When to See a Doctor About Balance IssuesApril 10, 2023 - Katie McCallum
When your balance is off, it's certainly noticeable.
You may get dizzy, lightheaded or nauseated. You may feel unsteady while standing and walking — which may cause you to fall. The room may seem like it's spinning or you may feel like you're in free fall, even when you're sitting or lying down.
"Many different things can make you feel like you're off-balance," says Dr. Kenny Lin, an ENT doctor at Houston Methodist who specializes in the inner ear issues that can cause balance disorders. "Some balance problems are more concerning than others, and it's important to know when one might be a sign of an underlying issue that needs treatment."
For instance, having a dizzy spell here and there isn't necessarily concerning. The explanation can be as simple as standing up too quickly.
"But if rolling over in bed makes you feel like you're doing somersaults or if you have episodes of severe dizziness that last several hours, these are things that need to be evaluated," adds Dr. Lin.
What causes balance problems?
"Balance issues can be hard to pin down at times," says Dr. Lin. "And that's because imbalance can be the result of several different factors."
Balance problems mainly stem from issues with the:
- Inner ears
- Musculoskeletal control
Vertigo is a subset of dizziness in which you may feel like you are spinning around even when you are not moving. The most common cause of vertigo is a particular issue within the inner ear called benign paroxysmal positional vertigo (BPPV), which is sometimes referred to as having crystals in the ear.
"BPPV occurs when the crystals attached to the walls of the inner ear — which are there to help sense changes in gravity — break off and float around," explains Dr. Lin. "If a crystal floats into the wrong part of the inner ear, it triggers an exaggerated sensation of tumbling or spinning."
Other inner ear issues that can lead to balance problems include viral ear infections, also called labyrinthitis; and fluid pressure changes inside the ear, called Ménière's disease. Both are less common than BPPV.
"Balance issues related to loss of muscle control are most common in older adults or after a joint replacement, just because the reflexes may not be as quick as they used to be or muscles and joints may not be as strong as they used to be," says Dr. Lin. "In terms of vision's impact on balance, simply thinking about how hard it is to walk around with your eyes closed helps us intuitively understand how issues with eyesight can lead to imbalance."
The classic example of how blood circulation can affect balance is orthostatic hypertension, when a temporary drop in blood pressure occurs after standing up quickly. This can leave you feeling dizzy for a moment or two. And a concussion is an example of how a mild brain injury can lead to trouble balancing.
"As the brain recovers from a concussion, the person is dizzy, nauseated," adds Dr. Lin. "That's because the brain is having trouble putting together what's going on in the world around it."
Sometimes the cause of a balance problem can't be pinned down. Dr. Lin, acknowledging the unsatisfactory nature of such diagnoses for people, refers to such cases as belonging to the "nebulous" category of balance disorders.
How do you know if you have a balance disorder?
Some of the reasons for feeling off-balance are short-lived, quickly resolving on their own.
But you should seek medical attention if imbalance isn't a fleeting sensation, if it's debilitating and disrupting your life or if it's putting your safety at risk.
The signs you might have a balance disorder include:
- Prolonged or extreme dizziness
- A spinning sensation when you're not actually moving (vertigo)
- Veering side to side as you walk
- Falling, or feeling like you are going to fall
- Constant motion sensitivity
- Blurred vision
"The issue is that, with so many potential reasons for a person to feel off balance, it's hard for people to know where to start," says Dr. Lin. "They may go see their primary care doctor, then get sent to a cardiologist or neurologist. If the person is describing symptoms of vertigo, one of these doctors may suspect an inner ear issue and refer the person to an ENT like me."
As far as inner ear issues go, BPPV is an easy one to diagnose in a doctor's office.
"There's a maneuver where, if you lay down on your side and turn your head, I can watch your eyes and see if they respond with a jumping, twisting motion called nystagmus," explains Dr. Lin. "This is a sign of BPPV. It tells me that the inner ears are feeling movement and triggering a reflex where the eyes twist around as they try to figure out where your body is."
In some cases, vestibular testing may be needed to determine whether a balance disorder is rooted in an inner ear problem.
"Vestibular testing is a series of tests that evaluate how well the balance organs in the inner ear are functioning," says Dr. Lin. "It essentially gives me more information and helps me formulate a diagnosis."
This testing can also play an important role in ruling out an inner ear issue.
"If vestibular testing comes back normal, I know that the inner ears are working as they should be and that problem is likely caused by one of the other factors mentioned," explains Dr. Lin. "Even though I'm not making the diagnosis, it helps move the person's workup along. We can cross the ears off the list, narrowing the possibilities."
Other tests, such as imaging and blood tests, may be needed in these cases.
What is the best treatment for balance problems?
Balance disorder treatment varies depending on what's causing the issue.
"BPPV is one of the easiest balance issues to treat," says Dr. Lin. "There are maneuvers you can perform, such as the Epley maneuver, which helps move the crystals back where they belong and where they won't affect balance sensation. This can be performed in a doctor's office or with a physical therapist."
Sometimes the Epley maneuver works to resolve vertigo right away. In other cases, the maneuver may need to be repeated a few times.
"If it's an inner ear infection, we may prescribe steroids to help reduce the inflammation, but this is typically just something that runs its course over time," says Dr. Lin. "Exercises can help rehabilitate normal balance once your body clears the virus."
Ménière's disease is also treated with steroids and rehab exercises, though if a person experiences multiple episodes of vertigo over many years, diet changes and/or other medications, such as diuretics, may be recommended.
For the other causes of balance disorders, ones related to the eyes, brain, circulation or muscle control, the relevant specialist will help you understand what treatment should look like for you.