Balance Problems

Balance problems are conditions that usually develop in elderly people, in which they experience dizziness or feel unsteady.

While standing, sitting, or lying down, you may feel as if you or your surrounding were in motion.

The feeling that things around you are spinning or vertigo are common symptoms of balance problems.

Many of our body systems — including the muscles, bones, joints, eyes, the balance organ in the inner ear, nerves, heart, and blood vessels — work in coordination to maintain a normal balance.

When any of these systems stop functioning properly, there may be balance problems.

Balance problems can be caused by certain health conditions, medications, or a problem in your inner ear or the brain.

However, most balance problems are a result of disturbances in the inner ear (vestibular system).

A balance problem can have a profound impact on older people, and are one of the common reasons for falls and fall-related injuries, such as hip fractures.

The common signs and symptoms of balance problems include:

• Dizziness
• Blurry Vision
• Sense of motion or things spinning around you (vertigo)
• Feeling lightheaded or faint (presyncope)
• Loss of balance or feeling as if you may fall (disequilibrium)

Other signs include nausea and vomiting, diarrhea, changes in heart rate and blood pressure and panic accompanied by fear and anxiety.

Symptoms can come and go after a short time period or sometimes last for a longer time, and lead to chronic fatigue and depression.

Balance problems can be caused by several different conditions such as ear infections, a head injury, or any disorder affecting the inner ear or brain.

The cause of balance problems usually vary with a specific sign or symptom.

Vertigo may be associated with several conditions, including:
   

• Benign paroxysmal positional vertigo (BPPV): BPPV is the most common cause of vertigo. It occurs as a result of the dislodgement of calcium crystals present in the inner ear that normally control your balance from one position to another. You may experience a spinning sensation when you turn in your bed or tilt your head back to look upwards.
• Meniere's disease: The precise cause of Meniere's disease is not known. It is a rare disease, and usually occurs in individuals between the ages of 20 and 60. Apart from sudden and severe vertigo, it can cause fluctuating hearing loss and a feeling of buzzing, ringing or fullness in your ear.
• Acoustic neuroma: This is a rare, benign tumor that involves a nerve that affects hearing and balance. You may experience symptoms such as dizziness and loss of balance, but the most common symptoms are loss of hearing and a ringing sensation in your ear.
• Vestibular neuritis: This is a viral inflammatory disorder that affects the nerves in the balance portion of your inner ear. Symptoms may be very severe and persistent, including nausea and difficulty walking. Symptoms last for several days, but gradually improve on their own.
• Ramsay Hunt syndrome: This condition is also called herpes zoster otitis, and it occurs when a shingles infection involves the portion of the facial nerve near one of your ears. You may experience vertigo, ear aches, and loss of hearing ability.
• Head injury: You might experience vertigo either due to concussion or another type of head injury.
• Persistent postural-perceptual dizziness: This disorder commonly occurs and is associated with other types of vertigo. Symptoms include a feeling of unsteadiness or motion in your head. Symptoms often worsen when you see moving objects, while reading, or when you are at a visually complex place such as a shopping mall.

Presyncope can be seen with following conditions:

•     Orthostatic hypotension (postural hypotension): Standing up too quickly from where you are sitting can cause a significant drop in your blood pressure that results in presyncope.
•     Cardiovascular diseases: Abnormal rhythms in your heart (heart arrhythmia), the narrowing or blockage of blood vessels, a thickened heart muscle (hypertrophic cardiomyopathy), or a reduced blood volume can decrease blood flow, resulting in presyncope.

Losing your balance while walking, or feeling imbalanced, can occur due to:

• Vestibular problems: Abnormalities in the inner ear cause a feeling of a floating or heavy head, and being unsteady in dark places.
• Nerve damage in your legs (peripheral neuropathy): The damage to nerves can lead to difficulty walking.
• Joint, muscle or vision problems: Instability of joints and muscle weakness may lead to a loss of balance. Eyesight problems can also lead to disequilibrium.
• Medications: Disequilibrium can occur as a side effect after taking certain medications.
• Certain neurologic conditions such as cervical spondylosis and Parkinson's disease.

Dizziness: A feeling of lightheadedness or dizziness can result from:

• Inner ear problems: Abnormalities of the vestibular system can lead to a sensation of floating or other false sensation of motion.
• Migraine: Migraine headache often causes dizziness and sensitivity to motion (vestibular migraine).
• Motion sickness: You may feel dizzy while traveling in boats, cars, and airplanes, or during amusement park rides.
• Psychiatric disorders: Depression, major depressive disorder, anxiety and other psychiatric conditions may cause dizziness.
• Rapid breathing (hyperventilation): This condition is often associated with anxiety disorders and may cause lightheadedness.
• Medications: Lightheadedness may occur as a side effect of certain medications.

You can help yourself and your doctor in making a diagnosis by listing down key information regarding your dizziness or balance problem.

Your primary care physician may refer you to an otolaryngologist, a doctor with specialized training in diagnosis and treatment of problems of the ear, nose, throat, head, and neck.

