What is a balance disorder?

A balance disorder is a condition that makes you feel 

unsteady or dizzy, as if you are moving, spinning, or 

floating, even though you are standing still or lying 

down. Balance disorders can be caused by certain 

health conditions, medications, or a problem in the 

inner ear or the brain.

Our sense of balance is primarily controlled by a mazelike structure in our inner ear called the labyrinth, 

which is made of bone and soft tissue. At one end 

of the labyrinth is an intricate system of loops and 

pouches called the semicircular canals and the otolithic 

organs, which help us maintain our balance. At the 

other end is a snail-shaped organ called the cochlea, 

which enables us to hear. The medical term for all of 

the parts of the inner ear involved with balance is the 

vestibular system (see Figure 1).

How does the vestibular system work?

Our vestibular system works with other sensorimotor 

systems in the body, such as our visual system (eyes) 

and skeletal system (bones and joints), to check and 

maintain the position of our body at rest or in motion. 

It also helps us maintain a steady focus on objects 

even though the position of our body changes. The 

vestibular system does this by detecting mechanical 

forces, including gravity, that act upon our vestibular 

organs when we move. Two sections of the labyrinth 

help us accomplish these tasks: the semicircular canals 

and the otolithic organs. 

The semicircular canals are three fluid-filled loops 

arranged roughly at right angles to each other. They 

tell the brain when our head moves in a rotating or 

circular way, such as when we nod our head up and 

down or look from right to left. 

Each semicircular canal has a plump base, which 

contains a raindrop-shaped structure filled with a gellike substance (see Figure 2). This structure, called 

the cupula, sits on top of a cluster of sensory cells, 

called hair cells. The hair cells have long threadlike 

extensions, called stereocilia, that extend into the gel. 

When the head moves, fluid inside the semicircular 

canal moves. This motion causes the cupula to bend 

and the stereocilia within it to tilt to one side. The 

tilting action creates a signal that travels to the brain 

to tell it the movement and position of your head.

Between the semicircular canals and the cochlea lie 

the otolithic organs, which are two fluid-filled pouches 

NIDCD Fact Sheet

Balance Disorders 

U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES ∙ NATIONAL INSTITUTES OF HEALTH ∙ NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS hearing balance Credit: NIH Medical Arts

Figure 1: The vestibular system 

in relation to the ear

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What are the symptoms of a 

balance disorder?

If your balance is impaired, you may feel as if the room 

is spinning. You may stagger when you try to walk or 

teeter or fall when you try to stand up. Some of the 

symptoms you might experience are: 

• Dizziness or vertigo (a spinning sensation)

• Falling or feeling as if you are going to fall

• Lightheadedness, faintness, or a floating sensation

• Blurred vision

• Confusion or disorientation

Other symptoms are nausea and vomiting, diarrhea, 

changes in heart rate and blood pressure, and 

fear, anxiety, or panic. Some people also feel tired, 

depressed, or unable to concentrate. Symptoms may 

come and go over short time periods or last for longer 

periods of time. 

What causes a balance disorder?

A balance disorder may be caused by viral or 

bacterial infections in the ear, a head injury, or 

blood circulation disorders that affect the inner ear 

or brain. Many people experience problems with 

their sense of balance as they get older. Balance 

problems and dizziness also can result from taking 

certain medications. 

In addition, problems in the visual and skeletal systems 

and the nervous and circulatory systems can be the 

source of some posture and balance problems. A 

circulatory system disorder, such as low blood pressure, 

can lead to a feeling of dizziness when we suddenly 

stand up. Problems in the skeletal or visual systems, 

such as arthritis or eye muscle imbalance, also may 

cause balance problems. However, many balance 

disorders can begin all of a sudden and with no 

obvious cause. 

called the utricle and the saccule. These organs tell the 

brain when our body is moving in a straight line, such 

as when we stand up or ride in a car or on a bike. They 

also tell the brain the position of our head with respect 

to gravity, such as whether we are sitting up, leaning 

back, or lying down.

