Balance problems can make you feel dizzy, as if the room is spinning, unsteady, or lightheaded. You might feel as if the room is spinning or you're going to fall down. These feelings can happen whether you're lying down, sitting or standing.
Many body systems — including your muscles, bones, joints, eyes, the balance organ in the inner ear, nerves, heart and blood vessels — must work normally for you to have normal balance. When these systems aren't functioning well, you can experience balance problems.
Many medical conditions can cause balance problems. However, most balance problems result from issues in your balance organ in the inner ear (vestibular system).
Signs and symptoms of balance problems include:
- Sense of motion or spinning (vertigo)
- Feeling of faintness or lightheadedness (presyncope)
- Loss of balance or unsteadiness
- Falling or feeling like you might fall
- Feeling a floating sensation or dizziness
- Vision changes, such as blurriness
Balance problems can be caused by several different conditions. The cause of balance problems is usually related to the specific sign or symptom.
Sense of motion or spinning (vertigo)
Vertigo can be associated with many conditions, including:
Benign paroxysmal positional vertigo (BPPV). BPPV occurs when calcium crystals in your inner ear — which help control your balance — are dislodged from their normal positions and move elsewhere in the inner ear. BPPV is the most common cause of vertigo in adults. You might experience a spinning sensation when turning in bed or tilting your head back to look up.
Vestibular neuritis. This inflammatory disorder, probably caused by a virus, can affect the nerves in the balance portion of your inner ear. Symptoms are often severe and persistent, and include nausea and difficulty walking. Symptoms can last several days and gradually improve without treatment. This is a common disorder second to BPPV in adults.
Persistent postural-perceptual dizziness. This disorder occurs frequently with other types of vertigo. Symptoms include unsteadiness or a sensation of motion in your head. Symptoms often worsen when you watch objects move, when you read or when you are in a visually complex environment such as a shopping mall. This is the third most common disorder in adults.
Meniere's disease. In addition to sudden and severe vertigo, Meniere's disease can cause fluctuating hearing loss and buzzing, ringing or a feeling of fullness in your ear. The cause of Meniere's disease isn't fully known. Meniere's disease is rare and typically develops in people who are between the ages of 20 and 40.
Migraine. Dizziness and sensitivity to motion (vestibular migraine) can occur due to migraine. Migraine is a common cause of dizziness.
Acoustic neuroma. This noncancerous (benign), slow-growing tumor develops on a nerve that affects your hearing and balance. You might experience dizziness or loss of balance, but the most common symptoms are hearing loss and ringing in your ear. Acoustic neuroma is a rare condition.
Ramsay Hunt syndrome. Also known as herpes zoster oticus, this condition occurs when a shingles-like infection affects the facial, auditory and vestibular nerves near one of your ears. You might experience vertigo, ear pain, facial weakness and hearing loss.
Head injury. You might experience vertigo due to a concussion or other head injury.
Motion sickness. You might experience dizziness in boats, cars and airplanes, or on amusement park rides. Motion sickness is common in people with migraines.
Feeling of faintness or lightheadedness
Lightheadedness can be associated with:
Hemodynamic orthostatic hypotension (postural hypotension). Standing or sitting up too quickly can cause some people to experience a significant drop in their blood pressure, resulting in feeling lightheaded or faint.
Cardiovascular disease. Abnormal heart rhythms (heart arrhythmia), narrowed or blocked blood vessels, a thickened heart muscle (hypertrophic cardiomyopathy), or a decrease in blood volume can reduce blood flow and cause lightheadedness or a fainting feeling.
Loss of balance or unsteadiness
Losing your balance while walking, or feeling imbalanced, can result from:
Vestibular problems. Abnormalities in your inner ear can cause a sensation of a floating or heavy head and unsteadiness in the dark.
Nerve damage to your legs (peripheral neuropathy). The damage can lead to difficulties with walking.
Joint, muscle or vision problems. Muscle weakness and unstable joints can contribute to your loss of balance. Difficulties with eyesight also can lead to unsteadiness.
Medications. Loss of balance or unsteadiness can be a side effect of medications.
Certain neurological conditions. These include cervical spondylosis and Parkinson's disease.
A sense of dizziness or lightheadedness can result from:
Inner ear problems. Abnormalities of the vestibular system can lead to a sensation of floating or other false sensation of motion.
Psychiatric disorders. Depression (major depressive disorder), anxiety and other psychiatric disorders can cause dizziness.
Abnormally rapid breathing (hyperventilation). This condition often accompanies anxiety disorders and may cause lightheadedness.
Medications. Lightheadedness can be a side effect of medications.
Balance problems care at Mayo medical institution
June 18, 2020
- Furman JM, et al. Evaluation of the patient with vertigo. https://www.uptodate.com/contents/search. Accessed April 6, 2020.
- Balance disorders. National Institute on Deafness and Other Communication Diseases (NIDCD). https://www.nidcd.nih.gov/health/balance-disorders. Accessed April 6, 2020.
- Rakel RE, et al., eds. Otorhinolaryngology. In: Textbook of Family Medicine. 9th ed. Elsevier Saunders; 2016. https://www.clinicalkey.com. Accessed April 6, 2020.
- Hyun AH, et al. Hemodynamic orthostatic dizziness/vertigo: Diagnostic criteria. 2019; doi:10.3233/VES-190655.
- Walls RM, et al., eds. Dizziness and vertigo. In: Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Elsevier; 2018. https://www.clinicalkey.com. Accessed April 6, 2020.
- Branch WT, et al. Approach to the patient with dizziness. https://www.uptodate.com/contents/search. Accessed April 6, 2020.
- Brown AY. Allscripts EPSi. Mayo medical institution. April 6, 2020.
- Shepard NT (expert opinion). Mayo medical institution. April 14, 2020.
- Barton JJS. Benign paroxysmal positional vertigo. https://www.uptodate.com/contents/search. Accessed April 6, 2020.
- Black DF, et al. Vestibular migraine. https://www.uptodate.com/contents/search. Accessed April 6, 2020.
- Thompson KJ. Retrospective review and telephone follow-up to evaluate a physical therapy protocol for treating persistent postural-perceptual dizziness: A pilot study. Journal of Vestibular Research. 2015; doi:10.3233/VES-150551.
- Moskowitz HS, et al. Meniere disease: Evaluation, diagnosis, and management. https://www.uptodate.com/contents/search. Accessed April 6, 2020.
- Vestibular testing. American Hearing Research Foundation. http://american-hearing.org/disorders/vestibular-testing/#rotatory. Accessed April 6, 2020.
- Furman JM, et al. Treatment of vertigo. https://www.uptodate.com/contents/search. Accessed April 6, 2020.
- Kaufmann, H. Treatment of orthostatic and postprandial hypotension. https://www.uptodate.com/contents/search. Accessed April 6, 2020.
- Park JA, et al. Vestibular schwannoma (acoustic neuroma). https://www.uptodate.com/contents/search. Accessed April 6, 2020.