Definition and Overview

Balance is important as it allows us to walk and stand without falling or suffering an injury. It is responsible for ensuring we can carry out a variety of activities such as sport and even everyday chores safely.

Balance problems, which can be caused by many factors including ear and neurological issues, are characterized by the feeling of dizziness, spinning, and sometimes, fainting spells.

There are many kinds of balance disorders depending on their manifestations. The most common are:

  • Benign paroxysmal positional vertigo (BPPV) - Also referred to as positional vertigo, it involves a sudden but strong spinning sensation or dizziness that lasts for a few seconds. It normally occurs when a person tries to change position, especially that of the head.

  • Ménière’s disease – This is a balance disorder affecting the inner ear or the vestibular system. Not only do the person experiences vertigo (spinning sensation), but he also suffers from temporary hearing loss or tinnitus (ringing of the ears).

  • Labyrinthitis and Vestibular neuronitis – These are inflammatory conditions affecting different parts of the vestibular system.

Causes of Condition

A problem with balance is often associated with issues of the inner ear, also known as the vestibular system. This is composed of many different parts such as the labyrinth. Inside the labyrinth are the semicircular canals, which contain ducts filled with fluid. These ducts work closely with the brain to encourage balance by sending out signals when a person changes the position of the head or the body.

Many issues, however, can affect the vestibular system, including bacterial or viral infection, which is the reason why sometimes balance disorders occur with diseases such as flu. These pathogens can also cause the inflammation of the inner ear, especially the nerves. Injuries to the inner ear, including acute trauma, can damage not only the cochlea but also the labyrinth.

Other causes of balance problems are:

  • Neurological conditions including trauma or injury to the head or the brain
  • Low blood pressure
  • Medications (where balance problem is the side effect)

Key Symptoms

  • Dizziness
  • Sensation of spinning
  • Fainting spells
  • Nausea and sometimes vomiting
  • Difficulty in focusing or maintaining proper gait
  • Blurred vision
  • Disorientation
  • Tumor affecting the brain or the ear
  • Changes in vital signs especially heart rate and blood pressure

Who to See and Treatments Available

Balance disorders are often managed either by a neurologist or an ENT specialist (also called otolaryngologist). To properly diagnose the condition, the doctor performs interviews, checks the patient’s medical and family history, and conducts tests including an ear examination and, if needed, CT scan of the brain.

Depending on the condition, the following treatments may be applied:

  • Epley maneuver: This is recommended for patients diagnosed with BPPV. Its aim is to move the buildup of calcium particles known as otoconia to their actual location after they have been displaced and moved to the posterior semi-circular canal. It involves a series of movements including that of the head. It can be completed in less than 20 minutes and it has a very high success rate.
  • Management of blood pressure and heart rate
  • Treatment of head or brain injury
  • Removal of the tumor
  • Use of hearing aids
  • Medications for nausea and motion sickness such as diazepam
  • Lifestyle changes such as quitting smoking

In the majority of cases, surgeries are not needed.


  • Baloh RW, Jen J. Hearing and equilibrium. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 436.
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