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Vestibular Balance Disorders: Learn About Causes & Treatment

What is a balance disorder?

The bony labyrinth inside the ear is how you sense balance. Disorders of this organ lead to dizziness and vertigo, among other symptoms.

SThe bony labyrinth inside the ear is how you sense balance. Disorders of this organ lead to dizziness and vertigo, among other symptoms.

A balance disorder is a condition that makes you feel unsteady or
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.

Our sense of balance is primarily controlled by a maze-like structure in
our inner ear called the labyrinth, which is made of bone and soft tissue.
At one end of the labyrinth is an intricate system of loops and pouches
called the semicircular canals and the otolithic organs, which help us
maintain our balance. At the other end is a snail-shaped organ called the
cochlea, which enables us to hear. The medical term for all of the parts of
the inner ear involved with balance is the vestibular system.

Hearing and Balance Anatomy

Medical Author: Benjamin C. Wedro, MD,
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR

The anatomy of the ear can be a little confusing, especially since the ear is
responsible not only for hearing, but also for balance.

There are three components to the ear: the outer ear, the middle ear and the
inner ear. All three are involved in hearing but only the inner ear is
responsible for balance.

The outer ear is composed of the pinna, or ear lobe, and the external
auditory canal. Both structures funnel sound waves towards the ear drum or
tympanic membrane allowing it to vibrate. The pinna is also responsible for
protecting the ear drum from damage. Modified sweat glands in the ear canal form
ear wax.

The middle ear is an air filled space located in the temporal bone of the
skull. Air pressure is equalized in this space via the Eustachian tube which
drains into the nasopharynx or the back of the throat and nose. There are three
small bones, or ossicles, that are located adjacent to the tympanic membrane.
The malleus, incus, and stapes are attached like a chain to the tympanic membrane
and convert sound waves that vibrate the membrane into mechanical vibrations of
the three bones. The stapes fills the oval window which is the connection to the
inner ear.

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    What causes a balance disorder?

    A balance disorder may be caused by viral or bacterial infections in the
    ear, a head injury, or blood circulation disorders that affect the inner ear
    or brain. Many people experience problems with their sense of balance as
    they get older. Balance problems and dizziness also can result from taking
    certain medications.

    In addition, problems in the visual and skeletal systems and the nervous
    and circulatory systems can be the source of some posture and balance
    problems. A circulatory system disorder, such as low blood pressure, can
    lead to a feeling of dizziness when we suddenly stand up. Problems in the
    skeletal or visual systems, such as arthritis or eye muscle imbalance, also
    may cause balance problems. However, many balance disorders can begin all of
    a sudden and with no obvious cause.


    What is vertigo?
    See Answer

    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 is a
    brief, intense episode of vertigo that occurs because of a specific change
    in the position of the head. If you have BPPV, you might feel as if you’re
    spinning when you look for an object on a high or low shelf or turn your
    head to look over your shoulder (such as when you back up your car). You
    also may experience BPPV when you roll over in bed. BPPV is caused when
    otoconia tumble from the utricle into one of the semicircular canals and
    weigh on the cupula. The cupula can’t tilt properly and sends conflicting
    messages to the brain about the position of the head, causing vertigo. BPPV
    sometimes may result from a head injury or just from getting older.

    Labyrinthitis is an infection or inflammation of the inner ear that
    causes dizziness and loss of balance. It frequently is associated with an
    upper respiratory infection such as the flu.

    Ménière’s disease is associated with a change in fluid volume within
    parts of the labyrinth. Ménière’s disease causes episodes of vertigo,
    irregular hearing loss,
    tinnitus (a
    ringing or buzzing in the ear), and a feeling of fullness in the ear. The
    cause of this disease is unknown.

    Vestibular neuronitis is an inflammation of the vestibular nerve and may
    be caused by a virus. Its primary symptom is vertigo.

    Perilymph fistula is a leakage of inner ear fluid into the middle ear. It
    can occur after a head injury, drastic changes in atmospheric pressure (such
    as when scuba diving), physical exertion, ear surgery, or
    chronic ear
    infections. Its most notable symptom, besides dizziness and nausea, is
    unsteadiness when walking or standing that increases with activity and
    decreases with rest. Some babies may be born with perilymph fistula, usually
    in association with hearing loss that is present at birth.

    Mal de debarquement syndrome (MdDS) is a balance disorder in which you
    feel as if you’re continuously rocking or bobbing. It generally happens
    after an ocean cruise or other sea travel. Usually, the symptoms will go
    away in a matter of hours or days after you reach land. However, severe
    cases can last months or even years.

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    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, your doctor may suggest you see an
    otolaryngologist. An otolaryngologist is a physician and surgeon who
    specializes in the ear, nose, and throat. An otolaryngologist may request
    tests to assess the cause and extent of the balance problem depending on
    your symptoms and health status.

    The otolaryngologist may request a hearing examination, blood tests, an
    electronystagmogram (which 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
    moves in response to movement of the platform, the patterned screen, or

    How is a balance disorder treated?

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

    Your doctor also may describe ways for you to handle daily activities
    that increase the risk of falling and injury, such as driving, walking up or
    down stairs, and using the bathroom. If you have BPPV, your doctor might
    prescribe a series of simple movements, called the Epley maneuver, to help
    dislodge the otoconia from the semicircular canal. You begin the Epley
    maneuver by sitting upright, with the help of a trained therapist, then
    quickly lie down on your back, turn your head to one side, and wait for a
    minute or two before sitting back up again (see Figure 3). For some people,
    one session will be all that is needed. Others might need to repeat the
    procedure several times at home to relieve their dizziness.

