Balance disorders are disturbances in co-ordination that makes a person feel unsteady, dizzy or have a sensation of movement or spinning.
The problem more often than not lies within the ears. Within the ear is a part called the inner ear. This has organs that are responsible for normal balance mechanisms.
The inner ear contains an organ called the labyrinth. The inner ear co-ordinates with the eyes (what they see), as well as the feeling of the bones and joints, to maintain normal balance.
The inner ear sends signals to the brain that also receives signals from these peripheral organs to given an idea of the position of the body. This helps in maintenance of balance.
The labyrinth has a structure called the semicircular canals. These allow a person to feel and experience rotary (circular) motion.
There are three semicircular canals called the superior, posterior, and horizontal canals. The canals converge at a point and this is close to the cochlea that is responsible for hearing. These are filled with a fluid.
As the body moves, this fluid also moves. The ends of the semicircular canals have a bulb like formation that contains hair-like tiny cells.
Rotation of the head causes a movement of the fluid leading to movement of the top portion of the hair cells that are embedded in the jelly-like cupula.
There are two other organs called the utricle and saccule that are called otoliths. These detect linear acceleration, or movement in a straight line.
The symptoms of balance disorders include difficulty in maintaining orientation. One of the commonest complaints is feeling dizzy or experiencing vertigo. The room appears to be spinning. There may be light headedness or a feeling of floating.
Sometimes there may be blurring of vision as well. Along with vertigo there is commonly nausea and vomiting, diarrhea, faintness, palpitations, drop in blood pressure, fear, anxiety, or panic.
There are several causes of balance disorders. Diseases and disorders affecting the brain or the inner ears are commonly responsible for balance disorders.
Some common causes include infections of brain or inner ear, head injury, disorders of blood circulation affecting the inner ear or brain, certain medications, as part of aging etc.
Some of the types of balance disorders include Benign Paroxysmal Positional Vertigo (BPPV), labrynthitis, Ménière's disease, vestibular neuronitis etc.
Diagnosis of a balance disorder involves several laboratory as well as imaging studies. There are several associated conditions that may lead to balance disorders including ear infections, blood pressure changes, problems in vision etc.
Diagnosis is usually made by an ENT specialist (Ear, nose and throat disease specialist) also known as an otolaryngologist.
Treatment of balance disorders depends on the cause underlying the condition. Problems of balance are symptoms of an underlying disease rather than a disease in itself.
One of the options is to treat the underlying disease such as ear infection, stroke, or multiple sclerosis.
The second option is to treat the symptoms of the condition. This can be achieved by balance retraining exercises (vestibular rehabilitation) etc.
Several diseases and disorders affecting the inner ear or brain or certain medications may cause balance disorders. The causes may vary from infections (viral or bacterial), head injury, disorders of blood circulation etc.
Those who have injuries or illnesses of the eyes or have problems with the skeletal system (e.g. arthritis) may also experience balance difficulties. These disorders may lead to a conflict of signals to the brain about the sensation of movement and can lead to balance problems.
If there is a conflict of signals between the eyes and the brain, for example, if a person tries to read while riding in a car, there is motion sickness. Some symptoms of motion sickness include dizziness, sweating, nausea, vomiting, and generalized discomfort.
Broadly classifying balance disorders may occur due to problems in any of the four areas:-
Some of the different types of balance disorder leading to impaired sense and maintenance of balance include:-
This condition is characterized by brief but severe episodes of vertigo brought about by specific positional change of the head. The movement could be trivial for example rolling within the bed or trying rise up to a sitting position from lying position or even looking up at an object.
It is found that movement of chalk crystals (otoconia) within the inner ear from one part of the balance system (utricle and saccule) to another part of the balance system (semi-circular canals) due to movement of the head gives rise to the symptoms.
Although the exact cause of the condition is unknown, it is thought to be caused as a part of normal aging, infection or head injury.
This is caused by an imbalance between the pressures of the fluids within the inner ear. The exact cause is unknown. There are episodes of vertigo, hearing loss and sensation of fullness in the ear along with tinnitus (a ringing or roaring in the ears).
This is caused by infection and/or inflammation of the inner ear causing dizziness and loss of balance.
This is caused by an infection of the vestibular nerve caused by a virus. There is generally rotatory vertigo (horizontal or vertical spinning) that may last for up to 48 hours, exacerbated by movement.
In this condition there is leakage of inner ear fluid to the middle ear. This occurs due to head injury.
Certain medications that depress the central nervous system may also increase the rate of falls by increasing the lack of coordination.
Arthritis, joint pain, stroke, visual impairment, back or neck pain, myelopathy due to cervival spondylosis, normal-pressure hydrocephalus, parkinsonism and fall of blood pressure on standing (orthostatic hypotension) are other causes of balance problems and risk of falls among the elderly.
Problems in the cerebellum of the brain also contribute to balance disorders.
Balance disorders are diseases that give rise to symptoms of impaired balance and co-ordination.
The balance problems are thus symptoms rather than a disease it itself. Some of the symptoms associated with balance disorders include:-
Balance disorders are caused by several incidents that may be episodes of infection, injury or blood flow problems to the inner ear or to the brain.
The ears are divided into three discernible parts – the outer, middle and the inner ear. The outer ear is composed of the pinna that brings in sound waves onto the ear drum.
The middle ear amplifies the sound wave and transmits it into the inner ear.
The inner ear contains an organ called the labyrinth. There two major organs in the inner ear – the cochlea or the shell shaped hearing organ and the semicircular canals or the balance organs.
The semicircular canals work to co-ordinate with the eyes (what they see) as well as the feeling of the bones and joints to maintain normal balance.
