Dizziness and Balance

Living With Balance Disorders

Living With Balance Disorders

Dizziness, vertigo or imbalance can all rob us of our independence and seriously impact our quality of life.

You don’t have to live with these debilitating conditions.

However, the chances are high that you may be impacted by them at some point in your life. According to the National Institute of Health, up to 90 million people in the United States alone will experience these balance disorders at some point of their lives.

In fact, in physician’s offices all across the country, complaints of dizziness are the number one reason people over the age of 70 have called for a consultation.

You may experience the symptoms of balance issues either acutely or chronically.

Those who suffer acute balance disorders fell dizzy or experience vertigo or motion sickness for just a few seconds or at most a few hours. Then they recover, only to experience it again and again, sometimes days or weeks apart. It is made worse if they turn their head quickly or when they walk or ride.

Those who suffer chronic balance disorders endure a persistent unsteadiness or feeling that they are going for fall constantly. They are unstable, and feel unsure about walking by themselves. When you have chronic balance disorders, you are in a high risk category for falls, which can lead to broken bones and even head trauma.

In the last decade, researchers have made great strides in discovering ways to diagnose and treat balance disorders. Now at least 85 percent of patients can find significant, long-term relief using effective treatments.


Because “feeling dizzy” is such a subjective complaint that is hard to measure objectively, it is the word patients with balance disorders most often use when they open discussions with their doctors.

The first challenge is to determine the category their balance disorder falls into, and then to evaluate and treat it. From the viewpoint of diagnosing these patients, it can be a huge challenge because they often have difficulty pinpointing the history of their symptoms.

One of the most common diagnosis of dizziness is vertigo with the other common category non-vestibular dizziness. In this article we will describe each condition and the differences between them.

For example, patients with a vestibular disorder normally describe experiencing the sensation of spinning and a feeling that their eyes are jerking back and forth or snapping rapidly. They will experience a sensation that the room is moving around them.

Patients with nonvestibular dizziness, on the other hand, describe a spinning sensation within their head. They have no eye issues and no room movement. They describe their symptoms as being similar to motion sickness and a sense of imbalance. They use adjectives like lightheaded, swimming, giddiness, and floating.

Sometimes they describe psychophysiological dizziness, which is a feeling that they have left their body

True vertigo is an acute phenomenon that occurs in episodes. Non-vestibular dizziness is more of a continuous symptom.

Vertigo is made worse with head movements, while non-vestibular dizziness is aggravated by moving targets in the patient’s visual field. They are impacted when they drive in a car, for example or shopping in a bustling mall.

In cases where the dizziness is linked mainly to changes in posture, and postural hypotension has been eliminated, a vestibular lesion should be considered. Other symptoms that are linked to vestibular causes of dizziness are nausea and vomiting or auditory or neurologic symptoms.


Peripheral vertigo is more severe than central forms and is more commonly linked to auditory symptoms such as tinnitus and hearing loss, as well as nausea and vomiting. Vertigo of central origin is more likely linked to symptoms such as diplopia, weakness, numbness and incoordination.

When the diagnosis is being made, it is important to know how long each episode lasts. If it is only for a few seconds, that suggest benign positional vertigo. The episode may be preceded by an initial period or episode with complains of general disorientation and imbalance associated with nausea and vomiting. They can last for hours or days.

In positional vertigo, the patience can normally describe more recent recurrent attacks and can clearly distinguish brief episodes.

A vertiginous episode that starts abruptly and lasts several minutes is more characteristic of a vascular etiology, such as vertebrobasilar insufficiency or migraines.

A patient with Meniere’s disease may also be subjected to episodes of vertigo that grow in severity over several minutes and last for several hours getting gradually better over that time.

Vestibular neuronitis and labyrinthitis episodes are usually present with abrupt onset vertigo (a period of a few hours) with the acute phase resolving over the next several days. Two conditions cause a sudden arrival of symptoms: a traumatic injury or vascular infarction the labyrinth. Recovery of the acute phase takes a period of several days to weeks, and the residual effects can last between a year and 18 months.

Vestibular Disorders That Are Most Common

Benign positional vertigo

This can occur at any time but is most commonly associated with head injury, vestibular neuronitis, staples surgery, or Meniere’s disease. It is the most commonly observed type of peripheral vertigo.

What causes it? It is related to an abnormality in the association of the octoconia to the cupula within the membranous labyrinth. The result is that when the patient moves his or her head, it triggers an abnormal response to endolymph movement.

