What Causes Balance Issues in Older Adults?

A balance issue is a feeling of being unsteady, dizzy, confused, floating, spinning, or lightheaded. There are many disorders and conditions that cause balance issues:

• Meniere’s disease
• Benign paroxysmal positional vertigo (BPPV)
• Vestibular migraine
• Vestibular neuritis
• Labyrinthitis
• Acoustic neuroma
• Persistent postural-perceptual dizziness
• Ramsay Hunt syndrome
• Perilymph fistula
• Motion sickness
• Cardiovascular disease
• Hemodynamic orthostatic hypotension (postural hypotension)
• Medications
• Some neurological conditions
• Vision problems
• Muscles and joints problems
• Psychiatric disorders

1. Which Part of the Body Controls Balance?

The body balance is controlled by different systems and organs including the inner ears, vision, touch, and muscles [1].

• Inner Ear

The inner ear contains the utricle, saccule, and the bony labyrinth which includes the semi-circular canals, and the cochlea.

The utricle and saccule are involved in displacement and linear accelerations such as tilting the head and orientation.

The semi-circular canals are filled with fluids and are involved in the maintenance of balance and coordination.

• Vision

To establish balance, the first sensory inputs (stimuli) to the brain are provided by the vision system. For instance, an individual is steadier if the visual field is clear, while a weak field or no field results in unsteadiness.

• Touch

Touch is a contact between the body and the environment that allows the evaluation of variation in pressure exerted by the body when standing or moving.

• Muscles

Muscles, together with the joints and bone, are essential in maintaining a correct posture and when our body is in movement.

2. What Is Meniere’s Disease?

Meniere’s disease is a disorder of the inner ear characterized by recurrent vertigo, tinnitus, and hearing loss. The causes of these diseases are unknown and may involve genetic and environmental factors [2].

3. What Is Benign Paroxysmal Positional Vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is a disorder of the inner ear labyrinth that manifests with symptoms of episodic vertigo, loss of balance, dizziness, nausea, and vomiting.

It is caused by the displacement of calcium crystal structures within the inner ear saccule and utricle known as uroliths which help hair cells (stereocilia) in converting sound and head movement into neural signals.

The misplacement of these calcium crystal structures can be due to sudden head movement or head trauma [3].

4. What Is Vestibular Neuronitis

Vestibular neuritis is the inflammation of the vestibulocochlear nerve which transmits to the brain, sound, and head movement neural signals that are received from hair cells.

Vestibular neuritis may be caused by infection with viruses such as herpes simplex virus (HSV-1), measles, mumps, or chickenpox [4].

5. What Is Labyrinthitis?

Labyrinthitis is the inflammation of the inner ear labyrinth causing symptoms such as vertigo, hearing loss, nausea, vomiting, and tinnitus [5].

Labyrinthitis is caused by viral and bacterial infection, and rarely by the formation of new bone in the inner ear labyrinth (Labyrinthitis Ossificans).

6. What Is Acoustic Neuroma?

Acoustic neuroma or vestibular schwannoma is a tumor that develops from the Schwann cells on the vestibulocochlear nerve [6].

Schwann cells produce the Schwann myelin sheet that insulates nerves and helps with the transmission of nerve impulses.

The pressure from an acoustic neuroma on the vestibulocochlear nerve results in hearing loss, tinnitus, and unsteadiness.

Acoustic neuroma may be associated with neurofibromatosis type 2, a genetic disease characterized by tumors that grow along nerves.

7. What Is Ramsay Hunt syndrome?

Ramsay Hunt syndrome or geniculate zoster is a rare condition that develops as a complication of an infection by the Varicella-Zoster Virus (VSV), and which affects the genicular ganglion (collection of sensory neurons) of the cranial nerve VII (facial nerve) [7].

It manifests with symptoms such as unilateral facial paralysis, otalgia (ear pain), and vesicles near the ear and auditory canal.

 8. What Is Persistent Postural-Perceptual Dizziness (PPPD)?

PPPD is one the most common cause of chronic dizziness in middle-aged individuals and manifests with symptoms including persistent sensations of rocking, swaying, and dizziness [8].

The cause of PPPD is unknown; however, it often develops following an acute vestibular disorder such as vestibular neuritis.

9. What Is Perilymphatic Fistula?

Perilymphatic Fistula is an abnormal opening between the inner ear and the surrounding structures due to congenital abnormalities or an injury [9].

The symptoms of Perilymphatic Fistula include hearing loss, vertigo, tinnitus, dizziness, spatial disorientation, and nausea.

10. What Is Motion Sickness?

Motion Sickness is due to repeated movements that confuse the brain in making sense of the information received from the eye, ear, and the rest of the body.

11. What Is Vestibular Migraine?

Vestibular migraine is vertigo with migraine that does not necessarily manifest with headaches. The causes of vestibular migraine are unknown; however, genetic factors may be involved [10].

Vestibular migraine has been associated with Meniere’s disease and Benign paroxysmal positional vertigo (BPPV).

12. Cardiovascular Diseases

Cardiovascular diseases that result in a reduction in blood supply to the brain (e.g., atherosclerosis) have been associated with dizziness.

13. Hemodynamic Orthostatic Hypotension (Postural Hypotension)

Hemodynamic orthostatic hypotension or postural hypotension is an excessive decrease in blood pressure while standing up and which manifests with dizziness, confusion, or blurred vision [11].

In some cases, postural hypotension can manifest with seizures and syncope (loss of consciousness).

It can be caused by prolonged bed rest, drugs, a decrease in the volume of circulating blood (hypovolemia), and adrenal insufficiency (reduced production of adrenal steroid hormones).

14. Psychiatric disorders

Several mental health disorders, such as major depressive disorder and anxiety, can cause dizziness.

15. Joint and Muscle Problems

Joint problems such as osteoarthritis or muscle weakness can cause a loss of balance

15. Certain Neurological Conditions

Certain neurological disorders such as multiple sclerosis, peripheral neuropathy, Parkinson’s disease, and cervical spondylosis (wearing and tearing of spinal disks) can cause loss of balance.

16. Vision problems

Vision disorders such as Aniseikonia, vertical imbalance, binocular vision dysfunction can cause dizziness and balance problems.

Aniseikonia is a difference in the perceived size of images between the two eyes.

Binocular vision dysfunction is characterized by uncoordinated vision between the two eyes.

Vertical imbalance of the eyes is characterized by a vertical misalignment of the eyes.

17. Medications

Drug abuse such as the excessive consumption of the psychoactive drug, benzodiazepines, can cause dizziness and loss of balance.

Conclusion

The body balance involves coordination between the inner ear, the vision system, and the muscles. Anomalies that affect one of these three actors can result in a loss of balance, dizziness, and vertigo.