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Balance Disorders, Causes, Types and Symptoms

The human balance system is complex. It includes input from and coordination of three sensory systems: vestibular, visual, and somatosensory.

A balance disorder is a condition that makes you feel unsteady or dizzy, as if you are moving, spinning, or floating, even though you are standing still or lying down. Balance disorders can be caused by certain health conditions, medications, or a problem in the inner ear or the brain.

Assessment and management of balance system disorders and their symptoms is an inter-professional endeavor, at times involving audiology, behavioral health, cardiology, neurology, neuro-ophthalmology, neurotology, occupational therapy, otolaryngology, otology, physical therapy, and/or a primary care provider.

What Are the Symptoms of a Balance Disorder?

Some of the common symptoms of a balance disorder include:

  • Dizziness or vertigo - Vertigo is the illusion that one’s body or the environment is spinning or tumbling and usually indicates a vestibular problem. Any sensation of motion, such as tilting or falling can also be caused by vestibular disease.
  • Motion Sickness - Motion sickness or travel sickness is characterised by nausea, vomiting, pallor and sweating when travelling in a moving vehicle, typically a car. It is a physiological response to a mismatch between vestibular and visual information about the moving environment. 
  • Falling or a feeling as if you are going to fall
  • Lightheadedness, fainting, or a floating sensation
  • Blurred vision
  • Confusion or disorientation
  • Nausea and vomiting - Nausea is a sensation of unease in the stomach associated with an involuntary urge to vomit. There are many nerve connections between the vestibular system and the vomiting centre and trigger zone in the medulla, so that nausea is a very common associated feature with any type of dizziness or imbalance.
  • Diarrhea
  • Changes in blood pressure and heart rate
  • Fear
  • Anxiety
  • Trauma
  • Panic

Symptoms may come and go over short periods of time, or last for longer periods of time.


THE CAUSES

The underlying causes of balance disorders and the resulting symptoms are many and varied. They include causes related to the vestibular system and causes related to other body systems and conditions. Conditions and events resulting in imbalance and/or dizziness may resolve spontaneously or may become chronic.

Causes of balance system disorders may include, but not be limited to, the following:

  • acute injury to the vestibular system
  • aging vestibular system
  • alcohol and/or drug ingestion
  • anatomic brain changes
  • autoimmune inner ear disease
  • benign paroxysmal positional vertigo (BPPV)
  • circulatory or cardiovascular conditions

What Are the Types of Balance Disorders?
There are more than a dozen types of balance disorders. Some of the most common include:
  1. Vertigo
  2. Benign paroxysmal positional vertigo (BPPV)
  3. Labyrinthitis
  4. Meniere's disease
  5. Vestibular neuronitis
  6. Perilymph fistula
  7. Mal de debarquement syndrome (MdDS)


How is a Balance Disorder Diagnosed?


Diagnosis of a balance disorder is difficult. There are many potential causes - including medical conditions and medications. To help evaluate a balance problem, a doctor may suggest the patient visit an otolaryngologist (a physician and surgeon who specializes in the ear, nose, and throat). The otolaryngologist may order a hearing examination, blood tests, an electronystagmogram (which measures eye movements and the muscles that control them), or imaging studies of the head and brain. Another possible test is called posturography. For this test, the patient stands on a special movable platform in front of a patterned screen. The doctor measures how the patient's body moves in response to movement of the platform, the patterned screen, or both.


How Is a Balance Disorder Treated?

The first thing a doctor will do to treat a balance disorder is determine if the patient's dizziness is caused by a medical condition or medication. If it is, the doctor will treat the condition or suggest a different medication for the patient.

The treatment for the different types of balance disorders described previously will depend on the specific balance disorder. Some treatment options include medication, vestibular rehabilitation therapy, head,; body,; and eye exercises, and modifications to home fixtures to make them safer (for example, handrails in the home).

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