Balancing Act

Millions of Americans suffer from balance disorders, but treatment can help

Remember when you were a kid and got such a thrill from turning your world topsy-turvy by spinning on a tire swing or carnival ride? Somehow that Tilt-A-Whirl sensation just doesn't hold the same allure when we grow up. It becomes downright frightening and even dangerous when it occurs unbeckoned. Ninety million Americans will experience dizziness or imbalance during their lifetime, according to the Vestibular Disorders Association. And for them, feeling dizzy is definitely not about fun and games.

Our sense of balance relies on the interplay of an array of factors, says Jeffrey M. Zimmerman, M.D., an otolaryngologist at Ear, Nose & Throat Specialists of Southern New Hampshire in Manchester. Balance-related input from many points in the body, including the eyes, inner ears, and sensory receptors located in muscles and joints, is sent to the brain. The brain then processes the information and sends signals back out to the body to maintain balance and prevent falling, he says. Communication must be seamless and in sync; a glitch in any area of the system can cause the brain to interpret the environment incorrectly, leading to dizziness or imbalance.

Although many elements of our body do their part to keep us upright, the heart of the balance system resides in our inner ear's vestibular system, says Sally Fodero, Au.D., an audiologist with New Hampshire Hearing and Balance in Greenland. And "many people, about a third of the population, will have some kind of viral inner ear event within their lives" that triggers balance trouble, she says.

Because our balance relies on non-conflicting input from a variety of sources, problems can arise almost anywhere. "Virtually any organ system in the body can malfunction and cause dizziness," says Zimmerman. Trouble might be rooted in something cardiovascular or neurologic in nature, for instance, or could stem from an injury or medication. Also, migraine headaches can interfere with the interpretation of incoming signals to the brain. "Migraine is a huge component when it comes to dizziness," Zimmerman says. "We see a lot of that," with patients experiencing varying degrees of balance impairment.

Age can also influence how steady we are on our feet, since our ability to balance declines as we grow older, Zimmerman says. Neurons in the brain that affect our balance functioning don't fire as quickly as we age, and health issues including strokes and Alzheimer's disease can gum up the balance works.

But unlike the sudden onset of, say, an injury or infection in the inner ear, the gradual changes that come with age at least give the brain time to adjust. That's important because the process that the brain goes through as it learns how to compensate for breakdowns in the balance system can take weeks or months, Zimmerman says, making everyday life difficult for patients whose sense of unsteadiness was triggered very suddenly.

With so many contributing balance system elements to consider, pinpointing the cause of balance woes can be tough. Some imbalance cases call for videonystagmography, a visually based series of tests that examine the reflexive communication that occurs between inner ears and eyes to look for abnormalities, Fodero says. Patients might also undergo a hearing evaluation since hearing and balance organs are in close proximity to each other and a problem in either can indicate trouble within the whole inner ear space, she says.

Searching for steadiness

Treatment for balance ailments varies, but patients suffering from inner ear disorders are often steered toward vestibular rehabilitation, a type of physical therapy that teaches the central nervous system to compensate for a weakened balance system. Some patients, particularly the young and active, might find that an acute balance problem goes away on its own, however, without any rehab or intervention.

Regardless, most patients should resist the urge to shy away from activity and take medications that are meant to prevent dizziness, Zimmerman says. "It's kind of like if you broke your leg or had knee surgery and didn't do any sort of rehabilitation," he says. Some strengthening and retraining are in order. After acute damage or weakening has occurred in the inner ear through an infection, for example, "the brain is trying to sort things out," Zimmerman says. "It needs to be taught what the new normal is, and the best way to do that is to put people through exercises, which, just like if you had knee surgery, at first will not feel good and will be uncomfortable." But without those movements and exercises, the brain will never properly adjust. "Physical therapy in the right situations often makes a world of difference," he says. "It can be fantastic. People can get their lives back."

Staying on an even keel

In fact, physical activity in general can be pursued as a preventive measure. Exercise will not necessarily prevent balance problems, but it can keep your balance system fine-tuned, Zimmerman says, making it easier for you to overcome a balance problem, should one arise. The more your activity calls upon balance skills, the better, he says; balance-intensive activities such as yoga and tai chi, for instance, are particularly effective balance system boosters that might not prevent an inner ear infection, but most likely will help you perform balance-related activities with ease as you age, Zimmerman says.

If yoga and tai chi are not your cup of tea, bowling, tennis – even a brisk one-mile walk while turning your head to the right and left – are good for balance too, Fodero says. Any activity in which you visually focus on something while you move will help to preserve balancing ability, as well as your confidence. "For some older people, the fear of breaking something consumes them," she says. "It becomes their biggest hindrance in living a full life." Ironically, the fear of falling often leads to falls, she says, because people develop unhealthy movement habits that place them at higher risk of stumbling. "Balance is a gift," she says. It's something many of us take for granted. But "every single one of us should be practicing balance on a daily basis to sustain an active, healthy life."