Like the semicircular canals, the utricle and the 

saccule have sensory hair cells. These hair cells line 

the bottom of each pouch, and their stereocilia 

extend into an overlying gel-like layer. On top of the 

gel are tiny grains made of calcium carbonate called 

otoconia. When you tilt your head, gravity pulls on 

the grains, which then move the stereocilia. As with 

the semicircular canals, this movement creates a signal 

that tells the brain the head’s position. 

Our visual system works with our vestibular system 

to keep objects from blurring when our head moves 

and to keep us aware of our position when we walk 

or when we ride in a vehicle. Sensory receptors in our 

joints and muscles also help us maintain our balance 

when we stand still or walk. The brain receives, 

interprets, and processes the information from these 

systems to control our balance.

NIDCD Fact Sheet

Balance Disorders

hearingbalance

Credit: NASA

Figure 2: The role of the cupula in balance

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What are some types of 

balance disorders? 

There are more than a dozen different balance 

disorders. Some of the most common are: 

• Benign paroxysmal positional vertigo (BPPV) 

or positional vertigo is a brief, intense episode 

of vertigo that occurs because of a specific change 

in the position of the head. If you have BPPV, you 

might feel as if you’re spinning when you look for 

an object on a high or low shelf or turn your head 

to look over your shoulder (such as when you back 

up your car). You also may experience BPPV when 

you roll over in bed. BPPV is caused when otoconia 

tumble from the utricle into one of the semicircular 

canals and weigh on the cupula. The cupula can’t 

tilt properly and sends conflicting messages to 

the brain about the position of the head, causing 

vertigo. BPPV sometimes may result from a head 

injury or just from getting older. 

• Labyrinthitis is an infection or inflammation of the 

inner ear that causes dizziness and loss of balance. 

It frequently is associated with an upper respiratory 

infection such as the flu. 

• Ménière’s disease is associated with a change in 

fluid volume within parts of the labyrinth. Ménière’s 

disease causes episodes of vertigo, irregular hearing 

loss, tinnitus (a ringing or buzzing in the ear), and 

a feeling of fullness in the ear. The cause of this 

disease is unknown. For more information, read the 

NIDCD fact sheet Ménière’s Disease at http://www.

nidcd.nih.gov/health/balance/meniere.asp. 

• Vestibular neuronitis is an inflammation of the 

vestibular nerve and may be caused by a virus. Its 

primary symptom is vertigo.

• Perilymph fistula is a leakage of inner ear fluid 

into the middle ear. It can occur after a head injury, 

drastic changes in atmospheric pressure (such as 

when scuba diving), physical exertion, ear surgery, 

or chronic ear infections. Its most notable symptom, 

besides dizziness and nausea, is unsteadiness when 

walking or standing that increases with activity and 

decreases with rest. Some babies may be born with 

perilymph fistula, usually in association with hearing 

loss that is present at birth. 

• Mal de debarquement syndrome (MdDS) is 

a balance disorder in which you feel as if you’re 

continuously rocking or bobbing. It generally 

happens after an ocean cruise or other sea travel. 

Usually, the symptoms will go away in a matter of 

hours or days after you reach land. However, severe 

cases can last months or even years.

How is a balance disorder diagnosed?

Diagnosis of a balance disorder is difficult. There are 

many potential causes—including medical conditions 

and medications. 

To help evaluate a balance problem, your doctor 

may suggest you see an otolaryngologist. An 

otolaryngologist is a physician and surgeon 

who specializes in the ear, nose, and throat. An 

otolaryngologist may request tests to assess the cause 

and extent of the balance problem depending on your 

symptoms and health status. 

The otolaryngologist may request a hearing 

examination, blood tests, an electronystagmogram 

(which measures eye movements and the muscles that 

control them), or imaging studies of your head and 

brain. Another possible test is called posturography. 

For this test, you stand on a special movable platform 

in front of a patterned screen. The doctor measures 

how your body moves in response to movement of the 

platform, the patterned screen, or both.

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Some people with a balance disorder may not be 

able to fully relieve their dizziness and will have 

to develop ways to cope with it on a daily basis. 

A vestibular rehabilitation therapist can help by 

developing an individualized treatment plan that 

combines head, body, and eye exercises to decrease 

dizziness and nausea. 

