Balance Disorder

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A balance disorder is a condition that makes you feel unsteady or dizzy, as if you’re moving, spinning, or floating, even though you are standing in a still position or lying down. Balance disorders can be caused by certain health conditions, medications, or a problem in the inner ear or the brain. A sense of balance in a person is mainly controlled by a maze-like structure in his or her inner ear called the labyrinth, which is made of bone and soft tissue. At one end of the labyrinth is an intricate system of loops and pouches called the semicircular canals and the otolithic organs, which help us maintain our balance. At the other end is a snail-shaped organ called the cochlea, which enables us to hear. The medical term for all the parts of the inner ear involved with the balance is known as the vestibular system.

Our vestibular system works with other sensorimotor systems in the human body, such as our visual system (eyes) and skeletal system (bones and joints), to check and maintain the position of our body at rest or in motion. It also helps us maintain a steady focus on objects even though the position of our body changes. The vestibular system does this by detecting mechanical forces, including gravity, that act upon our vestibular organs when we move.

Overall, there are more than a dozen different balance disorders. Some of the most common types are BPPV (Benign Paroxysmal Positional Vertigo), migraine, and Perilymph fistula, as described below:

 

BPPV (Benign Paroxysmal Positional Vertigo)

Also known as ‘positional vertigo’, is a brief and intense episode of vertigo that happens because of a specific change in the position of the head. If you have BPPV, you may feel as if you are spinning when you look for an object on a high or low shelf or turn your head to look over your shoulder. You may also experience BPPV when you roll over in bed. BPPV sometimes may result from a head injury or from getting older (wear and tear).

 

Perilymph fistula

This condition is a leakage of inner ear fluid into the middle ear. It can occur after a head injury, drastic changes in atmospheric pressure (such as scuba diving), physical exertion, ear surgery, or chronic ear infections. It’s most obvious symptom (besides dizziness) is unsteadiness when walking or standing, that increases with activity and decreases with rest. Some babies may be born with Perilymph fistula, normally in association with hearing loss that is present at birth.

 

Migraine

Migraines can happen with or without a headache, although often the two will occur together. Migraine can be the cause of dizziness if you have a history of prior disabling headaches.

Causes & Symptoms

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A balance disorder may be caused by bacterial infections in the ear, a head injury, or blood circulation disorders that affect the inner ear or brain. Balance problems and dizziness can also result from taking certain medications. In addition, problems in the visual and skeletal systems and the nervous and circulatory systems can be the source of some posture and balance problems.

A circulatory system disorder, such as low blood pressure, can lead to a feeling of dizziness when a patient suddenly stands up. Problems in the skeletal or visual systems, such as arthritis or eye muscle imbalance, also may cause balance problems. However, many balance disorders can begin all of a sudden and with no obvious cause.

 

Other common causes of balance disorders include the following:

 

  • Infections.

 

  • Neck injuries.

 

  • Dehydration.

 

  • Nervous systems diseases including Alzheimer’s disease, Multiple Sclerosis, and Parkinson’s disease.

 

  • Swelling in the inner ear.

 

If your balance is impaired, you may feel as if the room is spinning. You may stagger when you try to walk or fall when you try to stand up. Some other symptoms associated with balance disorders include:

 

  • A spinning sensation.

 

  • Lightheadedness

 

  • Blurred vision.

 

  • Confusion

 

  • Feeling as if you are going to fall.

 

Other symptoms linked to balance disorders are nausea, diarrhea, changes in heart rate, fear, anxiety, and panic. Some patients also feel depressed, unable to concentrate in an activity, and tired.

Who gets Balance Disorder?

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An individual may be at a higher risk of developing balance disorders if he or she is on medication, has a viral infection, experiencing inner ear problems, or recovering from a head injury. If you are age 65 or older and have arthritis, or high or low blood pressure, your risk of balance problems is much higher. Athletes may also have a chance of experiencing balance problems, such as boxing, football, basketball, and baseball.

You might also experience dizziness in boats, cars and airplanes, or on amusement park rides (motion sickness).

How Does it Affect You? How Serious is it?

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Several serious diseases can associate with the causes of balance disorders, such as the following:

 

  • Ménière’s disease – This condition is associated with a change in fluid volume within parts of the labyrinth. Ménière’s disease causes episodes of vertigo, irregular hearing loss, ringing or buzzing in the ear (tinnitus), and a sudden feeling of fullness in the ear.

 

  • MdDS (Mal de Debarquement Syndrome) – is a balance disorder in which you feel as if you’re continuously rocking or bobbing. It generally occurs after an ocean cruise or other sea travel. Typically, the symptoms will go away in a matter of hours or days. However, severe cases can last months or even years.

 

  • Tumor – Rarely, a balance disorder an occur because of a tumor that is growing on the vestibular nerve.

 

  • Vestibular neuritis – This inflammatory disorder, probably caused by a virus, can affect the nerves in the balance portion of your inner ear. Symptoms are often severe and persistent, and include nausea and difficulty walking.

Recommended Treatment & Rehabilitation

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During the diagnosis for balance disorders, your doctor will begin by reviewing your medical history and conducting a physical and neurological examination. In order to determine if your symptoms are caused by problems in the balance function in your inner ear, your doctor will most likely recommend the following tests below:

 

  • Hearing exam – Certain difficulties with hearing are frequently associated with balance problem.

