Balance Issues

What are balance issues?

Your sense of balance helps you stay upright and feel stable as you navigate your way through your day. Your sense of balance relies on a steady flow of information among your ears, eyes, tissues and brain. When something disrupts that flow of information, you lose your sense of balance. Balance issues may be symptoms of certain medical conditions. Healthcare providers treat balance issues by managing the underlying medical condition. You might also need physical therapy.

How does my sense of balance work?

Your sense of balance relies on the relationship between your central nervous system (brain) and your sensory system. Your sensory system includes:

• The vestibular labyrinth in your inner ear: This includes your semicircular canals (loops), which react when you turn your head, and otolith organs that react to gravity and movement.
• Your vision: Your eyes send impulses to your brain that show where your body is in relation to other objects.
• Your skin, joints and muscles: When your body moves, it puts pressure on tissues in your skin, muscles and joints. These tissues send signals to your brain, telling it where your body is in relation to space. For example, if you’re standing up and lean back, you put pressure on the back of your foot and lower leg. That pressure lets your brain know you’re leaning instead of standing straight.

Your central nervous system pulls this information together so it can tell your body how to maintain balance. When something interferes with the system’s connection, your central nervous system can’t process information correctly and you feel unsteady.

What are balance issue symptoms?

Balance issues cause several symptoms linked to underlying medical conditions or other issues. Balance issue symptoms include:

• Vertigo. Vertigo makes you feel dizzy or like you’re spinning when you’re not.
• Feeling lightheaded or faint.
• Feeling unsteady on your feet (as if you’re about to fall).
• Blurred vision.

Which conditions cause balance issues?

Many things can affect your sense of balance. Many people develop a balance issue as they grow older. But you can develop balance issues at any age. Inner ear disorders, head injuries and neurological conditions may affect your sense of balance.

Inner ear disorders

• Labyrinthitis: Labyrinthitis is inflammation in your labyrinth, the inner ear system that’s responsible for hearing and balance.
• Vestibular neuritis: Vestibular neuritis is inflammation of the vestibulocochlear nerve in your inner ear.
• Benign paroxysmal positional vertigo (BPPV): If you have BPPV, changes in your head position — such as tipping your head backward or sitting up in bed — cause vertigo.
• Ménière’s disease: People with this condition often experience sudden vertigo.
• Acoustic neuroma: This noncancerous tumor in your inner ear may affect your balance.
• Persistent postural perceptual dizziness (PPPD): Bouts of dizziness and feeling unsteady that are brought on by things or activities going on around you, like being around crowds. PPPD symptoms come and go.

Other medical conditions

Balance issues may be a symptom of several different medical conditions:

• Neurological conditions: Alzheimer’s disease and Parkinson’s disease are examples of medical conditions that may affect your sense of balance.
• Cardiovascular disease: Heart issues may make you feel faint, lightheaded or dizzy and affect your balance.
• Postural hypotension: Low blood pressure that happens when you stand up from sitting or lying down.
• Head injuries: A concussion is an example of a head injury that may affect your balance.
• Peripheral neuropathy: This condition affects nerves outside your brain or spinal cord. Nerves carry signals your brain uses to keep track of your hands and feet. You may have balance issues if something affects the connection between your brain and certain nerves.
• Headaches or migraines: Headaches and vestibular migraines may affect your balance.
• Motion sickness: Motion sickness may make you feel dizzy and affect your balance.

How do healthcare providers diagnose balance issues?

Healthcare providers diagnose balance problems with a physical exam. They’ll ask about your symptoms and medical history. They’ll probably use several kinds of tests included in a vestibular test battery:

• Videonystagmography (VNG): This test gives providers information about how parts of your inner ear system and eyes work. You’ll need to wear goggles so providers can monitor your eye movements as you complete different tasks (such as following a target and moving your head and body in different directions).
• Rotary chair: This test checks the reflex between your ears and eyes. To do this test, you’ll wear goggles and sit in a motorized chair that moves right and left. Your provider will ask you to keep your eyes open and answer questions as the chair moves.
• Modified clinical test of sensory interaction on balance (mCTSIB): This test shows how the sense of touch in your feet, vision and inner ears affect your balance. You’ll take off your shoes, stand on a foam and firm surface, both with eyes open and closed, and stay as steady as possible for 30 seconds.
• Video head impulse test (VHIT): This test checks the reflex between your ears and eyes in response to quick head movements. You’ll wear goggles that record your eye movements while you stare at a target. Your provider will move your head right and left or up and down.
• Vestibular-evoked myogenic potentials (VEMP): This test checks on specific parts of your inner ear system. You’ll sit in a chair and turn your head to the left and right and stare at a target while you listen to a series of tones.
• Dynamic visual acuity testing (DVA): This test evaluates how well your inner ear balance system works when you move your head. You’ll look at a computer screen and identify a target on the screen while your head is still, and then while you move your head right or left and up or down.

What is the best treatment for balance issues?

Healthcare providers treat balance issues by managing the cause. They may recommend vestibular rehabilitation therapy, a special form of physical therapy that involves exercises and techniques that may help you to manage your balance issues.

Can people prevent balance issues?

Because many different things cause balance issues, it’s not possible to prevent some of them. Talk to a healthcare provider about your balance issues. They may be symptoms of underlying conditions that require treatment.

What can I expect if I have balance issues?

Your healthcare provider is your best resource of information about what you can expect. If you have a medical condition that causes balance issues, your providers will treat that condition. You may also need therapy to learn ways to manage your balance issues. It may take some time for treatment and therapy to make a difference.

I have balance issues. How do I take care of myself?

Knowing why you have balance issues is the first step toward getting better. Here are some suggestions that may help you manage your balance issues:

• Maintain a weight that’s healthy for you.
• Strengthen your core. Your core (the muscles in your midsection or abdomen) helps stabilize your whole body.
• “Fall proof” your surroundings. Balance issues increase your risk of falling. Check the areas where you usually walk and remove items that could trip you up, like rugs and electrical cords.
• Take your time. If you have balance issues, give yourself time to get up if you’ve been sitting down. If you feel unsteady when you get up, walk slowly.

When should I see my healthcare provider?

Contact your healthcare provider if your balance issues get worse after treatment.

What questions should I ask my provider?

Balance issues happen for many different reasons. Here are some questions that may help you understand your balance issues and what can be done to resolve them:

• What’s causing my balance issues?
• What are treatments for the condition causing my balance issues?
• Will my balance issues go away?

A note from Cleveland Clinic

Most people have experienced losing their balance. But ongoing balance issues may be symptoms of underlying medical conditions. It can be disorienting and sometimes frightening to lose your sense of balance. Balance issues can affect your quality of life. If you’re concerned about your sense of balance, talk to a healthcare provider.