Whether it’s recurrent lightheadedness, a fleeting spell of dizziness, or the world around you going into a spin ever so often, balance disorder can strike in different ways. From side effects of medication and low blood pressure to ear infections, problems with the visual and skeletal systems, and head injuries that impact the inner ear or brain, there can be many causes for balance issues. Treatment for your condition will depend on what the underlying cause is and what type of balance disorder you have (see Common Types Of Balance Disorders below).
It’s extremely important to get the right treatment or therapy to ease discomfort and improve your quality of life. It is also imperative you get help in time to prevent a nasty fall or an accident just waiting to happen.
If you experience symptoms of a balance disorder, your next step is to get correctly diagnosed. Share information on your imbalance and dizziness symptoms with your doctor at the earliest – if possible, with timelines and details of triggers of episodes of dizziness/balance/hearing loss.
Specialists like ENTs, neurologists, neurotologists, vestibular physiotherapists, and audiologists may be roped in to understand the problem and suggest lines of treatment.1 The various mainstream and alternative treatment options from physiotherapy to therapy, medication, and even surgery are listed below.
1. Practice Balance Retraining Exercises To Cure Dizziness
If you are struggling with balance problems and dizziness, balance retraining is a great option to consider. These involve simple movements of the head and eyes. They start by helping reduce dizziness when you’re sitting still and then incorporate standing up and eventually moving. The exercises may make you a little dizzy at first, but they will go a long way in restoring your movement. It is best to work with a trained physical therapist who specializes in inner ear disorders.2
For people whose condition is very bad, making exercises difficult, medication may also be required, though this is not usually the case. Do remember that balance retraining does not work for all manner of dizziness, so you will first need to check if it can help with your medical condition.3
2. Try Vestibular Rehabilitation Therapy To Improve Coordination
Vestibular rehabilitation therapy (VRT) can be helpful to treat a persistent imbalance problem in those with benign positional paroxysmal vertigo (BPPV). It can also improve postural control and gaze stability and even help ring down residual dizziness for those with vestibular neuritis.4 This therapy especially offers respite to people with Mal de Debarquement, a condition that does not respond to other standard treatments for balance disorders.5
A trained vestibular or physical therapist will help you through a series of training exercises that strengthen your coordination and balance skills. The treatment may involve practicing standing, walking with eyes open/closed, bending down, walking barefoot on different uneven surfaces, and even swimming.6
While the deficit you may experience with most forms of vestibular disorder will be permanent, vestibular and balance rehabilitation therapy can help restore function by compensation. So your brain will use its other senses to compensate for the impairment in the vestibular system. How well the treatment works will depend on the health of the other parts of the nervous system which will need to compensate. But after undergoing the therapy, you should experience fewer falls. There will also be reduced incidence of dizziness, imbalance, and vertigo.7
3. Get Physiotherapy To Fight Vertigo And Dizziness
If you have vertigo or problems with dizziness, a physiotherapist can also manipulate your body to help relieve these problems. A main line of treatment for vertigo, canalith repositioning procedures like the Semont and Epley maneuvers can be performed to free up debris in your ear that’s causing vertigo.8
The Semont maneuver involves flipping you from one side to the other rapidly with a view to moving any debris from the sensitive section of the ear canal to somewhere less sensitive. The Epley maneuver is also done to move crystal debris called canaliths to other parts of the ear so they can move freely.
4. Take Medications That Ease Vestibular Symptoms
Vestibular suppressants are medications designed specifically to treat motion sickness and/or eye movements caused by vestibular imbalance. They are antihistamines, anticholinergics, or benzodiazepines.9 Depending on what kind of balance disorder you have, certain medication may also be prescribed to alleviate symptoms as follows:10
- Vestibular neuritis: Vestibular suppressants and corticosteroids
- Labyrinthitis: Medication to treat bacterial/viral infection, vestibular suppressants, and steroids
- Meniere’s disease: Vestibular suppressants if you have acute attacks or ototoxic antibiotics
- Perilymph fistula: Decongestants and allergy medication to clear clogged Eustachian tubes and minor tranquilizers11
5. Try Listening Therapy And Devices To Restore Hearing
Some individuals with balance disorders may also be struggling with hearing loss. If the loss of hearing is bad, it also affects balance. Which is why it is important to get the necessary therapy or have an implant to fix the problem. Here are the commonly offered alternatives12:
- Hearing aid
- Cochlear implant which is surgically implanted
- Listening therapy that uses sounds and music to help you adapt your balance and hearing – must be done with an audiologist
- Auditory trainer, a specialized device that can filter out background noises so you can focus on the important sounds
6. Adapt Diet To Maintain Fluid And Blood Stability
If you have Meniere’s disease or secondary endolymphatic hydrops, it is important to keep the inner-ear fluid stable. Regulating your water and food intake can help this along. Here are some tips you can follow13:
- Have a meal plan so you eat at regular intervals, about the same amount each time, and don’t skip meals.
