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Balance disorders are very difficult to diagnose and treat because there is often more than one underlying cause. Knowledge of all the sensory systems that contribute to balance as well as how each system works together and interacts with the brain is essential.

What causes balance disorders?

  • Benign Positional Vertigo (BPPV) – BPPV is the number one cause of all dizziness. Tiny crystals embedded in the ear become dislodged. The floating crystals cause brief episodes of dizziness/vertigo. These episodes are associated with changes in the position of the head, such as turning over in bed, reaching for something, or sitting or standing up straight.
  • Vestibular Neuronitis – inflammation of the inner ear
  • Ménière’s Disease – a buildup of fluid in the inner ear
  • Vestibular Migraine – dizziness and vertigo that may or may not be accompanied by headaches
  • Head Trauma
  • Multiple Sclerosis
  • Stroke and heart attack
  • Slow-growing tumors
  • Joint and muscle weakness
  • High or low blood pressure
  • Viral infections

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hearing health center

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How are balance disorders diagnosed?

  • Case History: One of the most important components in diagnosing balance disorders. Details about the imbalance can often determine which part of the inner ear or brain is involved.
  • Diagnostic Hearing Evaluation: The hearing system and the vestibular system are very close in physical proximity. They function together. Any part of the ear can cause and/or contribute to a loss of balance.
  • Auditory Brainstem Response: Tests both the ear and the brain by measuring the timing of electrical waves from the brainstem.
  • Voluntary Eye Movement Testing: Measures the ability to coordinate eye movements with head movements crucial for walking, driving, etc.
  • Videonystagmography (VNG): Computerized testing that measures, records and analyzes eye movements under various conditions.
  • Computerized Dynamic Posturography (CDP): Measures and tracks all of the components (eyes, inner ear, muscles and joints) involved in maintaining balance.

How are balance disorders treated?

An individual treatment plan is designed for each patient based upon the patient’s history, the findings from the diagnostic testing performed and the functional limitations caused by the imbalance.


Treatment Types:
  • Epley Maneuver (treatment for BPPV): BPPV is a result of the displacement of small crystals (canaliths) inside the ear, which causes dizziness/vertigo. The Epley Maneuver is a series of head and neck position changes performed by the doctor, with the purpose of moving the displaced canaliths.
  • Balance Retraining: Exercises designed to improve coordination of muscle responses in various situations.
  • Habituation Exercises: Used to make the brain adapt to the dizziness. Purposely trying to evoke the dizziness so the brain can resolve the conflict between the brain and the inner ear.
  • Visual/Motor Exercises: Strengthening gaze stabilization and eye/head coordination.

The goals of all treatment plans are:

  • Decreasing or eliminating dizziness/vertigo
  • Improving balance function and safety
  • Improving visual motor control and tolerance of motion
  • Increasing activity levels
  • Reducing falls or risks of falls