Balance and Dizziness

Identifying what’s causing a balance problem can be complicated. Several disorders have similar symptoms.

An infection or inflammation of the inner ear can trigger dizziness and loss of balance. This is called labyrinthitis. Inflammation can also affect the nerve that sends signals about balance to the brain. This is called vestibular neuritis.

The most common cause of dizzy spells is called benign paroxysmal positional vertigo, or BPPV. This occurs when tiny crystals in the inner ear fall out of place. BPPV can cause a brief, intense sense of vertigo triggered by certain changes in the position of your head. The spells last less than a minute.

A less common, but recurrent, cause of balance problems is Ménière’s disease. This can cause vertigo, hearing loss, and a ringing or buzzing sensation in the ear. It’s not known what causes this condition. But people living with it often have extra fluid in their inner ear.

To determine what’s causing your symptoms, your health care provider can do different tests. These include a hearing exam, blood tests, or tests to measure your eye movements. If these tests can’t rule out a stroke, you may also need an MRI scan.

Newman-Toker’s team is experimenting with goggles that measure eye movements automatically. They’re testing whether the goggles can help doctors in the emergency department make better diagnoses.

Because some balance disorders can look similar, people may not always get the right diagnosis and treatment on the first try, says Newman-Toker. You may need to visit another doctor or try different treatments before you feel better.

If you have a balance disorder, your symptoms might include:

• Dizziness or vertigo (a spinning sensation).
• Falling or feeling as if you are going to fall.
• Staggering when you try to walk.
• Lightheadedness, faintness, or a floating sensation.
• Blurred vision.
• Confusion or disorientation.

Other symptoms might include nausea and vomiting; diarrhea; changes in heart rate and blood pressure; and fear, anxiety, or panic. Symptoms may come and go over short time periods or last for a long time, and can lead to fatigue and depression.

There are more than a dozen different balance disorders. Some of the most common are:

• Benign paroxysmal positional vertigo (BPPV) or positional vertigo: A brief, intense episode of vertigo triggered by a specific change in the position of the head. You might feel as if you’re spinning when you bend down to look under something, tilt your head to look up or over your shoulder, or roll over in bed. BPPV occurs when loose otoconia tumble into one of the semicircular canals and affect how the cupula works. This keeps the cupula from flexing properly, sending incorrect information about your head’s position to your brain, and causing vertigo. BPPV can result from a head injury, or can develop just from getting older.
• Labyrinthitis: An infection or inflammation of the inner ear that causes dizziness and loss of balance. It is often associated with an upper respiratory infection, such as the flu.
• Ménière’s disease: Episodes of vertigo, hearing loss, tinnitus (a ringing or buzzing in the ear), and a feeling of fullness in the ear. It may be associated with a change in fluid volume within parts of the labyrinth, but the cause or causes are still unknown. For more information, read the NIDCD fact sheet Ménière’s Disease.
• Vestibular neuronitis: An inflammation of the vestibular nerve that can be caused by a virus, and primarily causes vertigo.
• Perilymph fistula: A leakage of inner ear fluid into the middle ear. It causes unsteadiness that usually increases with activity, along with dizziness and nausea. Perilymph fistula can occur after a 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 other sea travel, or even after prolonged running on a treadmill. Usually the symptoms go away within a few hours or days after you reach land or stop using the treadmill. Severe cases, however, can last months or even years, and the cause remains unknown.

The incidence of a disorder or condition refers to the number of new cases identified in a specified time period. Prevalence refers to the number of individuals who are living with the disorder or condition in a given time period.

Approximately 33.4 million adults in the United States report a dizziness or balance problem during the past 12 months (National Institute on Deafness and Other Communication Disorders, 2017). The true incidence and prevalence of balance system disorders in adults and children are unknown. This may be due, in part, to the wide range of symptoms attributable to balance disorders, the underlying cause(s), the length or frequency of the disorder, and the varied diagnostic techniques used for detection.

Adults

An epidemiological study conducted in the United States using data from the 2001–2004 National Health and Nutrition Examination Survey (Centers for Disease Control and Prevention, n.d.-a, n.d.-b) suggests that 35% of adults aged 40 years or older—approximately 69 million Americans—demonstrate some form of vestibular dysfunction when tested with a postural metric (Agrawal et al., 2009). A 2008 Balance and Dizziness Supplement to the U.S. National Health Interview Survey showed that 27.7% of adults aged 75 years and older experienced vestibular problems in the past year (Ward et al., 2013). A systematic review of the research by Murdin and Schilder (2015) identified that the rate of vestibular dysfunction increases with age, and women are more likely to experience dizziness and vertigo symptoms than men. Balance difficulties are a significant risk factor that contribute to falling injuries (Centers for Disease Control and Prevention, 2023), and more than 28% of adults over the age of 65 years reported falling at least once in the past 12 months (Bergen et al., 2016).

Statistics for balance system disorders can vary by type of disorder and how long it lasts. One study reported a 12-month prevalence of vestibular vertigo in adults to be roughly 5% and an incidence to be 1.4% (Neuhauser, 2007). From the 2008 Balance and Dizziness Supplement to the U.S. National Health Interview Survey, 20.6% of people reporting vestibular problems in the past 12 months demonstrated the features of benign paroxysmal positional vertigo (BPPV), and 1.4% of the same dizziness population presented with features of Ménière’s disease (Kerber et al., 2017).

Pediatrics

Dizziness and balance disorders can also occur in children (Rine, 2009; Wiener-Vacher et al., 2018). Reponses to the 2016 Balance Supplement to the U.S. National Health Interview Survey for children revealed dizziness or imbalance symptoms in 5.6% of children ages 3–17 years, of which 40% had visited a health care provider to evaluate their symptoms (Brodsky et al., 2020). The rate of dizziness and vertigo in adolescents reaches adult levels (Langhagen et al., 2015). Children with hearing difficulties are more at risk for dizziness and balance problems (Li et al., 2016).

From ASHA