What causes balance problems?

The ability to balance depends on various factors. This includes on how well the brain, nerves, eyes, muscles and joints, function, as well as the vestibular system, which is the group of structures behind the ear drum.

Leading consultant adult & paediatric ENT surgeon Miss Victoria Alexander looks at the most common causes of balance problems in connection to the vestibular system, their symptoms and treatment.

What are balance disorders?

Balance disorders happen when your experience of body movement changes. You may feel:

• unsteady;
• dizzy;
• lightheaded and;
• wobbly.

Consequently, this can affect the ability to walk and how you interact in your day-to-day life. These physical sensations can last for seconds, minutes or hours. They can be triggered by things like:

• moving your head;
• or moving from sitting to standing;
• or from lying down to sitting up.

What are the most common vestibular conditions that cause balance disorders?

Benign paroxysmal positional vertigo (BPPV)

This condition can cause short episodes of dizziness when you move your head. It’s caused by small crystals in the inner ear that become dislodged, for example after a head trauma or an inner ear infection.

When you move your head, the fluid in the inner ear moves. If you have BPPV, the dislodged crystals move along with it, and it turn it causes the sensation of dizziness. Once the head movement is completed, the fluid will stop moving. However, when there are crystals in the fluid, these continue to move and take longer to stop, usually by several seconds, which is why you feel dizzy.

Treatment for BBPV involves repositioning manoeuvres called Epley manoeuvres. These are highly successful in no longer triggering symptoms, because they remove the dislodged crystals.

Vestibular neuritis

Vestibular neuritis is when the vestibular nerve, which runs from your inner ear to your brain, is infected. It causes severe dizziness and vertigo and it can take several weeks for these symptoms to resolve.

Sometimes the infection can spread to the labyrinth structure in the vestibular system, causing labyrinthitis. This can result in hearing loss, which can be temporary or permanent.

Vestibular neuritis and labyrinthitis usually get better on their own. Antibiotics aren’t effective because they’re usually caused by a viral infection. However, if your doctor suspects the infection is bacterial, you may be prescribed antibiotics.

Your doctor may prescribe a short course of anti-motion sickness tablets if your symptoms are becoming difficult to manage. Once the severe vertigo has passed, home balance exercises called Cooksey–Cawthorne exercises can also help.

Migrainous vertigo

Also known as a vestibular migraine, the signs of migrainous vertigo include:

• a general feeling of imbalance and disconnectedness;
• which can occur alongside a headache;

as well as other migraine symptoms, such as:

• nausea and;
• sensitivity to sound, light and movement.

Treatment of migrainous vertigo includes preventative medication, as well as medication for when an attack occurs. Migraine medication can help to reduce the frequency of your headaches and dizziness.

Meniere’s disease

Meniere’s disease affects the pressure levels in the inner ear.  It causes:

• severe vertigo;
• nausea, and;
• vomiting.

These attacks can last 12–24 hours.

During an attack, people may also experience:

• temporary hearing loss;
• tinnitus (extra noises heard from inside of your head) and;
• a sensation of pressure or fullness in your ears.

There is currently no cure for Meniere's disease. However, symptoms may be alleviated by following a low-salt diet and taking medications that help prevent and treat attacks when they occur.

Other symptoms of the condition may also require specific treatments, such as:

• treatment for hearing loss;
• tinnitus;
• stress and/or anxiety, as well as;
• vestibular rehabilitation (i.e. exercises to help restore your balance).

It’s common to experience Meniere’s disease and migrainous vertigo together.

Your doctor may recommend steroid injections through your eardrum or surgery to destroy specific parts of your inner ear, in severe cases.

Who is at risk of balance problems?

They can occur at any age but become more common as you get older.

For example, you may develop arthritis in your joints or lose sensation in your feet and have problems with your vision, hearing or memory. Together, this makes balancing more difficult.

Your risk of developing a balance problem is also higher if you already have a mental health condition, such as anxiety. Furthermore, any pre-existing mental health condition can make it more challenging to recover from a balance problem.

When should you see a doctor about a balance problem?

It’s important to see your GP if you’ve suddenly developed a balance problem, particularly if you experience other critical symptoms like:

• spinning sensation;
• feeling lightheaded;
• palpitations;
• vision problems, and;
• nausea and/or vomiting.

If your balance problem occurs alongside neurological symptoms, such as;

• numbness of your face;
• weakness down one arm;
• drooping of part of your face;
• slurred speech, and/or;
• difficulty thinking of words or making sense of things;

you should also seek urgent medical help.

How are balance problems diagnosed?

Your GP will ask you about your symptoms, how long they last and if you know what triggers them, as well as your medical history. If its appropriate, they will refer you to a specialist in vestibular balance disorders like an ENT doctor.

The specialist will ask more detailed questions about your symptoms and triggers, and when they first started. They will perform various examinations and tests.

It may be helpful to keep a diary of your symptoms and notes of anything going on around the time of your symptoms. For example, how well you slept, what you ate and drank, your stress levels, etcetera. This can help your doctor to identify patterns, which can help in coming to a diagnosis.

How can you reduce your risk of balance problems?

It’s important to follow a healthy lifestyle, including:

• sleeping well;
• exercising regularly and;
• following a healthy, balanced diet.

Also, be aware of stress levels and practice stress-management techniques such as mindfulness, meditation, yoga and Pilates, as well as other relaxing activities or hobbies.

If you’re interested in exploring issues regarding balance problems, arrange a consultation with Miss Alexander via her Top Doctors profile.