Balance is one of the most basic functions of our bodies. Many abnormalities can affect our balance. When balance is abnormal it can result in sensations ranging from floating and disorientation to vertigo (spinning or a merry-go-round sensation).
Balance is a learned function. The system that maintains our balance is developed over the first several years of life. Our brains take information from the inner ear, our vision, and the muscles in our head, neck, and back and correctly point our eyes at a target and put our bodies in the correct posture. Within months of being born, we learn to point both eyes at a target. We learn to follow a moving target, and by age one, we can walk and follow a target simultaneously.
The muscles in our neck and back develop in the first few years of life. When we are first born, our heads are much larger and heavier relative to the rest of the body, than when we mature. A child must be able to support and move the head to maintain balance. There are special nerves in the neck and back muscles that tell the brain where the head is pointing. The brain takes this information and adjusts the posture of the body and the position of the eyes properly. Neck and back injuries are commonly associated with imbalance.
Our vision is critical to balance. If our vision changes or is distorted, it confuses our brain and makes it difficult for the brain to orient our eyes and body. Imbalance and dizziness often occur after getting a new pair of glasses, especially bifocals or progressive lenses.
The inner ear plays a critical role in balance. Your physician will often order a hearing test to evaluate a balance abnormality. In the first few years of life the inner ear and the eyes learn to coordinate their movements so both eyes automatically point and stay fixed on a target while the head is moving. Think of reading a sign while driving a car. Both eyes automatically point at the sign. You don’t have to consciously adjust your eye movements to read the sign. See, you really are better at calculus than you thought.
The balance system can be affected by a large number of abnormalities. A sudden injury to one or the other of the inner ears usually causes acute vertigo. Changes in vision can cause sensations of floating and disorientation. Injuries to the muscles of the neck can cause dizziness and even vertigo. Brain injuries (such as a concussion or stroke) can cause dizziness.
Remember that balance is learned. Usually if one part of the balance system is injured, our bodies can compensate for the injury by using information from the healthy parts of the system. For instance, if there is an injury to one of the inner ears, the brain recognizes that the information from the ear does not match the information from the eyes and neck muscles. Over several days, the brain will adjust the posture and eye movements to correct for the injured inner ear. This correction process can be slowed by stress, tiredness, and other systemic diseases such as diabetes, liver problems, or renal problems. In general younger people compensate for injuries to the balance system better and faster than older people.
At times balance problems are due to a problem with the heart or lungs. Correction of these underlying problems is critical to resolving these sorts of imbalance.
The treatment of balance disorders first starts with a detailed history and a physical exam. It is very important to rule out serious causes of dizziness such as stroke or heart problems. Testing is tailored to your specific situation. It can be very extensive and include specialized imaging, blood tests, hearing and balance testing.
The treatment of dizziness depends on the underlying cause and the specific condition of the patient. For acute vertigo, sedation and use of vestibular suppressants are initially used to make the patient more comfortable. For long term dizziness and unsteadiness, treatment can include diuretics to reduce the amount of fluid in the inner ear, blood thinners to enhance the blood flow to the brain and inner ear, and balance therapy to retrain the whole balance system. The specific treatment depends on the particular cause of the dizziness.