Your otolaryngologist will review your medical history and perform a physical as well as neurological examination to determine the possible causes of the balance disorder.

Be prepared to answer these questions your doctor may ask:

• How would you describe your balance problem?
• When you feel that the room is spinning around you, which direction does it appear to turn?
• How often do you have spells of dizziness or other symptoms?
• Have you ever had a fall due to loss of balance?
• If yes, when, where, and how often do you fall?
• Are you on any medications?
• What is the name of the medication? Include all over-the-counter medications, including aspirin, antihistamines, and sleeping aids.
• For which health condition do you take the medication?

Your doctor may recommend some tests to determine whether your symptoms are due to disturbances in the balance function of your inner ear.

These tests include:

• Hearing tests: These are performed to test your hearing ability as trouble with loss of hearing is often associated with balance problems.
• Posturography test: During this test, you will be asked to stand on a moving platform with a safety harness worn around you. A posturography test shows the parts of your balance system you depend on the most.
• Electronystagmography and video nystagmography: Both these tests are done to record the eye movements that have an important role in vestibular function and balance. An electronystagmography makes use of electrodes and a video nystagmography involves the use of small cameras to record the eye movements.
• Rotary chair test: In this test, your eye movements will be analyzed while you sit in a computer-controlled chair that moves in a slowly circular motion.
• Dix-Hallpike maneuver: Your doctor will gently turn your head in various positions, and at the same time your eye movements are observed to check whether you have a false sense of motion or spinning.
• Vestibular evoked myogenic potentials test: In this test, sensor pads are attached to your neck, forehead, and below your eyes to measure small changes in muscle contractions as a reaction to sounds.
• Imaging tests: MRI and CT scans may be ordered to determine if there any underlying medical conditions that are causing your balance problem.
• Blood pressure and heart rate tests: Your blood pressure will be determined in a sitting position, and then after standing for about 2-3 minutes to check if you have any significant drop in blood pressure. Your heart rate might be checked when standing to help determine if a heart condition is causing your symptoms.

Your doctor will advise a treatment method based on the cause of your balance problem.

If the effects of the balance problem are due to another health condition or medication, your doctor will treat the condition, prescribe a different medication, and if necessary, refer you to a specialist.

Your treatment may include:

• Balance retraining exercises (vestibular rehabilitation): Physical therapists professionally trained to understand the balance system and its relation with other body systems can develop an individualized program of balance retraining and exercises. This therapy can compensate your imbalance, help you adapt yourself to less balance, and maintain physical activity. To prevent falls, your therapist will recommend the use of a balance aid such as a walker or cane, and teach you ways to decrease your risk of falls at home.
• Positioning procedures: If you have BPPV, it is treated through a procedure called canalith repositioning that involves careful maneuvering of your head position. This moves the displaced particles of calcium back to their original place in your inner ear.

• Diet and lifestyle changes: If you have Meniere's disease or migraine headaches, dietary changes may be recommended to ease your symptoms. Quit smoking if you are a smoker. If you have orthostatic hypotension, you should drink more amounts of fluids and wear compressive stockings.
• Medications: If you have severe vertigo that lasts for more than a few hours or days, prescription medications that can control dizziness and vomiting will be advised.
• Surgery: In conditions such as Meniere's disease or acoustic neuroma, surgical treatment may be recommended. Stereotactic radiosurgery is an option for patients with acoustic neuroma. This procedure involves directing the radiation precisely over your tumor and does not need any incision.

With certain methods, you can prevent balance problems.

Disorders of the circulatory system such as a stroke: Strokes can cause balance problems. Quitting smoking and maintaining blood sugar levels can help decrease the risk of a stroke and balance problems.

Ototoxic medications: Avoid medicines for low blood pressure that can cause dizziness. Such drugs can cause damage to the inner ear.

Diet and Lifestyle: Low sodium intake or salt-free foods, and avoiding caffeine and alcohol can help reduce the severity of Ménière's disease symptoms. Balance problems resulting from high blood pressure can be avoided by less sodium, maintaining a healthy body weight and exercising. Balance problems from low blood pressure can be reduced by drinking plenty of fluids, especially water, avoiding alcohol, and being watchful of your posture and movements, such as standing up slowly and avoiding crossing the legs while sitting.

Preventing infection of the ears: Otitis media can sometimes cause dizziness. You can help prevent otitis media by frequently washing your hands. Also, getting a yearly flu shot can prevent flu-related ear infections. If you get an ear infection, consult your doctor before it turns more serious.

Sometimes, patients with balance problems may not be able to get complete relief from dizziness, and will require other measures to cope.

A vestibular rehabilitation therapist will be able to help formulate a specialized treatment plan.

You can discuss with your doctor about ways to reduce your risk of falling during daily activities such as while climbing stairs, using the bathroom and exercising.

Some helpful tips include: 

• Avoid walking in the dark
• Wear shoes with low-heels or wear walking shoes
• Use a cane or walker
• Modify your home to increase safety, such as adding handrails to staircases