Why choose Mayo Clinic

By Mayo Clinic Staff

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Diagnosing Nick's Mysterious Illness

Melissa Shultz, a freelance writer living in Plano, Texas, wrote an article for Newsweek online about her son Nick's mysterious illness and his diagnosis and treatment at Mayo Clinic. Fatigue set in a day after Nick's dizziness started. Swollen glands followed close behind. Our general practitioner ordered blood work, including studies for mononucleosis and Lyme [...]

  • Experience. Mayo Clinic doctors diagnose and treat thousands of people for balance problems each year.
  • Diagnosis capabilities. Mayo Clinic offers the latest diagnostic tests to help identify the cause of your balance problem. Mayo Clinic is one of few medical centers in the country to offer comprehensive testing in state-of-the-art vestibular and balance laboratories.
  • Team approach. A team of doctors trained in ear, nose and throat conditions (ENT doctors), hearing conditions (audiologists), brain and nervous system conditions (neurologists), brain and nervous system surgery (neurosurgeons), mental health conditions (psychiatrists and psychologists), physical medicine and rehabilitation (physiatrists), and physical therapists work together to identify the source of your balance problem. Your team will discuss treatment options with you and recommend a treatment approach for you.

Types

Many types of balance problems exist. Balance problems may be caused by several different conditions.

Vertigo

Some people experience a sense of motion or spinning (vertigo). Vertigo may be caused by many conditions, including:

  • Benign paroxysmal positional vertigo (BPPV). BPPV is caused by particles that come loose from the area in which they are held and move into other parts of the inner balance organ and change the way those parts function.
  • Meniere's disease. In Meniere's disease, sudden vertigo, fluctuating hearing loss, and buzzing, ringing or a feeling of fullness in your ear occurs, but the cause is unknown.
  • Migrainous vertigo. A migraine headache may cause sensitivity to motion and dizziness.
  • Acoustic neuroma. An acoustic neuroma is a noncancerous (benign) tumor that develops on a nerve that affects your hearing and balance. Symptoms may include dizziness, loss of balance, hearing loss and ringing in your ear.
  • Motion sickness. You may experience dizziness while riding in boats, cars and airplanes, or on amusement park rides.
  • Vestibular neuritis. A certain inflammatory disorder (vestibular neuritis) may cause damage to the balance portion of the inner ear and the nerve from that part of the inner ear, which may cause vertigo, nausea, imbalance and other symptoms.
  • Herpes zoster oticus. People with an active herpes zoster infection that involves the ear may experience vertigo, ear pain and other symptoms.
  • Injury. You may experience symptoms of vertigo due to a head injury, such as a mild traumatic brain injury (concussion).

Presyncope

Some people may feel faint (presyncope) but remain conscious. They also may experience lightheadedness, dizziness or other symptoms.

  • Blood pressure drop (orthostatic hypotension). Some people may experience a significant drop in their blood pressure after standing or sitting up too quickly.
  • Cardiovascular diseases. Some heart and blood vessel diseases may cause presyncope. Heart diseases, including abnormal heart rhythms (arrhythmias), narrowed or blocked blood vessels, a thickened heart muscle (hypertrophic cardiomyopathy), or a decrease in blood volume, may reduce blood flow and cause presyncope.

Disequilibrium

Some people may feel imbalanced (disequilibrium) or lose their balance easily when walking.

  • Inner ear problems. Abnormalities in your inner ear (vestibular problems) can cause a sensation of a floating or heavy head, and unsteadiness in the dark.
  • Peripheral neuropathy. Nerve damage in your legs (peripheral neuropathy) may cause balance problems.
  • Joint, muscle or vision problems. Muscle weakness and unstable joints can contribute to your loss of balance. Vision difficulties also can lead to imbalance.
  • Medications. Loss of balance may be a side effect from use of medications.
  • Cervical spondylosis, Parkinson's disease and other conditions. Cervical spondylosis, Parkinson's disease and other conditions may cause imbalance.

Lightheadedness

Lightheadedness or dizziness may be due to many causes.

  • Inner ear problems. Abnormalities of the inner ear (vestibular problems) can lead to a false sense of motion and a sensation of floating.
  • Psychiatric disorders. People may experience dizziness or lightheadedness with depression, anxiety disorders or other psychiatric disorders.
  • Hyperventilation. Abnormally rapid breathing (hyperventilation) often accompanies anxiety disorders and may cause lightheadedness.
  • Medications. Lightheadedness or dizziness may be a side effect from medications.

Read more about dizziness, benign paroxysmal positional vertigo (BPPV), Meniere's disease, migraine, acoustic neuroma, orthostatic hypotension, heart arrhythmias, hypertrophic cardiomyopathy, peripheral neuropathy, cervical spondylosis, Parkinson's disease, depression and generalized anxiety disorder.

Diagnosis

Mayo Clinic doctors trained in ear, nose and throat conditions, brain and nervous system conditions (neurologists), and other specialties evaluate you to determine the cause of your balance problem.

To diagnose your balance problem, your doctor will review your medical history and your symptoms. Your doctor will conduct a physical and neurological examination.