To reduce your risk of injury from dizziness, avoid 

walking in the dark. You also should wear low-heeled 

shoes or walking shoes outdoors and use a cane or 

walker if necessary. If you have handrails in the home, 

inspect them periodically to make sure they are safe 

and secure. Modifications to bathroom fixtures can 

make them safer. Conditions at work may need to be 

modified or restricted, at least temporarily. Driving a 

car may be especially hazardous. Ask your doctor’s 

opinion about whether it’s safe for you to drive. 

How do I know if I have a 

balance disorder?

Everyone has a dizzy spell now and then, but the term 

“dizziness” may mean something different to different 

people. For some people, dizziness might be a fleeting 

sensation of spinning, while for others it’s intense and 

How is a balance disorder treated?

The first thing a doctor will do to treat a balance 

disorder is determine if your dizziness is caused 

by a medical condition or medication. If it is, your 

doctor will treat the condition or suggest a 

different medication. 

Your doctor also may describe ways for you to handle 

daily activities that increase the risk of falling and 

injury, such as driving, walking up or down stairs, and 

using the bathroom.

If you have BPPV, your doctor might prescribe a series 

of simple movements, called the Epley maneuver, to 

help dislodge the otoconia from the semicircular canal. 

You begin the Epley maneuver by sitting upright, with 

the help of a trained therapist, then quickly lie down 

on your back, turn your head to one side, and wait 

for a minute or two before sitting back up again (see 

Figure 3). For some people, one session will be all that 

is needed. Others might need to repeat the procedure 

several times at home to relieve their dizziness.

If you are diagnosed with Ménière’s disease, your 

doctor may recommend changes in your diet, such 

as reducing the use of salt in your food and limiting 

alcohol and caffeine. Not smoking also may help. 

Some anti-vertigo or anti-nausea medications may 

relieve your symptoms, but they can also make you 

drowsy. Other medications, such as the antibiotic 

gentamicin or corticosteroids, may be injected 

behind the eardrum to reach the inner ear. Although 

gentamicin helps reduce dizziness, it occasionally 

destroys sensory cells in the cochlea and causes 

permanent hearing loss. The risk of hearing loss can be 

lowered if small doses of gentamicin are given off and 

on until your symptoms decrease. Corticosteroids don’t 

cause hearing loss; however, research is underway 

to determine if they are as effective as gentamicin. 

Surgery on the vestibular organ may be necessary if 

you have a severe case of Ménière’s disease.

NIDCD Fact Sheet

Balance Disorders

hearingbalance

Credit: NIDCD

Figure 3: Dislodging otoconia using the 

Epley maneuver

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lasts a long time. Experts believe that more than four 

out of 10 Americans will experience an episode of 

dizziness significant enough to send them to a doctor. 

To help you decide whether or not you should 

seek medical help for a dizzy spell, ask yourself the 

following questions. If you answer “yes” to any of 

these questions, talk to your doctor.

• Do I feel unsteady? 

• Do I feel as if the room is spinning around me? 

• Do I feel as if I’m moving when I know I’m sitting or 

standing still? 

• Do I lose my balance and fall? 

• Do I feel as if I’m falling? 

• Do I feel “lightheaded” or as if I might faint? 

• Do I have blurred vision? 

• Do I ever feel disoriented, such as losing my sense 

of time or where I am? 

How can I help my doctor make 

a diagnosis?

You can help your doctor make a diagnosis and 

determine a treatment plan by answering the 

questions below. Be prepared to discuss this 

information during your appointment. 

1. The best way I can describe my dizziness or balance 

problem is:

2. How often do I feel dizzy or have trouble keeping 

my balance?

3. Have I ever fallen?

• When did I fall?

• Where did I fall?

• Under what conditions did I fall?

• How often have I fallen?

4. These are the medicines I take:

(Include prescription medications and over-thecounter medicine, such as aspirin, antihistamines, 

or sleep aids.)

• Name of medicine: 

• How much (milligrams) ______and how often 

(times) per day: 

• The condition I take this medicine for is: 

What research is being done for 

balance disorders?

