Diagnosis

Your doctor will start by reviewing your medical history and conducting a physical and neurological examination.

To determine if your symptoms are caused by problems in the balance function in your inner ear, your doctor is likely to recommend tests. They might include:

  • Hearing tests. Difficulties with hearing are frequently associated with balance problems.
  • Posturography test. Wearing a safety harness, you try to remain standing on a moving platform. A posturography test indicates which parts of your balance system you rely on most.
  • Electronystagmography and video nystagmography. Both tests record your eye movements, which play a role in vestibular function and balance. Electronystagmography uses electrodes and video nystagmography uses small cameras to record eye movements.
  • Rotary chair test. Your eye movements are analyzed while you sit in a computer-controlled chair that moves slowly in one place in a circle.
  • Dix-Hallpike maneuver. 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. Sensor pads attached to your neck and forehead and under your eyes measure tiny changes in muscle contractions in reaction to sounds.
  • Imaging tests. MRI and CT scans can determine if underlying medical conditions might be causing your balance problem.
  • Blood pressure and heart rate tests. Your blood pressure might be checked when sitting and then after standing for two to three minutes to determine if you have significant drops in blood pressure. Your heart rate might be checked when standing to help determine if a heart condition is causing your symptoms.

Treatment

Treatment depends on the cause of your balance problems. Your treatment may include:

  • Balance retraining exercises (vestibular rehabilitation). Therapists trained in balance problems design a customized program of balance retraining and exercises. Therapy can help you compensate for imbalance, adapt to less balance and maintain physical activity. To prevent falls, your therapist might recommend a balance aid, such as a cane, and ways to reduce your risk of falls in your home.
  • Positioning procedures. If you have BPPV, a therapist might conduct a procedure (canalith repositioning) that clears particles out of your inner ear and deposits them into a different area of your ear. The procedure involves maneuvering the position of your head.
  • Diet and lifestyle changes. If you have Meniere's disease or migraine headaches, dietary changes are often suggested that can ease symptoms. If you experience orthostatic hypotension, you might need to drink more fluids or wear compressive stockings.
  • Medications. If you have severe vertigo that lasts hours or days, you might be prescribed medications that can control dizziness and vomiting.
  • Surgery. If you have Meniere's disease or acoustic neuroma, your treatment team may recommend surgery. Stereotactic radiosurgery might be an option for some people with acoustic neuroma. This procedure delivers radiation precisely to your tumor and doesn't require an incision.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Balance problems care at Mayo Clinic

May 17, 2018
References
  1. Furman JM, et al. Evaluation of the patient with vertigo. http://www.uptodate.com/home. Accessed Oct. 1, 2015.
  2. Balance disorders. National Institute on Deafness and Other Communication Diseases (NIDCD). https://www.nidcd.nih.gov/health/balance-disorders. Accessed April 13, 2018.
  3. Rakel RE, et al., eds. Otorhinolaryngology. In: Textbook of Family Medicine. 9th ed. Philadelphia, Pa.: Elsevier Saunders; 2016. http://www.clinicalkey.com. Accessed Oct. 2, 2015.
  4. Furman JM, et al. Pathophysiology, etiology, and differential diagnosis of vertigo. http://www.uptodate.com/home. Accessed Oct. 2, 2015.
  5. Marx JA, et al., eds. Dizziness and vertigo. In: Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2014. http://www.clinicalkey.com. Accessed Oct. 12, 2015.
  6. Branch WT, et al. Approach to the patient with dizziness. http://www.uptodate.com/home. Accessed Oct. 1, 2015.
  7. Riggin EA. Allscripts EPSi. Mayo Clinic, Rochester, Minn. March 12, 2018.
  8. Shepard NT (expert opinion). Mayo Clinic, Rochester, Minn. April 18, 2018.
  9. Barton JJS. Benign paroxysmal positional vertigo. http://www.uptodate.com/home. Accessed Oct. 1, 2015.
  10. Black DF, et al. Vestibular migraine. http://www.uptodate.com/home. Accessed Oct. 1, 2015.
  11. Thompson KJ. Retrospective review and telephone follow-up to evaluate a physical therapy protocol for treating persistent postural-perceptual dizziness: A pilot study. Journal of Vestibular Research. 2015;25:97.
  12. Moskowitz HS, et al. Meniere disease. https://www.uptodate.com/contents/search. Accessed April 13, 2018.
  13. Vestibular testing. American Hearing Research Foundation. http://american-hearing.org/disorders/vestibular-testing/#rotatory. Accessed Oct. 12, 2015.
  14. Furman JM, et al. Treatment of vertigo. http://www.uptodate.com/home. Accessed Oct. 2, 2015.
  15. Kaufmann, H. Treatment of orthostatic and postprandial hypotension. http://www.uptodate.com/home. Accessed Oct. 2, 2015.
  16. Park JA, et al. Vestibular schwannoma (acoustic neuroma). http://www.uptodate.com/home. Accessed Oct. 2, 2015.
  17. Bisdorff A, et al. Classification of vestibular symptoms: Towards an international classification of vestibular disorders. Journal of Vestibular Research. 2009;19:1.