Patient Daily Living

Keeping Your Balance

By Chris Iliades

About eight million Americans have balance problems and one in three Americans over age 65 will fall every year. Injuries from falls, like a fractured hip, can change a senior's life in ways senior fear most—isolation and loss of independence.

About eight million Americans have balance problems and one in three Americans over age 65 will fall every year. Injuries from falls, like a fractured hip, can change a senior's life in ways senior fear most—isolation and loss of independence. For seniors and caregivers, understanding balance disorders and fall prevention along with knowing when to get help can go a long way toward avoiding falls and the devastating consequences that may come with it.

"A balance disorder is a disturbance that causes you to feel unsteady, lightheaded or as if you or the room is spinning. Balance disorders can be due to a disturbance in the inner ear, but they can also be caused by visual problems, skeletal problems or nerve problems," says Lawrence Meiteles, MD, medical director of The Balance Center at Northern Westchester Hospital in Mount Kisco, New York.

"Dizziness is the most common complaint of people over age 75 when they go to their doctor's office." —Lawrence Meiteles, MD

Symptoms of a Balance Disorder

Being able to maintain good balance means being able to keep a steady position while walking or standing. Someone with a balance problem may walk unsteadily, fall sideways when standing or have trouble going up or down stairs. Here are some common symptoms that go along with a balance disorder:

  • Dizziness
  • Feeling as if you are going to fall
  • Visual problems
  • Confusion
  • Anxiety
  • Nausea

Common Causes of Balance Disorders

"The most common cause is a combination of factors that go along with aging. We know from studying the inner ear that the cells responsible for maintaining balance start to degenerate with age. Aging and the diseases of aging also affect vision and the bones and joints. Good balance requires that all these systems work together," explains Dr. Meiteles. Here are some other common causes:

  • Positional vertigo. The medical name for this condition is "benign paroxysmal positional vertigo" (BPPV). Vertigo is the false sensation of movement, usually described as spinning. Paroxysmal means that the symptoms come on suddenly. BPPV is caused by cell changes in the inner ear. The main symptom is a sudden attack of vertigo when you change your head position such as looking over your shoulder or rolling over in bed.
  • Labyrinthitis or vestibular neuronitis. The inner ear organ that controls balance is called "the labyrinth." It is a bony structure that contains fluid and the nerve cells for balance. If this organ becomes infected or inflamed, such as from a viral upper respiratory infection, it causes vertigo and loss of balance. The main nerve that communicates balance signals to and from the brain is called the "vestibular nerve." It can also be affected by infection or inflammation.
  • Meniere's disease. This is a condition in which the fluid inside the labyrinth increases. Meniere's disease affects both balance and hearing. Symptoms include hearing loss that comes and goes, a roaring sound and a sensation of fullness in the ears and vertigo.
  • Other causes. Head trauma may cause a leak of inner ear fluid that causes vertigo. Some types of tumors can affect balance. Certain types of medications, circulation problems, neurological diseases and arthritis in the neck can all be causes of a balance disorder.

Diagnosis and Treatment of Balance Disorders

The first step is to see your primary care doctor to rule out common medical problems or medications that might be causing a balance disturbance. If your doctor thinks you need a specialist you will usually be referred to an ear, nose and throat specialist or ENT. "Patients who come to The Balance Center get a complete ear, nose and throat exam and a complete neurological exam," says Meiteles. Here are some of the tests used to diagnose a balance disorder:

  • Audiogram. A complete hearing test is important to detect diseases like Meniere's or tumors that might be pushing on the vestibular nerve.
  • Electronystagmogram (ENG). This test measures the movement of your eyes and is useful in detecting abnormalities of the inner ear.
  • Computerized Posturography. In this test the patient stands on a moveable platform while a computer measures the body's response to changing positions.

Other tests that may be done include blood tests and special imaging of the brain and inner ear. Depending on the diagnosis, some common treatments for balance disorders include:

  • Vestibular rehabilitation. These are special exercises that are done with the help of a therapist. "When you have a condition like positional vertigo, as soon as you feel dizzy you lie still. This does not allow your brain to learn how to adapt and turn off the dizzy signal," says Meiteles. Vestibular rehabilitation exercises may be continued for one to six weeks.
  • Physical and occupational therapy. For people who have long-standing or recurrent balance problems physical therapy can help them strengthen the muscles needed for balance as well as learn techniques to compensate safely for balance problems.
  • Medications and surgery. Medications that calm dizziness, nausea and anxiety may all be useful. In severe cases of vertigo certain types of antibiotics may be used that knock out sick nerves in the inner ear. If medical therapy and physical therapy are not effective a surgical procedure that interrupts the vestibular nerve may be needed.
  • Diet. A low-salt diet and the avoidance of caffeine and alcohol can be helpful in Meniere's disease and other balance disorders complicated by high blood pressure.

Final Tips for Seniors and Caregivers

"In most cases balance disorders can be successfully treated and in many cases this can prevent a fall-related injury. A balance disorder may also be a sign of a serious medical problem so symptoms should never be ignored," warns Meiteles.

Pay attention to the way your loved one describes what he or she is experiencing to know when to seek a medical consultation:

  • Symptoms of dizziness can be hard to express and may be described as feeling unsteady, lightheaded, spinning, moving, giddy or tipsy.
  • Symptoms other than dizziness may be described such as nausea, blurred vision, anxiety or confusion.
  • Watch out for any history of falls, a staggering gait, having to reach out and hold on or trouble getting out of a chair or bed.
  • Seniors may need to rely more on visual cues for balance, so make sure hallways are lit at night.
  • Seniors may not compensate well for a slight trip, so clear walking areas of loose rugs, electric cords and low furniture.

The ability to balance decreases with age, but losing your balance is not a normal part of aging. Most balance disorders can be treated and many falls can be prevented.

- Written By

Chris Iliades

Chris Iliades, MD has many years of experience in clinician medicine, clinical research, and medical writing. After 15 years in private practice as a board-certified ear, nose, and throat specialist, he helped start a clinical research support company and served as its medical director.