Overview: What are balance disorders?
Brief dizziness, a perceived sway – disturbances of balance can last only a fraction of a second, but can also be longer or recurrent. Especially when the disorders appear for the first time, they are unsettling and cause anxiety. Around one in four people experience balance problems at least once in their lives. The risk of balance problems and dizziness increases with age.
The sense of balance is a complex network and reacts sensitively. The organ of balance is located in the right and left inner ear, protected by the respective temporal bone. Each consists of five different tiny hollow organs: two vestibular sacs (otolith organs) and three semicircular canals arranged in different spatial directions, approximately at right angles to each other. All these hollow organs contain a gel on their membrane and fluid inside and are lined with sensory cells, which in turn contain tiny, antenna-like hairs. Tiny calcium carbonate crystals, the otoliths, also known as ear stones, sit on the hairs of the otolith organs.
Every movement of the head changes the position of the liquid. This change in position is transmitted from the hairs to the sensory cells as a stimulus. Nerve pathways (vestibular nerve) lead from them to the brain, where the stimulus is transmitted to the balance center of the brain. Here, these stimuli are processed together with the information sent by the eyes – as well as by sensors in the muscles and joints (position sense). This gives the brain an impression of our current position, posture and stance.
Balance disorders: causes and risk factors
The sense of balance is therefore dependent on many different factors. The causes of balance disorders and dizziness can be just as varied.
One of the best-known causes of imbalance is the consumption of alcohol and other drugs. But the swaying ground on a boat trip, a winding road in a car or turbulence during a flight can also flood the inner ear with stimuli. Dizziness, but also vomiting, can be the consequences; this phenomenon is summarized under the term motion sickness.
Some drugs used to treat cardiovascular diseases, such as antihypertensives, can also cause balance disorders as a side effect. This risk can also exist with psychotropic drugs, tranquilizers and some hormonal drugs such as thyroid hormones.
However, experts differentiate between the causes of balance disorders primarily by whether they are caused by disorders in the ear, i.e. in the organ of balance, or by problems in other organs.
Balance disorders – causes in the organ of equilibrium
- Benign positional vertigo: This is the most common form of vertigo, in which some of the crystals have detached from the hairs and have been washed into the archways. In this case, the loosened ear stones cause false messages to the brain that have nothing to do with the actual body position.
- Inflammation of the inner ear
- Inflammation of the vestibular nerves
- Tumor between the brain and auditory canal, such as an acoustic neuroma
- Disease of the bone in one of the semicircular canals that can lead to an anatomical change in the organ of balance, such as semicircular canal dehiscence
- Meniere’s disease: This is a disease of the inner ear, which causes a build-up of fluid inside the ear, which in turn can lead to attacks of vertigo
Balance disorders – causes that do not affect the ear
Why the very elderly often suffer from balance problems
Especially in old age, many people complain of dizziness and balance disorders with gait disturbances, often referred to as senile vertigo. This is because age-related changes are important risk factors for these problems. This means that blood circulation no longer works as well as it did when we were younger. The inner ear is also affected by this reduced blood flow. In addition, stimuli are no longer transmitted as quickly via the nerves. Such symptoms should not generally be accepted as “age-related”, as suitable measures can often be taken through a detailed examination and assessment, for example to reduce the risk of falls as an important consequence of dizziness.
Other areas of the body that have to do with balance are often also impaired by signs of aging: The eyes no longer function as well, osteoarthritis causes gait instability. Medication, which older people often have to take, plays a not insignificant role.
Balance disorders with gait disturbances are also often the reason why older people have a high risk of falling. They cannot react as quickly when they trip and often no longer have the muscle strength to stop the fall. This increases the risk of injury for them.
Symptoms: Dizziness and coordination problems
Everyone has probably experienced the signs – the world seems to spin around you, as can typically occur with too much alcohol, for example, or when you stand up too quickly after sitting or lying down for a long time. Sometimes those affected also have the feeling that the ground is being pulled out from under their feet for a moment or that they are falling into the void.