 

  • Rotary chair test – Your eye movements are analyzed while you sit in a computer-controlled chair that moves slowly in a circle.

 

  • Posturography test – Wearing a safety harness, you try to remain standing on a moving platform. A Posturography test may indicate which parts of your balance system you rely on most.

 

  • Blood pressure and heart rate tests – Your blood pressure might be checked when sitting and then after standing for two to three minutes to determine if you have significant drops in blood pressure. Your heart rate might be checked when standing to help determine if a heart condition is causing your symptoms.

 

  • Vestibular evoked myogenic potentials test – Sensor pads attached to your neck and forehead and under your eyes measure small changes in muscle contractions in reaction to sounds.

 

  • MRI (Magnetic Resonance Imaging) and CT scans – These can determine if underlying medical conditions might be causing your balance problems.

 

Once a diagnosis has been done, a physiotherapist can work with you and design specific treatment plans depending on your condition. Certain treatment plans include the following below:

 

  • Reduce your falls risk – Your physiotherapist will assess problem footwear and hazards in your home that increase your risk of balance problems or falling. Hazards can include loose rugs, poor lighting, pets under your foot, or other obstacles.

 

  • Improve your mobility – Your physiotherapist will help you regain the ability to move around with more ease, coordination, and confidence. They will also develop a personalized treatment and exercise program to gradually build your strength and movement skills.

  

  • Improve your balance – Your physiotherapist will teach you exercises for both static balance and dynamic balance. They also may work with you on exercise to improve your ability to react to a balance disturbance to prevent a fall. They will increase these exercises gradually as your skills improve to help you progress.

 

  • Improve your strength – Your physiotherapist will teach you exercises to address muscle weakness, or to improve your overall muscle strength. Strengthening muscles in the trunk, hip, and stomach can be especially important to improve balance.

 

  • Improve your movement – Your physiotherapist will choose specific activities and treatments to help restore normal movement in any stiff joints. These might begin with passive motions that the physiotherapist does for you, and progress to active exercises that you do yourself.

 

  • Improve your flexibility and posture – Your physiotherapist will determine if any of your major muscles are tight. They will teach you how to gently stretch them. Your physiotherapist will also assess your posture, and teach you exercises to improve your ability to keep a proper posture. Good posture can improve your balance.

 

  • Increase activity levels – Your physiotherapist will discuss activity goals with you. They will design an exercise program to address your specific needs and goals.

 

There are a few additional exercises that can help reduce symptoms of balance disorders (mainly symptoms linked to dizziness), such as the following:

 

Foster maneuver

Firstly, kneel down and place your hands on the floor. Secondly, tilt your head up and back as you wait until any dizziness passes. Place your forehead on the floor, tucking your chin toward your knees. Turn your head 45 degrees to face your left elbow. Hold this position for 30 seconds, then, while keeping your head 45 degrees, raise your head until it’s level with your back and shoulders. Finally, hold for 30 seconds, then raise your head to the fully upright position. Perform this stretch 3 times a day.

 

Epley maneuver

Sit upright in bed. Place your legs straight and put a pillow behind you. Afterward, turn your head 45 degrees to the left. Lie back quickly until your shoulders are on the pillow. Wait for your dizziness to subside, then turn your head 90 degrees to the right without lifting it; holding this position for 30 seconds. Turn your body until you’re lying on your right side. Wait for the dizziness to subside, then sit upright on the right edge of the bed. Repeat this exercise 3 times a day.

 

Brandt-Daroff exercise

Sit in the middle of a bed with your feet on the floor. Turn your head 45 degrees to the right. Without moving your head, lie down on your left side. Wait for the dizziness to pass, then wait 30 more seconds before returning to the starting position. Next, turn your head 45 degrees to the left, then return back to your starting position. Complete this exercise with 1 set of 5 repetitions on each side.

Alternative & Homeopathic Treatment

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Some people living with balance disorders report that natural or homeopathic treatments can improve the spinning and dizzy sensations they experience. Some people with this condition may also benefit from altering their diet. For example, those with Ménière’s disease may find that avoiding certain types of foods or substances can promote fluid balance in the ears and body.

Common culprits that could aggravate dizziness in certain people include salty foods, sugary foods, alcohol, and caffeine. Other studies have shown that a lack of vitamin D can worsen balance disorder symptoms in some people. You can increase your levels of vitamin D by taking a supplement, getting more sunlight, or eating foods rich in vitamin D.

Some patients claim that using essential oils, like peppermint, lavender, lemon balm, and ginger can all help improve symptoms of balance problems. While there is some evidence that certain oils have medicinal benefits, the results are often mixed.

Yoga is another good way to improve flexibility and balance, strengthen muscles, and reduce stress. Simple yoga poses (with a yoga mat for added support) may also help symptoms of this condition. However, you will want to avoid any positions that require sudden forward bends, as these may worsen balance problem symptoms. Additionally, studies have shown acupuncture may be a safe and effective way to treat balance issues and dizziness. Acupuncture involves inserting tiny needles into the skin to stimulate certain points on your body.

 

Other simple remedies include the following below:

 

  • Rest – Sleep deprivation can trigger episodes of spinning and dizziness. Try to get at least 7-8 hours of sleep at night to help ease this specific symptom.

 

  • Hydration – It is always recommended to drink enough fluids (either water or beverages contained with electrolytes) to stay hydrated. Some causes of balance disorders are linked to dehydration.