BPPV is the most common balance disorder. Because 

the source of the problem—displaced otoconia—is 

located deep within the ear, doctors have had to rely 

mainly on observation and a medical history to make 

a diagnosis. Researchers supported by the National 

Institute on Deafness and Other Communication 

Disorders (NIDCD) now have created a head-mounted 

apparatus that uses 3-D animation to map the location 

of otoconia in the inner ear. The apparatus is built 

around a pair of infrared video goggles that gather 

data from eye and head movements and then sends 

it to a computer program for mapping. A second 

computer program uses the data to develop a stepby-step guide for repositioning maneuvers to dislodge 

the otoconia from the semicircular canals. If shown 

to be effective in clinical trials, the apparatus and its 

software programs will help doctors more accurately 

diagnose BPPV and guide repositioning maneuvers to 

ensure the best possible treatment. 

Other NIDCD-supported scientists are looking at the 

molecular mechanisms that regulate the development 

of the inner ear. One research team has identified 

a gene that encodes a protein that helps in the 

formation of the semicircular canals and their related 

sensory tissue. Another team has identified a family of 

genes, called the otopetrins, which help form otoconia 

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NIDCD supports and conducts research and research training on the 

normal and disordered processes of hearing, balance, smell, taste, 

voice, speech, and language and provides health information, based 

upon scientific discovery, to the public.

hearing, balancesmell, tastevoice, speech, language

NIDCD Fact Sheet: Balance Disorders

NIH Publication No. 09-4374

Updated December 2009

For more information, contact:

NIDCD Information Clearinghouse

1 Communication Avenue

Bethesda, MD 20892-3456

Toll-free Voice: (800) 241-1044

Toll-free TTY: (800) 241-1055

Fax: (301) 770-8977

E-mail: nidcdinfo@nidcd.nih.gov

Internet: http://www.nidcd.nih.gov

The NIDCD Information Clearinghouse is a service of the 

National Institute on Deafness and Other Communication 

Disorders, National Institutes of Health, U.S. Department 

of Health and Human Services.

in mice. Findings from the mouse study could help 

researchers determine if otoconia destroyed by aging, 

medications, infections, or trauma can someday be 

regenerated in humans with balance problems. 

NIDCD-supported scientists also are experimenting 

with several types of vestibular prostheses, or 

replacement parts, in balance-impaired animals. 

Researchers hope these devices will one day be used to 

compensate for vestibular system loss in people. 

One prosthesis uses a head-mounted motion sensor 

to mimic the ear and brain’s natural signaling system. 

The sensor measures the head’s rotation and sends the 

information to a microprocessor. The microprocessor 

then converts the signals into electrical impulses 

and sends them to an electrode implanted in the 

ear. The electrode stimulates the vestibular nerve, 

creating a signal that helps the brain move the eyes to 

compensate for the head’s rotation. 

A second prosthesis is designed to simulate the 

movement of fluid within the semicircular canal. In a 

normal ear, fluid changes help the brain understand 

the movement and position of the head. The 

device combines microcontroller circuitry with a 

tiny mechanical device that increases normal fluid 

movement to provide a stronger vestibular signal to 

the brain. 

Researchers also are studying the effectiveness of 

different types of rehabilitative exercises as a treatment 

option for balance disorders. In one NIDCD-funded 

study, researchers have used virtual reality technology 

to simulate the aisles of a grocery store. Using a real 

cart attached to a custom-built treadmill in front of 

a projection screen, patients “walk” down aisles, 

scanning virtual store shelves for items on their list. 

Researchers are testing whether practicing in the 

virtual store will lessen episodes of dizziness in the real 

world, especially in visually complex environments. 

Where can I get more information? 

The NIDCD maintains a directory of organizations 

that provide information on the normal and 

disordered processes of hearing, balance, smell, taste, 

voice, speech, and language. Please see the list of 

organizations at http://www.nidcd.nih.gov/directory. 

Use the following keywords to help you search for 

organizations that can answer questions and provide 

printed or electronic information on balance disorders:

• Balance

• Vertigo

• Ménière’s disease

For more information, additional addresses and phone 

numbers, or a printed list of organizations, contact:

NIDCD Information Clearinghouse

1 Communication Avenue

Bethesda, MD 20892-3456

Toll-free Voice: (800) 241-1044

Toll-free TTY: (800) 241-1055

Fax: (301) 770-8977

E-mail: nidcdinfo@nidcd.nih.gov

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