Balance Problems – Diagnosis and Treatment

Diagnosis

When checking for causes of dizziness, vertigo, or balance disorders, a doctor reviews the person’s medical history and performs both physical and neurological exams.

The doctor looks for signs like spinning, disorientation, hearing loss, or nausea. They may ask about symptoms like visual blurring, motion sickness, faintness, headaches, or a feeling of floating.

Tests that help find the source of balance problems include:

• Hearing Exam: Many balance disorders link to hearing loss or tinnitus.
• Posturography: The person stands on a moving platform to show how the visual system, inner ear (vestibular system), and skeletal system work together for balance.
• Eye Movement Tests:
  • Videonystagmography (VNG) and electronystagmography (ENG) check for abnormal eye movements, which helps identify issues with the inner ear, like benign paroxysmal positional vertigo (BPPV) or labyrinthitis.
  • Rotary chair test analyzes eye responses while the doctor slowly turns the person.
• Positioning Maneuvers:
  • The doctor uses the Dix-Hallpike maneuver to see if certain head movements cause vertigo, helping diagnose conditions like BPPV.
• Vestibular Evoked Myogenic Potentials (VEMP):
  • Sensors on the neck, forehead, and under the eyes track muscle responses to sounds, checking vestibular nerve function.
• Imaging Tests:
  • MRI or CT scans can reveal problems like tumors, head injury, or vascular disorders.
• Cardiovascular Checks:
  • The doctor measures blood pressure and heart rate when the person sits and stands to identify drops that could cause dizziness or fainting.

Here’s a table showing some key tests and what they help identify:

Test Name	What It Checks For
Hearing exam	Hearing loss, tinnitus
Posturography	Balance strategy and system reliance
VNG/ENG	Abnormal eye movements, vestibular injury
Dix-Hallpike maneuver	BPPV, motion-induced vertigo
VEMP	Vestibular nerve function
Imaging (MRI/CT)	Structural or vascular issues
BP/Heart Rate check	Cardiovascular causes of dizziness

Specialist doctors, such as otolaryngologists or otologists, often use a combination of these tests to trace the exact cause of a balance disorder, whether it relates to the vestibular system, migraines, infections, or aging.

These tools also help rule out serious causes like central vestibular disorder or perilymph fistula.

Treatment

Doctors create treatment plans for balance issues based on the person’s needs and the cause of the problem. Vestibular rehabilitation, also known as balance retraining therapy, often plays a key role.

Physical therapists design exercises and movements to help improve balance and reduce the risk of falls. Sometimes, they might suggest using aids, like canes, or share tips to make the home safer.

For certain balance conditions like BPPV, the doctor performs the canalith repositioning procedure (such as the Epley maneuver).

This involves gently moving the head in specific ways to move tiny crystals in the inner ear to where they will not cause problems.

Lifestyle changes can also make a difference. Adjustments in diet, such as reducing salt or avoiding caffeine and alcohol, often help those with Meniere’s disease or migraines.

Some people may need to increase their water intake or use compression stockings if blood pressure drops when standing up.

Treatment Type	Purpose
Vestibular rehabilitation	Improves balance, prevents falls
Positional maneuvers	Moves ear particles to reduce vertigo
Medications	Eases vertigo, dizziness, and nausea
Surgery	For certain conditions like acoustic neuroma
Diet and lifestyle changes	Eases symptoms, prevents triggers

Other approaches include medications for severe symptoms or talk therapy and counseling if depression is present. In some cases, doctors may recommend surgery or specialized radiation.

They base all treatment decisions on careful evaluation and adjust them for each person to support safety, comfort, and overall quality of life.