.

It is important to remember that prior to treating anything on your own, you should consult a doctor, particularly an ENT in the case of vertigo.