- Avoid high-sugar and high-salt foods. This is easiest achieved through a food rich in fresh produce.
- Drink fluids through the day. Aim at drinking at least 5 glasses of water spaced evenly through the day.
- Don’t have food or drink with caffeine.
- Avoid alcohol.
- Do not consume tobacco or products containing tobacco.
7. Have Vitamin B And Magnesium Foods To Prevent Migraines
Certain foods can ring down the incidence of migraines. By consuming them, you are less likely to have a bad headache which can bring on spells of dizziness and nausea.
- Have magnesium-rich foods like legumes, beans, pumpkin seeds, walnuts, brazil nuts, almonds, pine nuts, green leafy vegetables, and whole grains.14 Research shows that daily intake of magnesium can help reduce headache frequency among migraine-prone individuals.15
- Get in vitamin B-rich foods like meat, milk, eggs, nuts, and green vegetables to reduce migraine frequency.16 17 Vitamin B3 that is found in organ meat, salmon, tuna, swordfish, brewer’s yeast, sunflower seeds, beets, and peanuts18 has vasodilatory properties and can boost circulation and suppress inflammation that is associated with migraines.19
8. Avoid Foods That Trigger Migraines
If you have migraine-associated dizziness, modification of diet can help avoid triggering a migraine. Watch for foods that set you off and steer clear of them. Common offenders include:20
- Peanut butter
- Citrus fruit
- Fermented and pickled foods
- Hot dogs, bacon, salami and other nitrate-containing foods
- Smoked fish, chicken livers, aged cheese, red wine, figs which have tyramine (amino acid)
- Monosodium glutamate (MSG)
9. Get Enough Water, Salt, And Potassium For Low BP
If you have balance issues and dizziness linked to low blood pressure or orthostatic hypotension, a diet that’s high in both sodium and potassium as well as fluids is important. Aim at consuming 1.25 to 2.5 liters of water daily depending on how active you are. Consume 10 to 20 g of salt to get in 150 to 250 mmol of sodium. Eat potassium-rich foods like bananas and vegetables to keep the electrolyte balance right.21
10. Use Pressure Stockings And Massage Limbs For Low BP
Over-the-knee pressure stockings can help prevent blood pooling in your lower extremities due to orthostatic hypotension. In addition, learn to clench fists and massage ankles, calves, and forearms before you shift from supine or seated positions to standing. This helps stimulate blood flow to the upper body and prevents your blood pressure from dipping suddenly. You could thus avoid the dizziness and loss of balance that follow.22
11. Try Gingko Biloba To Suppress Vertigo
In some parts of the world like France, gingko biloba is an accepted and widely used alternative treatment for vertigo. Animal studies have shown its effectiveness in enhancing vestibular compensation.23 As studies have found, this extract taken with vestibular training can help those with Ménière’s syndrome, neuropathia vestibularis, as well as posttraumatic vertigo. What’s more, there are early indications that the herbal remedy also acts swiftly, showing results in as little a few hours. 24
However, more large-scale human studies are needed to test for both effectiveness and safety of the remedy. Do be sure to check with your doctor if you decide to take this remedy. There is the off-chance of an adverse interaction with some other medication or treatment you are on.
12. Explore Surgery To Tackle Severe Balance Disorder
If your vertigo attacks are frequent or very intense or put you in life-threatening situations, you may want to consider surgery. In Meniere’s disease, a labyrinthectomy or vestibular nerve section may help those suffering from debilitating or frequent attacks.25 A perilymph fistula often heals itself if you undertake strict bed rest for a few weeks as it closes. Doctors tend to observe it for at least 6 months before deciding to do surgical repair, to allow for natural healing first. If it fails to resolve through conservative treatment, you may need surgery to repair the fistula.26
Common Types Of Balance Disorders
Like we said, the treatment option you choose will depend on the type of balance disorder you have and what’s causing it. What follows are some of the most common disorders to affect the vestibular system that controls the balance of your body.27
According to the Vestibular Disorders Association (VEDA), balance disorders most people are diagnosed with include benign positional paroxysmal vertigo (BPPV), Meniere’s disease, labyrinthitis, and secondary endolymphatic hydrops.28
- Benign positional paroxysmal vertigo (BPPV): Often referred to simply as “vertigo,” BPPV happens when you change the position of your head. The result is an overwhelming and intense, albeit short-lived, episode of vertigo. Trigger movements could be tilting, raising, turning or bending the head, or even rolling over when you’re lying down. This condition can set in with old age or may happen due to a head injury that causes incorrect information to be transmitted to your vestibular system – for instance, making it seem like your head is one position when it is in another.29