Your doctor may order several tests to determine the cause of your balance problem. Your tests may include vestibular tests to determine whether your symptoms are caused by problems in the balance (vestibular) function in your inner ear. Mayo Clinic is among few medical centers in the country to offer comprehensive diagnostic testing in state-of-the-art vestibular and balance laboratories.

  • Hearing tests. Many hearing tests, such as audiometry and others, evaluate your hearing in your inner ear and can help determine the cause of your balance problem.
  • Posturography test. A posturography test indicates which parts of your balance system you rely on most.
  • Electronystagmography (ENG) and video nystagmography. These tests analyze eye movements to evaluate your balance (vestibular) function in your inner ear. Your doctor may use an ENG to assess if your balance problems are due to problems in your inner ear.
  • Rotary chair test. This test analyzes eye movements while you're seated in a computer-controlled chair that moves slowly in one place in a circle.
  • Dix-Hallpike maneuver. In this test, your doctor carefully turns your head in different positions while watching your eye movements to determine if you have a false sense of motion or spinning.
  • Vestibular evoked myogenic potentials test. In a vestibular evoked myogenic potentials (VEMPs) test, sensor pads with wires (electrodes) attached to your neck, under your eyes and forehead measure tiny changes in muscle contractions in reaction to sounds.
  • Imaging tests. Your doctor may recommend imaging tests, including magnetic resonance imaging (MRI) or computerized tomography (CT) scans, to determine if brain conditions may be causing your balance problem.
  • Blood pressure and heart rate tests. You may have your blood pressure checked when sitting and then after standing for 2 to 3 minutes to determine if you have significant drops in blood pressure (orthostatic hypotension). Also, you may have your heart rate checked when standing. These tests can help determine if a heart condition or other conditions may be causing your symptoms.

Treatment

A team of Mayo Clinic doctors trained in balance problems, including doctors trained in ear, nose and throat conditions, brain and nervous system conditions (neurologists) and other specialties, treats your condition.

Your treatment depends on the cause of your balance problems. Doctors will work with you to develop an individualized treatment plan. Your treatment may include:

  • Vestibular rehabilitation. People with inner ear or central nervous system disorders may benefit from balance retraining exercises (vestibular rehabilitation). Therapists trained in balance problems will work with you to design a customized program of balance retraining and exercises. Therapy may help you compensate for imbalance, adapt to less balance and maintain physical activity.
  • Fall prevention. In vestibular rehabilitation, your therapists will work with you to prevent falls. Some people may benefit from a balance aid, such as a walking stick or cane. Therapists also may discuss with you home safety and assistive devices to help reduce your risk of falls in your home.
  • Positioning procedures. If the cause of your balance problems is benign paroxysmal positional vertigo (BPPV), a therapist may conduct a positioning procedure, which involves maneuvering the position of your head. This procedure clears particles out of your inner ear canal and deposits them into a different area of your ear, which often reduces or resolves your symptoms. Canalith repositioning procedures may help improve your condition.
  • Diet and lifestyle changes. Diet and lifestyle changes may help some people with balance problems. If you have Meniere's disease, reducing your salt intake may help your symptoms. Some people with migraine-related dizziness also may benefit by reducing caffeine, alcohol, nicotine and chocolate. If you experience drops in blood pressure when standing (orthostatic hypotension), you may need to drink more fluids, wear compressive stockings or undergo postural conditioning.
  • Medications. If you have Meniere's disease, migrainous vertigo or psychiatric disorders, some medications may help manage your balance problems.
  • Surgery. If you have Meniere's disease or acoustic neuroma, your treatment team may recommend surgery. Stereotactic radiosurgery may be an option for some people with acoustic neuroma. This procedure delivers radiation precisely to your tumor and doesn't require an incision.

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

 

Mayo Clinic in Rochester, Minn., ranks #1 for ear, nose and throat in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Scottsdale, Ariz., is ranked among the Best Hospitals, and Mayo Clinic in Jacksonville, Fla., is ranked high performing for ear, nose and throat by U.S. News & World Report.

Mayo Clinic in Rochester, Minn., ranks #1 for neurology and neurosurgery in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Scottsdale, Ariz., is ranked among the Best Hospitals for neurology and neurosurgery, and Mayo Clinic in Jacksonville, Fla., is ranked high performing for neurology and neurosurgery by U.S. News & World Report.

Mayo Clinic: Answers you can trust

At Mayo Clinic, we assemble a team of specialists who take the time to listen and thoroughly understand your health issues and concerns. We tailor the care you receive to your personal health care needs. You can trust our specialists to collaborate and offer you the best possible outcomes, safety and service.

Mayo Clinic is a not-for-profit medical institution that reinvests all earnings into improving medical practice, research and education. We're constantly involved in innovation and medical research, finding solutions to improve your care and quality of life. Your doctor or someone on your medical team is likely involved in research related to your condition.

Our patients tell us that the quality of their interactions, our attention to detail and the efficiency of their visits mean health care — and trusted answers — like they've never experienced.

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