Balance Problems

Treatment

A team of Mayo Clinic specialists experienced in balance problems will develop an individualized treatment plan for you based on the cause of your problem. Since many balance problems originate in your inner ear (vestibular system), an ear, nose and throat (ENT) specialist will typically manage your care. If your balance problem is caused by a neurological, heart or psychiatric condition, your doctor will refer you to the appropriate specialist for treatment.

Among the treatments offered at Mayo Clinic are:

Vestibular rehabilitation

Vestibular rehabilitation therapy is an exercise program for people with inner ear disorders. It is created for you by Mayo Clinic physical therapists specializing in balance problems. Because each person's symptoms are different, therapists design a customized program of balance retraining and eye or head movement exercises to help you compensate for the loss or imbalance in your vestibular system.

Fall prevention

Fall prevention is an important part of vestibular rehabilitation for inner ear disorders and other causes of imbalance such as poor eyesight, poor sensation in the feet or weak leg muscles. Its goal is to prevent falls and to keep you independent and safe. A balance aid such as a walking stick may be all that is needed. Your doctor may refer you to an occupational therapist to discuss home safety and assistive devices.

Positioning procedures

Typically, when the cause of balance problems is benign paroxysmal positional vertigo (BPPV), positioning procedures involving precise head maneuvers are used to clear crystals out of the inner ear canal and deposit them back into the part of the ear where they belong. Mayo Clinic offers several positioning procedures, including the canalith repositioning procedure, Semont's liberatory procedure and a procedure using an electric circle bed that rotates the ear canals 360 degrees in a vertical plane.

Diet and lifestyle changes, and medication management

If you have Meniere's disease, dietary changes such as reducing your salt intake may help your symptoms. Others find that reducing alcohol and caffeine intake or avoiding nicotine use can be helpful. Sometimes doctors recommend antibiotics to manage symptoms. Because of potentially serious side effects, your doctor will carefully monitor antibiotic use and dosage. If you don't respond to these treatments, you may need surgery.

Your doctor may also recommend treatment with medications if the cause of your balance problem is migraine-associated dizziness or a psychological condition such as an anxiety disorder. People with an anxiety disorder may be referred to a psychiatrist for counseling as well.

Surgery

If you have Meniere's disease or acoustic neuroma, your treatment team may recommend surgery as part of your treatment plan.

Meniere's disease

Surgery is sometimes recommended when other treatments have not been successful. Options include:

• Endolymphatic sac decompression. This surgical technique reduces inner ear pressure caused by fluid buildup.
• Vestibular nerve sectioning. Nerve sectioning refers to cutting the nerve that controls balance in the affected ear.
• Labyrinthectomy. Total or near total removal of the inner ear is performed in labyrinthectomy surgery.

Acoustic neuroma

Surgeons remove acoustic neuroma tumors on the acoustic nerve, which connects the ear to your brain, through an incision in your skull. Mayo Clinic surgeons work together to preserve as much of the facial nerve as they can to prevent facial paralysis and preserve hearing, if possible.

Stereotactic radiosurgery

Stereotactic radiosurgery may be suggested as a treatment option for people unable to have surgery. This method delivers radiation precisely to the tumor region through the skin. Effects can take weeks or months to appear. Your doctor will monitor your progress with follow-up imaging scans and hearing tests.

Read more about canalith repositioning procedure and exercises to prevent falls on MayoClinic.com.