    If you are diagnosed with Ménière’s disease, your doctor may recommend
    changes in your diet, such as reducing the use of salt in your food and
    limiting alcohol and caffeine. Not smoking also may help. Some anti-vertigo
    or anti-nausea medications may relieve your symptoms, but they can also make
    you drowsy. Other medications, such as the antibiotic gentamicin or
    corticosteroids, may be injected behind the eardrum to reach the inner ear.
    Although gentamicin helps reduce dizziness, it occasionally destroys sensory
    cells in the cochlea and causes permanent hearing loss. The risk of hearing
    loss can be lowered if small doses of gentamicin are given off and on until
    your symptoms decrease. Corticosteroids don’t cause hearing loss; however,
    research is underway to determine if they are as effective as gentamicin.
    Surgery on the vestibular organ may be necessary if you have a severe case
    of Ménière’s disease.

    Some people with a balance disorder may not be able to fully relieve
    their dizziness and will have to develop ways to cope with it on a daily
    basis. A vestibular rehabilitation therapist can help by developing an
    individualized treatment plan that combines head, body, and eye exercises to
    decrease dizziness and nausea.

    To reduce your risk of injury from dizziness, avoid walking in the dark.
    You also should wear low-heeled shoes or walking shoes outdoors and use a
    cane or walker if necessary. If you have handrails in the home, inspect them
    periodically to make sure they are safe and secure. Modifications to
    bathroom fixtures can make them safer. Conditions at work may need to be
    modified or restricted, at least temporarily. Driving a car may be
    especially hazardous. Ask your doctor’s opinion about whether it’s safe for
    you to drive.

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    How do I know if I have a balance disorder?

    Everyone has a dizzy spell now and then, but the term “dizziness” may
    mean something different to different people. For some people, dizziness
    might be a fleeting sensation of spinning, while for others it’s intense and
    lasts a long time. Experts believe that more than four out of 10 Americans
    will experience an episode of dizziness significant enough to send them to a

    To help you decide whether or not you should 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, such as losing my sense of time or where I

    How can I help my doctor make a diagnosis?

    You can help your doctor make a diagnosis and determine a treatment plan
    by answering the questions below. Be prepared to discuss this information
    during your appointment.

    1. The best way I can describe my dizziness or balance problem is:

    2. How often do I feel dizzy or have trouble keeping my balance?

    3. Have I ever fallen? (When did I fall?)

    • Under what conditions did I fall?
    • How often have I fallen?

    4. These are the medicines I take:

    Name of medicine:

    • How much (milligrams) and how often (times) per day:
    • The condition I take this medicine for is:

    Name of medicine:

    • How much (milligrams) and how often (times) per day:
    • The condition I take this medicine for is:

    Name of medicine:

    • How much (milligrams) and how often (times) per day:
    • The condition I take this medicine for is:

    At your appointment, take a minute to write down any instructions your
    doctor has given you. Be sure to ask any questions you have before you leave
    the office.

    What research is being done for balance disorders?

    BPPV is the most common balance disorder. Because the source of the
    problem—displaced otoconia—is located deep within the ear, doctors have had
    to rely mainly on observation and a medical history to make a diagnosis.
    Researchers supported by the National Institute on Deafness and Other
    Communication Disorders (NIDCD) now have created a head-mounted apparatus
    that uses 3-D animation to map the location of otoconia in the inner ear.
    The apparatus is built around a pair of infrared video goggles that gather
    data from eye and head movements and then sends it to a computer program for
    mapping. A second computer program uses the data to develop a step-by-step
    guide for repositioning maneuvers to dislodge the otoconia from the
    semicircular canals. If shown to be effective in clinical trials, the
    apparatus and its software programs will help doctors more accurately
    diagnose BPPV and guide repositioning maneuvers to ensure the best possible

    Other NIDCD-supported scientists are looking at the molecular mechanisms
    that regulate the development of the inner ear. One research team has
    identified a gene that encodes a protein that helps in the formation of the
    semicircular canals and their related sensory tissue. Another team has
    identified a family of genes, called the otopetrins, which help form
    otoconia in mice. Findings from the mouse study could help researchers
    determine if otoconia destroyed by aging, medications, infections, or trauma
    can someday be regenerated in humans with balance problems.

    NIDCD-supported scientists also are experimenting with several types of
    vestibular prostheses, or replacement parts, in balance-impaired animals.
    Researchers hope these devices will one day be used to compensate for
    vestibular system loss in people.

    One prosthesis uses a head-mounted motion sensor to mimic the ear and
    brain’s natural signaling system. The sensor measures the head’s rotation
    and sends the information to a microprocessor. The microprocessor then
    converts the signals into electrical impulses and sends them to an electrode
    implanted in the ear. The electrode stimulates the vestibular nerve,
    creating a signal that helps the brain move the eyes to compensate for the
    head’s rotation.

    A second prosthesis is designed to simulate the movement of fluid within
    the semicircular canal. In a normal ear, fluid changes help the brain
    understand the movement and position of the head. The device combines
    microcontroller circuitry with a tiny mechanical device that increases
    normal fluid movement to provide a stronger vestibular signal to the brain.

    Researchers also are studying the effectiveness of different types of
    rehabilitative exercises as a treatment option for balance disorders. In one
    NIDCD-funded study, researchers have used virtual reality technology to
    simulate the aisles of a grocery store. Using a real cart attached to a
    custom-built treadmill in front of a projection screen, patients “walk” down
    aisles, scanning virtual store shelves for items on their list. Researchers
    are testing whether practicing in the virtual store will lessen episodes of
    dizziness in the real world, especially in visually complex environments.


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