Balance problems: what causes poor balance?

Your ability to balance depends on many different factors, including how well your brain, nerves, eyes, muscles and joints are working, as well as your vestibular system, which refers to structures that sit behind your ear drum. 

Here we’ll look at the most common causes of balance problems that relate to your vestibular system, their symptoms and treatment. 

What are balance disorders? 

Balance disorders occur when your experience of how your body is moving around changes. You may feel unsteady, dizzy, lightheaded and wobbly, and this can consequently affect your ability to walk and how you interact with the world. These sensations can last for a few seconds, minutes or even hours. 

This feeling could, for example, be triggered by moving your head, moving from sitting to standing, or from lying down to sitting up. 

Four common balance disorders of the vestibular system

Problems with your vestibular system, which includes a maze-like network of channels called the labyrinth and an oval-shaped bony cavity called the vestibule, can affect your ability to balance and hear. 

Here we’ll look at the four most common problems of the vestibular system that can cause balance issues. 

1. Benign paroxysmal positional vertigo (BPPV) 

BPPV causes short episodes of dizziness when you move your head. It’s caused by small crystals in the inner ear that become dislodged. These crystals commonly become dislodged after a head trauma or inner ear infection. 

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

Treatment involves repositioning manoeuvres (Epley manoeuvres), which are highly successful in removing the dislodged crystals so they no longer trigger symptoms. 

2. Vestibular neuritis

This refers to an infection of the vestibular nerve, which runs from your inner ear to your brain. It causes severe dizziness and vertigo, which can last for hours or days, to the extent that you can’t get out of bed. It can take several weeks for these symptoms to resolve. 

Sometimes the infection can spread to your labyrinth, causing labyrinthitis, which results in hearing loss, which can be temporary or permanent. 

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

If you’re struggling to cope with your symptoms, your doctor may prescribe you a short course of anti-motion sickness tablets to help you get back on your feet. Home balance exercises, once the severe vertigo has passed, called Cooksey–Cawthorne exercises can also help you recover.

3. Migrainous vertigo 

Also known as a vestibular migraine, this refers to 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 involves taking medication to help control the migraines — this includes preventative medication, as well as medication to be taken when an attack occurs. Migraine medication helps reduce the frequency of your headaches and dizziness. 

4. Ménière’s disease

Around one in every 1,000 people in the UK has Ménière’s disease, which is thought to affect the pressure levels in the inner ear. This causes severe vertigo, nausea and vomiting — these attacks can last 12–24 hours. 

During an attack, you 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, your symptoms can sometimes be controlled by following a low-salt diet and taking medications that help prevent attacks and treat attacks when they occur. 

Other symptoms of your condition may also need specific treatments, such as treatment for hearing loss, tinnitus, stress and/or anxiety, as well as vestibular rehabilitation (ie exercises to help restore your balance). It is common to have both Ménière’s disease and migrainous vertigo together. 

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

Are you at risk of balance problems?

Balance problems can occur at any age but become more common as you get older and your body’s systems become less resilient. 

For example, as you age, your muscle mass decreases, your core becomes weaker, you may develop arthritis in your joints or lose sensation in your feet and have problems with your vision, hearing or memory. Collectively, 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. Any pre-existing mental health illness can make it more challenging to recover from a balance problem. 

When to see a doctor

If you have suddenly developed a balance problem, it’s important to see your GP, particularly if you experience other critical symptoms, such as a spinning sensation, feeling lightheaded, palpitations, vision problems, nausea and/or vomiting. 

You should also seek urgent medical help 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. 

Getting a diagnosis 

If you’re concerned that you have a balance disorder, see your GP. They will ask you about your symptoms, how long they last and what triggers them, as well as your medical history. If appropriate, they will refer you to a doctor specialising in treating vestibular balance disorders ie an ear, nose and throat (ENT) doctor. 

The ENT doctor will ask more detailed questions about your symptoms and triggers, and when your symptoms first started. They will examine your ears, conduct a hearing test and may also perform other tests to check your brain function, such as asking you to stand up and walk. They may also ask you to make certain movements with your head to see if these trigger your symptoms. 

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

How to reduce your risk of balance problems 

If you have a balance problem or want to reduce your risk of developing a balance problem, it’s important to follow a healthy lifestyle. 

This includes sleeping well, exercising regularly and following a healthy, balanced diet. Also, be aware of your stress levels and practice techniques to help you better cope with stress and anxiety, such as mindfulness, meditation, yoga and Pilates, as well as other activities or hobbies that you find relaxing.

Yoga and Pilates can also improve your balance. Alternatively, you can use a balance board at home. 

Author biography

Miss Victoria Alexander is a Consultant Ear, Nose and Throat Surgeon and Otorhinolaryngologist at Spire St Anthony's Hospital, St George's NHS University Hospital and Epsom and St Helier NHS University Hospitals. She specialises in ear surgery, hearing loss and hearing preservation surgery, cosmetic pinnaplasty/ear pinning, general ENT (tonsils, grommets, benign skin lesions), inner ear balance disorders and mastoid surgery. Miss Alexander also co-led the development of the TympaHealth Hearing screening pilot in South West London, which has seen over 6,000 patients, and she is actively engaged in research into improving outcomes for necrotising otitis externa. 

We hope you've found this article useful, however, it cannot be a substitute for a consultation with a specialist

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