Balance disorder
A disturbance causing unsteadiness when standing or walking.
A balance disorder makes a person feel unsteady, especially when standing or walking. This can come with feelings of giddiness, wooziness, or a sense of moving, spinning, or floating. Balance depends on three body systems working together: the eyes (visual system), the inner ears (vestibular system), and proprioception—the body’s awareness of its position in space. If any of these systems degenerates or loses function, balance problems can result.
**Signs and symptoms** Vestibular disorders can cause cognitive disorientation. These cognitive issues aren’t limited to spatial tasks; they also affect non-spatial abilities like recognizing objects. Vestibular dysfunction can impair attention, and when attention demands increase, postural sway often worsens. MRI studies have shown that people with damage to both inner ears (bilateral vestibular damage) experience shrinkage of the hippocampus, and the degree of shrinkage matches their difficulty with spatial memory tasks.
**Causes** Balance problems can arise when the vestibular, visual, or proprioceptive systems are disrupted. Abnormal balance may point to a wide range of conditions, including inner ear disorders, low blood pressure, brain tumors, and brain injuries such as stroke.
**Related to the ear** Dizziness from ear problems often involves vertigo (a spinning sensation) and nausea. Nystagmus—a flickering of the eye linked to the vestibulo-ocular reflex—is common in people with an acute peripheral cause of dizziness. Benign paroxysmal positional vertigo (BPPV) is the most frequent cause of vertigo. It feels like a brief, intense spinning that happens when the head changes position relative to gravity—for example, rolling over in bed, getting up in the morning, or looking up at a high shelf. BPPV occurs when tiny calcium crystals called otoconia, normally located in the utricle and saccule (the otolith organs that sense movement), become dislodged and fall into the semicircular canals. There, they distort movement signals, causing a mismatch between actual head motion and the information sent to the brain, which triggers the spinning sensation.
**Migraine** Migraine headaches are a common neurological condition. While typical migraines involve moderate to severe throbbing pain, vestibular migraines can include dizziness, disequilibrium, nausea, and vomiting.
- Field
- Medicine, Neurology, Otolaryngology
- Known for
- Disturbance causing unsteadiness, often linked to vestibular, visual, or proprioceptive system dysfunction
- Common causes
- Inner ear disorders, low blood pressure, brain tumors, brain injury including stroke
- Common symptoms
- Giddiness, wooziness, sensation of movement, spinning, floating, cognitive dysfunction
- Treatment options
- Addressing underlying disease, vestibular rehabilitation, tai chi for fall prevention in elderly
Lore & Background
Balance disorders arise when the vestibular, visual, or proprioceptive systems are disrupted. The most common cause of vertigo is benign paroxysmal positional vertigo (BPPV), which occurs when misplaced calcium crystals called otoconia fall from the utricle into the semicircular canals, distorting the sense of movement. Other causes include migraine headaches, presyncope from low blood pressure, and bilateral vestibular loss from ototoxic drugs such as gentamicin. Cognitive dysfunction, including disorientation and deficits in spatial and non-spatial memory, may occur with vestibular disorders; MRI studies show that bilateral vestibular damage can lead to atrophy of the hippocampus.
Reader's Guide
Balance disorders represent a significant clinical challenge, as reflected in the fact that more than one-third of patients with a vestibular disease consult more than one physician, sometimes up to fifteen. Diagnosis involves assessing symptoms, medical history, and test results. Treatment varies individually and may include addressing underlying conditions such as ear infection, stroke, multiple sclerosis, or Parkinson's. Vestibular rehabilitation, prescribed by occupational therapists or physiotherapists, uses standardized outcome measures like the Functional Reach Test and Berg Balance Scale to design intervention programs. Research by the National Institute on Deafness and Other Communication Disorders (NIDCD) continues to explore eye movement, posture, and exercise effectiveness, with a recent study indicating that balance problems may be an indicator of mortality due to altered metabolism of the vestibular system.
Did You Know?
- Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo and involves misplaced calcium crystals called otoconia.
- Bilateral vestibular damage can cause atrophy of the hippocampus, correlating with impairment on spatial memory tasks.
- A study published in JAMA Otolaryngology-Head & Neck Surgery found that balance problems are an indicator of mortality potentially due to altered metabolism of the vestibular system.
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