Medical News Today: Loss of balance: Everything you need to know

By | May 20, 2019
A loss of balance often occurs due to a problem with the signals the ear sends to the brain. These usually control our sense of balance and spatial awareness.

However, if a person has a condition that affects the brain or inner ear, they may experience a loss of balance, spinning sensations, unsteadiness, lightheadedness, or dizziness.

Loss of balance can occur for a range of reasons, including ear infections, head injuries, medication, and neurological disorders.

Learn more about the causes of a loss of balance, as well as how doctors diagnose and treat them, here.

Causes

Possible causes of a loss of balance include:

Labyrinthitis

Woman holding her head due to dizziness and loss of balance
Labyrinthitis may cause dizziness, nausea, and a loss of balance.

Labyrinthitis is an infection of the inner ear, or the labyrinth.

The labyrinth, or the vestibular system, is the structure of the inner ear that helps people stay balanced.

If the labyrinth becomes infected or inflamed, it can cause a loss of balance and affect hearing. People may also feel dizzy and nauseated.

People may develop labyrinthitis after having an upper respiratory infection, such as the flu.

Learn more about labyrinthitis, and how it affects balance, here.

Ménière’s disease

Ménière’s disease affects the inner ear. Fluid builds up in the inner ear, making it difficult for signals to reach the brain.

This disruption affects a person’s ability to balance and hear. If people have Ménière’s disease, they may feel dizzy and have a ringing in their ears.

The cause of Ménière’s disease remains unclear, but experts think it may have to do with:

  • genetics
  • viral infections
  • autoimmune conditions
  • constricted blood vessels

Learn more about Ménière’s disease here, including the early signs and who is at risk.

Vertigo

Vertigo is a symptom of various conditions, and it often accompanies a loss of balance. There are two main types of vertigo:

  • Peripheral vertigo: This often results from a condition affecting the inner ear, such as an inner ear infection or Ménière’s disease.
  • Central vertigo: Central vertigo is less common and can be a result of a neurological disorder, such as stroke or multiple sclerosis.

Learn all about vertigo and its causes here.

Benign paroxysmal positional vertigo

People with benign paroxysmal positional vertigo (BPPV), or positional vertigo, tend to feel a spinning sensation when they turn their head in a certain way.

BPPV occurs when calcium carbonate crystals in the ear come loose and move into the semicircular canals of the inner ear.

The semicircular canals use fluid to sense head movement. The loose crystals get in the way of the fluid movement, and the inner ear starts sending incorrect signals to the brain about the position of the head, which causes dizziness.

BPPV can affect older adults and people who have had a head injury.

Learn more about the signs and symptoms of BPPV in this article.

Lightheadedness

Man holding his head and feeling lightheaded
A person with lightheadedness may feel that they are about to faint.

A feeling of lightheadedness is also called presyncope. People may feel as though they are about to faint but do not lose consciousness.

Presyncope can occur for many reasons, from experiencing a stressful event to having low blood pressure.

If people have lightheadedness regularly without a known cause, they may wish to speak with a doctor about diagnosing the underlying issue.

Learn more about the possible causes of lightheadedness here.

Medication

Some drugs may cause a loss of balance as a side effect by affecting the inner ear or vision, causing people to feel lightheaded, or creating drowsiness.

Drugs that may cause balance issues include:

Vestibular neuronitis

Vestibular neuronitis is an infection of the inner ear that can cause dizziness and a loss of balance. It can happen when the vestibular nerve in the inner ear is infected or inflamed due to a virus, such as the flu.

Learn more about types of ear infection and their complications here.

Perilymph fistula

Perilymph fistula is a condition wherein a small hole between the inner ear and middle ear allows fluid to leak through to the middle ear.

A fistula can occur due to a head injury, chronic ear infections, or extreme changes in air pressure.

People may feel unsteady, dizzy, or nauseated, especially with movement.

Mal de Debarquement syndrome

If a person has been on a boat or running on a treadmill for a long period of time, they may develop Mal de Debarquement syndrome (MdDS).