When the inner ear coordinates with the signals from the eyes, it is called the vestibulo-ocular reflex (VOR). The inner ear sends signals to the brain that also receives signals from these peripheral organs to given an idea of the position of the body. This helps in maintenance of balance.
The semicircular canals are three tubes set in three different right angles. They have a bulb at their ends. These are called superior, posterior, and horizontal canals. The canals converge at a point and this is close to the cochlea. These are filled with a fluid. As the body or the head moves, this fluid also moves.
The bulbs at the ends of the canals contain tiny hair like structures. Rotation of the head causes a movement of the fluid leading to movement of the top portion of the hair cells that are embedded in the jelly-like cupula.
There are two other organs called the utricle and saccule that are called otoliths. These detect linear acceleration, or movement in a straight line. When the hair is displaced, it sends signals to the brain via nerves and the body corrects itself or balances accordingly.
An acute loss of balance sensation can be either partial or total. It may be caused by viral infections or due to injury to the vital structures of the brain or inner ear.
In the case of benign paroxysmal positional vertigo (BPPV), calcium carbonate crystals get dislodged from their usual position and move to one of the semicircular canals of the inner ear when the head is moved. There is an incorrect registration of movements with changes in body position and this may trigger an episode of intense vertigo.
Injuries to the central nervous system may be caused by head injury or by disturbances of the blood circulation. This leads to dizziness, vertigo, and disequilibrium.
With age there is a deterioration of the balance system leading to balance problems. Physical disabilities such as arthritis and joint pain also contribute to the problem.
There are several disorders that may lead to balance problems. Diagnosis aims at detecting the cause of balance problems. Balance problems thus are symptoms of an underlying condition rather than a disease in itself.
The cause of balance problems may vary between ear infections, blood pressure changes, vision problems or even medications that may cause balance problems.
Steps in diagnosis of the conditions include:-
A precipitating ear infection, vision problem or head injury or a history of intake of a balance problem causing medication is often found upon enquiring the history from the patient. This may provide valuable clues in diagnosing balance problems.
Evaluation and diagnosis may be made by a primary physician who may then request the opinion or refer to an otolaryngologist to help evaluate a balance problem. An otolaryngologist or ENT surgeon is a physician/surgeon who specializes in diseases and disorders of the ear, nose, throat, head, and neck.
For this test each ear is flushed with warm and then cold water one at a time. When water is flushed, the eyes move rapidly from side to side. This is called nystagmus. The amount of nystagmus resulting from the test is measured. Weak nystagmus or the absence of nystagmus may indicate an inner ear disorder.
Balance problems are symptoms of an underlying condition rather than disease in itself. There are several different causes and varieties of disorders that may lead to balance problems. Thus treatment of balance disorders is also wide ranging and varied.
For example, balance problems caused by ear infections are treated using antibiotics and anti-inflammatory agents while those due to side effects of medications are treated with stopping the suspected drug or medication. Some of the treatment options include:-
Other drugs include sedatives for dizziness including lorazepam that does not ease symptoms but helps patients cope with the sensation. Some drugs that work on motion sickness may be used. This includes drugs belonging to the classes antihistaminics and anticholinergics.
Some calcium channel blockers like Verapamil and Nimodipine and GABA modulators like gabapentin and Baclofen may also help. Neurotransmitter reuptake inhibitors such as antidepressants SSRIs (Selective Serotonin Reuptake Inhibitors) including Fluoxetine, Escitalopram and trycyclic antidepressants including imipramine etc. may be useful in some patients.
Those with Benign Paroxysmal Positional Vertigo (BPPV) suffer from dizziness due to misplaced crystals within the ear. Treatment involves moving these crystals out of areas that may trigger dizziness. This is achieved by head and neck positional exercises.
Balance disorders are a variety of diseases and disorders that affect the inner ear or the brain. These conditions may also be caused as a side effect of several chemicals and medications. Scientists are researching the various underlying pathologies that may give rise to balance problems.
The areas of research include the complex interactions between the balance-sensing organs, vision, labyrinth and the brain.
Researchers are looking at how advanced age is affecting normal balance. With the increase in the elderly population due to longer life expectancies these areas of research are gaining importance.
More elderly are suffering from an impaired quality of life due to impaired mobility, lack of motor co-ordination and inability to lead an independent life.
The correlation between vision and balance disorders is also an important area of research. Researchers are looking at disease and injuries of the eyes and the nerves that connect the balance organs, eyes and the brain. Researchers are looking at eye movement and posture changes that may affect balance.
Pathological diseases of the inner ear and long term consequences of ear infections and brain infections like meningitis and encephalitis are also an area of research.
Genetic causation of ear problems and subsequent balance problems in some diseases and disorders are being studied widely all over the world.
The other part of research focuses on treatments of balance disorders. In addition, there are studies supported by the National Institute on Deafness and Other Communication Disorders (NIDCD) that also show that the vestibular system plays an important role in modulating blood pressure. This could help in management of posture related fall of blood pressure called orthostatic hypotension.
Orthostatic hypotension refers to sudden fall of blood pressure when an individual changes his or her position from sitting to standing or lying to sitting. This leads to severe dizziness and balance problems.
There are studies that explore otolithic organs within the inner ears that detect linear movement. It is being studied how these organs differentiate between downward (gravitational) motion from linear (forward-backward or side-to side) motion.
Several researchers are working on the effectiveness of certain exercises as a treatment option. Strategies for new physical rehabilitation are also under investigation in clinical and research settings.
NIDCD, along with other Institutes at the National Institutes of Health, joined the National Aeronautics and Space Administration (NASA) for Neurolab are studying exposure to the weightlessness of space and balance changes associated with the condition.