By Ejaz A. Shamim, MD, MBA, MS, FAAN
Do you sometimes feel unsteady or dizzy while walking, sitting, or even lying down? If so, you might have balance disorder, something doctors take very seriously—not only because it might indicate an underlying condition that needs treatment, but because balance disorder can cause you to fall. According to the Centers for Disease Control and Prevention (CDC), one out of five falls causes serious injury, ranging from broken bones (including hip fractures) to head trauma. So, it’s important to consult your doctor if you experience any of the following:
- You often feel unsteady, as if you are tipping over, or you stagger when you walk
- You experience dizziness or vertigo (the feeling that you or the room is spinning)
- You fall for no apparent reason, or feel as if you are going to fall
- You experience persistent feelings of lightheadedness, faintness, or a floating sensation
- You experience blurred vision
- You feel confused or disoriented.
Other symptoms can include nausea and vomiting, anxiety and changes in blood pressure and heart rate. Your symptoms may come and go, or they may persist over months or years.
Who gets a balance disorder?
A balance disorder can develop at any point, but aging is by far the biggest risk factor. Being able to maintain your balance is a complicated dance between delicate parts of your inner ear; eyes; sense receptors in your skin, joints, and muscles; and, of course, your brain. Deterioration of any or all of these systems as a result of wear and tear or degenerative disease can interfere with your ability to remain steady on your feet and can lead to falls.
We do see young people with balance disorder. A 2016 survey by the National Institute on Deafness and other Communication Disorders (NIDCD) found that one in 20 children report balance or dizziness problems. Common causes of balance disorder in young people are inner ear problems; injuries from falls; sports injuries, including concussions; and musculoskeletal problems.
But balance disorder is far more common in adults, and especially older adults, with the NIDCD estimating that 15 percent of American adults have balance or dizziness problems. That number jumps to 35 percent of people 65 and older, and 42 percent of people over 70.
How are balance disorders diagnosed?
Because a balance disorder can be a symptom of so many different things—from heart disease and neurodegenerative diseases to a variety of inner ear disorders and anxiety—we start with a very thorough medical history and physical exam. Your primary care doctor might have you see an otolaryngologist (a specialist in treatment of diseases of the ear, nose and throat) and/or an audiologist to rule out inner ear problems and determine whether further testing and treatment is necessary. Neurodegenerative conditions require evaluation by a neurologist and can be managed, but in most cases, not reversed.
Sometimes the cause of a balance disorder is quite simple. Low blood pressure can cause dizziness when you stand up too quickly. Or you might have an ear infection, a head injury or another condition that affects the inner ear or brain. Psychological problems can cause balance issues and are usually resolved with appropriate treatment. Problems that affect the skeletal or visual systems, such as arthritis or eye muscle imbalance, can also cause balance disorders. Or, you could just be dehydrated; many older people urinate more frequently and avoid drinking enough water as a result.
Common causes of dizziness include:
Benign paroxysmal positional vertigo (BPPV) or positional vertigo: The most common cause of vertigo, BPPV is the result of a change of position of your head and is rarely serious.
Vestibular neuronitis: An infection of a nerve in the inner ear that causes vertigo. A similar infection, labyrinthitis, often causes hearing problems and tinnitus (a ringing or buzzing in the ear) as well as vertigo.
Ménière’s disease: A chronic inner ear disorder characterized by vertigo, progressive hearing loss, tinnitus and sometimes a feeling of pressure in the ear.
Perilymph fistula: A leakage of inner ear fluid into the middle ear causing dizziness and nausea that can result from head injury, dramatic changes in air pressure (such as when scuba diving), physical exertion, ear surgery, or chronic ear infections. Some people are born with perilymph fistula.
Mal de Debarquement syndrome (MdDS): A feeling of continuously rocking, swaying or bobbing, typically after an ocean cruise, or even after prolonged running on a treadmill. Symptoms usually go away within a few hours or days, but sometimes last months or even years.
As a neurologist, I’ve found that the leading cause of balance problems in my older patients stems from nerve damage: conditions like diabetes that affect the peripheral nerves; diseases like Alzheimer’s and Parkinson’s that affect the brain; and ataxia, which is a loss of muscle control or coordination that occurs when certain parts of the brain begin to shrink and don’t function as well. Being sedentary can also cause balance problems.
When evaluating older patients with balance disorder, I usually ask about any history, even in the distant past, of heavy alcohol use, since alcohol is known to damage nerves. I also inquire about a history of drug use, including prescription drugs. Some drugs, like certain blood pressure medications, can cause dizziness, and other drugs can cause problems when they interact with one another. I might also check for Vitamin E, B-12 or thiamine deficiency, and ask about past head trauma (perhaps from a fall), stroke or tumor.
Treating Balance Disorder
Many conditions that cause balance disorder can be treated. If you have diabetes, you can eat fewer carbs and keep your blood sugar under control. If you have a B-12 deficiency, you can have B-12 shots and eat more meat. Psychological causes are treatable. But we can’t stop the aging process, and we don’t have an easy fix for neurodegenerative disorders. Instead, our goal is to keep our patients functional, and our most important and effective tool is exercise. I encourage my patients to keep walking, using a cane or walker as necessary for safety. I always tell them, “The only thing that keeps you walking is the walking.”
My specialty is Parkinson’s Disease, and I highly recommend yoga, as well as tai chi and qi gong, traditional mind/body practices that combine gentle meditative movements with a focus on breathing. Numerous studies have found that these exercises reduce Parkinson’s-related motor symptoms and lead to improved balance and mobility. Patients who practice these disciplines also experience fewer falls.
Part of the reason these kinds of exercise programs help is that they require us to use parts of the brain we don’t normally use. And we know that one way to regenerate nerves and brain cells is to increase blood flow to the nerves and the brain—which is why exercise of all kinds is the best therapy we know for age-related balance disorder.
Ejaz A. Shamim, MD, MBA, MS, FAAN, is a board-certified neurologist with the Mid-Atlantic Permanente Medical Group. He sees patients at the Kaiser Permanente Largo and Gaithersburg Medical Centers.
