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Common balance disorders

Balance problems are usually caused by one of four things:

  • Disturbances in the inner ear itself, this is known as a peripheral balance problem and may be down to viral or bacterial infections, blood circulation affecting the inner ear, certain medications and aging

  • Changes in the connecting nerves of the inner ear and the way the brain receives the signals from the inner ear this can be caused by head injuries and disorders such as multiple sclerosis and migraines

  • Systemic disorders of the body for example thyroid problems and the effects of diabetes

  • Blood flow problems such as low blood pressure or cardiac arrhythmia


Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo (BPPV) causes short episodes of vertigo or dizziness when moving your head in certain directions. Getting out of bed and rolling over in bed are two common “problem” motions.

Also some people feel dizzy and unsteady when they tip their heads back to look up although symptoms can vary or come and go. Small crystals of calcium carbonate (sometimes called “ear rocks”) break loose from their correct position in the balance organ and collect as debris within another part. With head movements, these crystals move, sending false signals to the brain about how you are moving.

  • About 20% of all dizziness is due to BPPV

  • The most common cause of BPPV in people under age 50 is head injury

  • About 50% of dizziness in older people is due to BPPV

  • In half of all cases, there is no known reason for the onset of BPPV

Tests for BPPV are a form of positional testing where you are asked to lay flat on a clinical bench and the tester will observe your eyes for a phenomenon called nystagmus (which is an involuntary eye movement). Sometimes this also includes videonystagmography which is a test where a pair of video goggles records these eye movements.

Labyrinthitis – inflamation of the labyrinth

Labyrinthitis is an inner ear infection. It causes a delicate structure deep inside your ear called the labyrinth to become inflamed, affecting your hearing and balance. Inner ear infections are not the same as middle ear infections, which are the type of bacterial infections common in childhood that affects the area around the eardrum.

Symptoms may include:

  • Labyrinthitis (inflammation of the labyrinth)

  • Dizziness/vertigo

  • Nausea/sickness

  • Tinnitus (ringing in ears)

  • Hearing loss

No specific balance tests exist to diagnose labyrinthitis, however a test battery of videonystagmography, caloric testing and posturography can be helpful alongside a strong history.

Vestibular neuritis (or neuronitis) – inflammation of the hearing nerve

Vestibular neuritis, also known as neuronitis, is an infection of the vestibular nerve in the inner ear. It causes the vestibular nerve to become inflamed, disrupting your sense of balance. Infections of the inner ear are often caused by viruses and less commonly by bacterial infections. Although the symptoms may be similar, the treatments are very different, so correct diagnosis by a doctor is essential.  An inner ear viral infection may be caused by a general viral illness or the infection may be just in the inner ear.  Usually, only one ear is affected.

Symptoms can be mild or severe, ranging from mild dizziness to a violent spinning sensation.  They may also include nausea, vomiting, unsteadiness and imbalance, difficulty with vision, and impaired concentration.  Sometimes the symptoms can be so severe that they affect the ability to sit up, stand, or walk.

The onset of symptoms is usually very sudden, interrupting routine daily activities.  After a period of gradual recovery over several weeks, some people are completely free of symptoms while others do not recover fully and continue to have chronic dizziness, which is referred to as a lack of compensation.

No specific balance tests exist to diagnose vestibular neuritis, however a test battery of videonystagmography, caloric testing and posturography can be helpful alongside a strong history.

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