In addition, hearing and visual disturbances may occur, and headaches, nausea and vomiting are also possible. Overall, those affected feel very insecure. Because the problems are unsettling and ultimately there is a fear that “something might be wrong in the brain.”
In old age, symptoms can often be subtle or “atypical” or less easily attributed to a specific cause. Here, geriatric assessment can help identify potential age-associated diseases and problems in those affected and provide individualized treatment planning.
Balance disorders: diagnosis with us
These are alarm signs:
- Dizziness plus vomiting
- Dizziness accompanied by visual disturbances or shortness of breath
- Balance disorders that occur as part of an infection
- Dizziness that always occurs with certain head movements
- Dizziness that has led to a fall
Have these symptoms clarified by us as soon as possible. We will first ask you about your symptoms and also want to know about your other health conditions, any medication you are taking and other information. Guidelines include standardized questionnaires such as the Dizziness Handicap Inventory (DHI-G) or the Vertigo Symptom Scale (VSS-G).
This is linked to various diagnostic options that can be used to clarify the causes of the balance disorders and what form of vertigo is involved:
Romberg test and Unterberger test for balance disorders
There are two frequently used methods for testing balance: For the first, the Romberg test, the person concerned must stand upright with their legs closed – first with their eyes open, then with them closed. If it fluctuates, this is an indication of a disturbance of the vestibular system. This can also be checked with the second method, the Unterberger test: the person concerned walks on the spot, arms stretched out in front, eyes closed. If the vestibular system does not function properly, the affected person may, for example, turn around on their own.
Nystagmus test with Frenzel glasses
Nystagmus, i.e. involuntary trembling of the eyes, is also an indication of a disorder of the vestibular system. The tremor develops as a reaction to the false messages to the brain. If the gaze is fixed, however, the trembling cannot be recognized. This is where the Frenzel glasses help. It enlarges very strongly. Due to these strong magnifying lenses, it is impossible for the person affected to fixate anything precisely and we can recognize the eye tremor.
Storage test and thermal irritation
- Positioning test: The person concerned sits down on the examination couch and then has to assume various, rapidly changing positions, sometimes with our help. This can be used to diagnose benign positional vertigo, for example.
- Thermal stimulation: With thermal stimulation, we apply warm and then cool water to the ear. If the vestibular system is functioning well, this caloric test leads to nystagmus.
Further examinations for balance disorders
In order to check the functions of the various organs associated with our sense of balance, further examinations can be carried out if necessary, for example:
- Hearing and eye tests
- Computed tomography (CT)
- Magnetic resonance imaging (MRI)
- Electroencephalography (EEG)
- Blood tests
- Cerebrospinal fluid examination (cerebrospinal fluid puncture)
- Orthostasis test
- Functional balance test (e.g. tandem stance test, Tinneti test, or mountain balance scale)
Balance disorders: prevention, early detection, prognosis
This advice will help you to avoid dizziness and balance problems as far as possible:
- Drink enough, at least two liters a day, more if you sweat a lot.
- Don’t push yourself physically, don’t go beyond your limits.
- Get enough and regular sleep.
- Eat a sensible and sufficient diet.
- Drink alcohol only occasionally and in small quantities, if at all.
- If you have high blood pressure and/or diabetes: Check your values regularly and optimize them if necessary.
- Reduce stress.
- Check the medication you are taking to see if dizziness is listed as a side effect. Then talk to us about it, perhaps you can switch to another product.
- Keep moving in old age, e.g. through regular dancing or other movement exercises such as Tai Chi or Jaques-Dalcroze rhythmics, which promote balance
- Avoid taking sleeping pills or sedatives that can affect your balance as you get older
Progression and prognosis (balance disorders)
In the vast majority of cases, balance disorders disappear again – with the appropriate therapy and if the causes are eliminated. However, medication alone is often not enough; the person affected must take regular action themselves.
Balance disorders: treatment depends on cause
In most cases, the trigger for the balance disorders can be found with careful diagnosis. Then we can put together the appropriate therapy.
Balance disorders: treatment depends on cause
