Balance Problems: Why You Feel Unsteady and What a Visit Can Sort Out

What it involves

MedlinePlus says a balance problem can feel like dizziness, lightheadedness or a room spinning around you, and may come with blurred vision, confusion or disorientation. It says some balance problems come from the inner ear, while others involve another part of the body such as the brain or the heart.

Who this is for

• Adults who feel unsteady when they walk or turn
• Patients who feel the room spinning when they move their head
• Patients who feel lightheaded on standing up
• Adults who have fallen, or who are afraid of falling, and want a cause looked for

What to expect

• Questions about when the unsteadiness began, what brings it on and how long it lasts
• A physical exam, a blood pressure reading and a review of your medicines
• An EKG at the Loxahatchee and West Palm Beach offices if your provider thinks it is useful
• A referral for hearing, balance or head imaging tests if the cause points to the ear or brain

Two feelings that get called dizziness

The MedlinePlus encyclopedia says dizziness describes two different symptoms. Lightheadedness is a feeling that you might faint, and vertigo is a feeling that you are spinning or moving, or that the world is spinning around you. The two have different usual causes, so the first question at a visit is which one you feel. Telling your provider whether it happens when you stand up, when you turn your head in bed, or without any trigger is often the most useful thing you can bring. The dizziness guide covers this distinction in more detail.

When the cause is blood flow

MedlinePlus says lightheadedness occurs when the brain does not get enough blood. Examples it gives are a sudden drop in blood pressure, dehydration from vomiting, diarrhea or fever, and getting up too quickly from sitting or lying down, which it notes is more common in older people. Medicines that lower blood pressure can contribute. More serious causes include heart problems, stroke and bleeding inside the body, which usually come with other symptoms such as chest pain, a racing heart, loss of speech or a change in vision. The fainting guide and the heart palpitations guide cover those related symptoms.

When the cause is the inner ear

For vertigo, the encyclopedia lists benign positional vertigo, a spinning feeling that occurs when you move your head, labyrinthitis, a viral inner ear infection that usually follows a cold or flu, and Meniere disease, an inner ear problem that often also causes hearing loss or ringing in the ears. The MedlinePlus balance problems page adds that aging, infections, head injury, certain medicines and problems with blood circulation can also cause balance trouble. Hearing loss together with dizziness is one of the reasons the encyclopedia says to contact your provider.

Why falls make this worth checking

MedlinePlus states that balance problems are one cause of falls and fall-related injuries, such as a broken hip, and that they can be a sign of other health problems such as an ear infection or a stroke. That is the practical reason not to simply live with unsteadiness. A provider can look for a reversible cause, such as a medicine, low blood pressure on standing or dehydration, before assuming the problem is permanent. If you have already fallen, tell the provider when, where and what you were doing, since that pattern helps narrow the cause.

Signs that mean call 911

The encyclopedia says to call the local emergency number or go to an emergency room if you are dizzy and also have a head injury, a fever over 101 degrees with headache or a very stiff neck, seizures, trouble keeping fluids down, chest pain, an irregular heart rate, shortness of breath, weakness, inability to move an arm or leg, a change in vision or speech, or fainting with loss of alertness for more than a few minutes. The chest pain guide explains when chest pain should skip the appointment calendar altogether.

What testing and treatment can involve

MedlinePlus says a provider may order a hearing test, blood tests or imaging studies of the head and brain, and may look at eye movements and how your body responds to movement. It says treating the illness behind the problem can help, and that exercises, a change in diet and some medicines can also help. At Serenity By A Dr. Sareen, a blood pressure reading, blood work and an EKG at the Loxahatchee and West Palm Beach offices can be part of the visit. Hearing, balance and brain imaging tests would be a referral to a specialist.

Sources

• MedlinePlus — Balance Problems (health topic)
• MedlinePlus — Dizziness (medical encyclopedia)