In MdDS, people experience the sensation of moving or swaying even when they are not on a moving surface. They may also feel drowsy and find it hard to concentrate.

MdDS usually goes away shortly after the person returns to still ground, but the symptoms can sometimes last longer.

Acoustic neuroma

Acoustic neuroma, or vestibular schwannoma, is a noncancerous tumor that presses on the inner ear nerves, affecting balance and hearing.

Acoustic neuroma can make people feel unsteady or dizzy and lead to hearing loss or ringing in the ear.

Learn more about how acoustic neuroma affects balance here.

Stroke

If a person experiences a loss of balance and coordination along with the following symptoms, it may be a sign of stoke.

Anyone who thinks that they or someone near them is having a stroke should call 911 and seek emergency medical attention. Symptoms include:

  • numbness in one side of the body
  • sudden onset of vision problems
  • a severe headache
  • weakness in the face, arms, or legs
  • nausea or vomiting
  • confusion
  • trouble speaking or understanding others

Learn more about the signs of stroke here.

Symptoms

man vomiting into a toilet
A loss of balance may occur with vomiting and nausea.

People who experience a loss of balance may feel as though they are moving when they are standing still. They may feel unsteady on their feet or feel as though the space around them is spinning.

They may feel confused or disorientated. This can make people lose their sense of where they are.

A loss of balance may feel like or occur with any of the following symptoms:

  • feeling as though the room is spinning
  • dizziness
  • lightheadedness
  • feeling faint
  • a “floating” feeling
  • staggering or having difficulty walking
  • nausea
  • vomiting and diarrhea
  • blurred vision
  • a change in heart rate
  • a change in blood pressure
  • anxiety or panic

A person should see a doctor if they experience a loss of balance with any of the above symptoms.

Diagnosis

A doctor may refer a person to an audiologist or otolaryngologist, who specialize in hearing and conditions affecting the ears, nose, and throat, respectively.

People may need to undergo many different types of test during the diagnosis, including:

  • blood tests
  • hearing tests
  • tests that measure eye muscle movement
  • tests that measure brain activity
  • posture and balance assessments when standing on a moving surface
  • sitting in a rotating chair and measuring eye movements
  • blowing warm and cool air into the ear canal to monitor the response
  • attaching electrodes to the neck to observe how the muscles respond

Treatment

If a certain type of medication causes a loss of balance, a doctor may be able to reduce the dosage or prescribe alternative options.

People can use the Epely maneuver to treat BPPV. The Epely maneuver is a set of movements that aim to dislodge the crystals from the semicircular canal and return them to their correct position. A doctor will teach a person how to do these movements.

If a person has an ear infection that causes a loss of balance, a doctor may prescribe antibiotics or antiviral medications.

To treat Ménière’s disease, a doctor may prescribe medication to treat nausea and dizziness. Injections or applying ear pressure pulses may also help.

People with Ménière’s disease can also make lifestyle changes to reduce their symptoms, such as stopping smoking and limiting salt, alcohol, and caffeine intake. If these treatment methods do not work, surgery may be an option.

According to the National Institute of Neurological Disorders and Stroke, if people feel lightheaded due to a triggering event, such as the sight of blood, they may be able to avoid fainting by:

  • clenching their fingers into their fists
  • tensing their arms
  • crossing their legs or clenching their thighs together tightly
  • sitting with their head lower than their heart
  • lying down to prevent any injuries from falling

Outlook

The inner ear is responsible for maintaining humans’ sense of balance, but it is a complex system. Many different conditions can affect a person’s sense of balance, so it is best to see a doctor to diagnose the underlying cause.

Treatment for loss of balance may involve taking medication, making lifestyle changes, or even undergoing surgery in some cases.

Some people will need to manage a balance condition long-term, and they may need to work with a specialist called a vestibular rehabilitation therapist. Together, they will be able to create an individualized treatment plan.

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