Common balance disorders

Balance problems are usually caused by one of four things:

• Disturbances in the inner ear itself. 
• Changes in the connecting nerves of the inner ear and the way the brain perceives the signals from the inner ear. 
• 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. 

What are the symptoms of Benign Paroxysmal Positional Vertigo (BPPV)?  

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 within the inner ear 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 (Menieres Society)
• In half of all cases, there is no known reason for the onset of BPPV 

What treatments are there for Benign Paroxysmal Positional Vertigo (BPPV)?  

Treatment is usually by attempting to return the debris to its correct location with a particle-repositioning manoeuvre. These include specialist manoeuvres or exercises, these are very effective in treating BPPV.  Some are performed in hospital clinics and others as a set of home exercises. 

Labyrinthitis 

Labyrinthitis is an inner ear infection, causing a delicate structure deep inside your ear called the labyrinth to become inflamed, affecting your hearing and balance.

What are the symptoms of Labyrinthitis?

Common symptoms of Labyrinthitis are: 

• Dizziness/vertigo 
• Nausea/sickness 
• Tinnitus (ringing in ears) 
• Hearing loss

No specific tests exist to diagnose labyrinthitis, however a good complete history taken by a specialist may indicate a test battery to be performed to exclude other diagnoses or illnesses. 

What treatments are there for Labyrinthitis?

Medications are often prescribed to control nausea and to improve dizziness during the severe stage. If treated promptly, many inner ear infections cause no permanent damage. In some cases, however, permanent loss of hearing or damage to the vestibular system can occur. 

If symptoms of dizziness or imbalance continue for several months, vestibular rehabilitation exercises may be prescribed in order to teach the brain to adjust to the imbalance.  An important part of a successful recovery is to keep moving, despite the symptoms. 

Many people diagnosed with labyrinthitis only experience the balance symptoms without hearing loss. This is actually known as vestibular neuronitis rather than labyrinthitis. However, both terms are often used to describe the same diagnosis. 

Vestibular neuritis (neuronitis) 

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 balance symptoms may be similar, the treatments are very different, so correct diagnosis by a specialist 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. 

What are the symptoms of Vestibular Neuritis (Neuronitis)?

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 good complete history taken by a specialist may indicate a test battery to be performed to exclude other diagnoses or illnesses. 

What are the treatments for Vestibular Neuritis (Neuronitis)?

Medications are often prescribed to control nausea and to improve dizziness during the severe stage. If treated promptly, many inner ear infections cause no permanent damage. In some cases, however, the vestibular nerve fails to recover, resulting in chronic vestibular neuronitis. 

If symptoms of dizziness or imbalance continue for several months exercises may be prescribed in order to teach the brain to adjust to the imbalance.  An important part of a successful recovery is to keep moving, despite the symptoms. 

Meniere’s disease

Meniere’s disease is a relatively rare disorder that affects the inner ear. It can cause vertigo, tinnitus, hearing loss, and a feeling of pressure deep inside the ear. The correct name is ‘Endolymphatic Hydrops’ which is an increase of pressure in the Endolymphatic system of the inner ear and labyrinth. This increase in pressure can lead to all of the symptoms previously described. 

What are the symptoms of Meniere’s disease?

Sufferers often describe feeling the pressure build up in the ear prior to any episode of Meniere’s, followed by balance problems and the hearing/tinnitus. 

No specific balance tests exist to diagnose Meniere’s disease, however a good complete history taken by a specialist may indicate a test battery to be performed to exclude other diagnoses or illnesses. 

How can your treat Meniere’s disease?

Medications are often prescribed to control nausea and to improve dizziness during the severe stage. Generally Meniere’s will only affect one ear, but bilateral problems have been reported. Left alone Meniere’s will generally ‘burn out’ but this can take several years with sufferers struggling with balance and hearing problems – leaving no useful hearing or balance function on the affected side. 

Webpage reviewed: October 2023