Patients often describe its onset when they roll over or get in or out of bed. It is a brief episode of vertigo, just lasting a few seconds, and is classified as an acute form of vertigo or an intermittent or chronic form.

Labyrinthine Infarction

This vestibular disorder involves a sudden and profound loss of auditory and vestibular function and is most often experienced by older patients. In younger patients, if it is present it is most often associated with atherosclerotic vascular disease or hyper coagulation disorders.

Episodic vertigo can be a sign of a pending complete occlusion in the form of a transient ischemic attack. Following that, the acute vertigo will subside, but it can leave the patient with residual unsteadiness and disequilibrium during the next several months.

Vestibular Neuronitis

This condition is recognizable as a sudden vertigo episode without hearing loss in a person who appears to be otherwise healthy. It can be a single occurrence or a series of multiple attacks. It is most often experienced in the spring and summer and is often linked to a simultaneous upper respiratory tract infection.

The onset of vertigo is sudden and is often linked with nausea and vomiting. It can last over a period of many days and gradually improve over the following weeks. It is often followed by episodes of benign positional vertigo.


Labyrinthitis happens when the membranous labyrinth becomes inflamed, often as the result of a bacterial or viral infection. The patient experiences feelings of dizziness just as in vestibular neuronitis, but there is cochlear dysfunction as well.

Bacterial labyrinthitis can be present in a supparative form, such as direct involvement of the membranous labyrinth by the pathogen, or in a serious form, such as seen with acute otitis media when diffusion of bacterial toxins around the round window membrane happens.

Meniere’s Disease

This inner ear disorder prompts episodic vertigo attacks, sensorineural hearing loss, pressure or fullness in the involved ear, and tinnitus.

At the onset, the patient experiences hearing loss involving the lower frequencies and then it fluctuates, getting worse with repeated attacks.

The attacks are marked by true vertigo, usually with nausea and vomiting lasting many hours in duration.

This disorder is thought to be because of dilation of the endolymphatic spaces (hydrops) with ruptures and subsequent healing of the membranous labyrinth.

There are variations of this disease including vertigo with associated auditory symptoms.


There are two primary categories of migraine: without aura and with aura. Aura means a focal neurological disorder.

Auras are believed to be abnormal sensory perceptions. Visual auras are the most frequent type and can come in a wide variety of phenomena or hallucinations.

At least 30 percent of people with migraines may also have vertigo, tinnitus, photophobia, and phonophobia, and on occasion, hearing loss. The later usually involved a low frequency fluctuating sensorineural hearing loss.

However, some patients can have a permanent hearing loss or vestibulopathy secondary to a migraine attack.

Originally this group of symptoms was linked to Meniere’s disease or some other inner ear disorder, and there can still be diagnostic challenges in distinguishing one from the other. As well, 60% of both patients will have a lifelong history of motion sickness or sensibility. To complicate things further, the incidence of Meniere’s disease in the overall population is double that of patients with migraines.

Further challenging the correct diagnosis is that patients with multiple sclerosis will often experience an acute, debilitating vertigo as their initial symptom, and up to 50% of patients with MS will have at least one occurrence of acute vertigo during the course of the disease.

One in 10 patients with MS will also experience hearing loss, either partial or complete, but they often recover, just as patients with migraine or Meniere’s.

Mal de Debarquement

A common and normal occurrence, disembarkment sickness is recognizable as the continued sensation of motion, rocking or swaying that continues after a person returns to a stable environment following a long exposure to motion.

It often occurs after a cruise or a long train, bus or car ride.

The sensation lasts for a few hours or even a few days, impacting patients especially when they are standing in the shower with their eyes closed or when lying in bed.

It is different from seasickness which a person may experience while on a boat or motion sickness experienced while driving in a car, for example. The person with disembarkment sickness feels fine, but they keep feeling this rocking and rolling sensation even though they are on solid ground.

Even people who have just experienced an afternoon boat ride can experience this for several hours afterwards.



Sloane P. D. Dizziness in primary care: results from the National Ambulatory Medical Care survey. J Fam Pract 1989: 29:33-38

Kroenke kHz, Arrington MA, Mangelsdorff AD. The prevalence of symptoms in medical outpatients and the adequacy of therapy. Arch Intern Medical 1990: 1685-1689

Baloh RW, Honrubia V. Clinical Neurophysiology of 3. The Vestibula