- Labyrinthitis: If you have an infection of the inner ear or there is some kind of inflammation in this region, say if you have the flu or some other upper respiratory infection, you may lose your sense of balance and experience dizziness.30
- Meniere’s disease: This inner ear disorder causes dizziness, hearing loss, ringing/buzzing in the ear (tinnitus), or congestion and a feeling of fullness in the ears. You may experience sudden dizziness that comes unannounced or happens after a spell of muffled hearing or tinnitus. If the vertigo is very bad, it can cause you to lose your balance and even fall down. Attacks may be close together or far apart – this varies for each person.31
- Secondary endolymphatic hydrops: When the pressure, composition, or quantity of the fluid in the endolymphatic sac, a compartment of your inner ear, is out of whack, it can bring on imbalance, dizziness, tinnitus, or a feeling of fullness in the ears. Secondary endolymphatic hydrops may be triggered by ear surgery, head trauma, inner ear disorders, systemic disorders like diabetes or autoimmune problems, or even allergies.32
- Vestibular neuronitis: A viral infection of the vestibular nerve results in inflammation, which in turns causes episodes of vertigo.33
- Perilymph fistula: If you’ve had a head injury or been exposed to extreme changes of air pressure like when you go mountaineering or scuba diving, you could be susceptible to developing this condition. Physical exertion may also trigger the problem. A chronic ear infection or ear surgery may also be to blame. A perilymph fistula causes the fluid from your inner ear to leak into your middle ear, resulting in dizziness as well as nausea. It gets worse when your activity levels increase.34
- Mal de debarquement syndrome (MdDS): This syndrome may set in after being on an ocean liner or undertaking other sea travel. It can make you feel like you’re perpetually rocking or bobbing. For most people, the problem resolves after a few hours on dry land. For the less fortunate it can linger for months or years.35
- Vestibular migraine: An estimated 40 percent of those with a migraine problem also have some symptoms of vestibular syndrome like dizziness or balance issues, as well as nausea. This kind of headache is marked by unilateral head pain, a throbbing/pounding in the head, sensitivity to noise and light, and progressive increase in intensity of the pain.36
- Low blood pressure/orthostatic hypotension: A specific kind of low blood pressure problem where your blood vessels do not constrict when you stand upright, orthostatic hypotension causes dizziness, lightheadedness, blurred vision, nausea and muscular tremors.37
|↑1||Vestibular disorders. Whirled Foundation.|
|↑2||Treatment for Vestibular Disorders. NCBI.|
|↑3||Balance Retraining: Exercises Which Speed Recovery from Dizziness & Unsteadiness. VEDA.|
|↑4, ↑8, ↑10, ↑25||Differential Diagnosis and Treatment of Common Vestibular Disorders. American Physical Therapy Association, Neurology Section.|
|↑5||Mal de Debarquement. National Organization for Rare Disorders.|
|↑6, ↑12||Balance disorders. The Nemours Foundation.|
|↑7||Vestibular Rehabilitation Therapy. VEDA.|
|↑9, ↑23||Medical Treatment of Vertigo. American Hearing Research Foundation.|
|↑11, ↑26||Perilymph fistula. American Hearing Research Foundation.|
|↑13||Dietary Considerations for Secondary Endolymphatic Hydrops, Meniere’s Disease, and Vestibular Migraine. VEDA.|
|↑14||Magnesium. University of Maryland Medical Center.|
|↑15||Peikert, A., C. Wilimzig, and R. Köhne-Volland. “Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study.” Cephalalgia 16, no. 4 (1996): 257-263.|
|↑16||Riboflavin. U.S. National Library of Medicine.|
|↑17||Vitamin B-2. National Headache Foundation.|
|↑18||Vitamin B3. University of Maryland Medical Center.|
|↑19||Prousky, Jonathan, and Dugald Seely. “The treatment of migraines and tension-type headaches with intravenous and oral niacin (nicotinic acid): systematic review of the literature.” Nutrition journal 4, no. 1 (2005): 3.|
|↑20||Migraine Headache. University of Maryland Medical Center.|
|↑21||Figueroa, Juan J., Jeffrey R. Basford, and Phillip A. Low. “Preventing and treating orthostatic hypotension: as easy as A, B, C.” Cleveland Clinic journal of medicine 77, no. 5 (2010): 298.|
|↑22||Balance Problems Care and Treatment. American Geriatrics Society.|
|↑24||Diamond, Bruce J., Samuel C. Shiflett, Nancy Feiwel, Robert J. Matheis, Olga Noskin, Jennifer A. Richards, and Nancy E. Schoenberger. “Ginkgo biloba extract: mechanisms and clinical indications.” Archives of physical medicine and rehabilitation 81, no. 5 (2000): 668-678.|
|↑27||Balance disorders. National Institute on Deafness and Other Communication Disorders.|
|↑28||Types of Vestibular Disorders. VEDA.|
|↑29, ↑30, ↑31, ↑33, ↑34, ↑35||Balance disorders. National Institute on Deafness and Other Communication Disorders.|
|↑32||Secondary endolymphatic hydrops. VEDA.|
|↑36||Vestibular Migraine. VEDA.|
|↑37||Dizziness – orthostatic hypotension. Department of Health & Human Services, State Government of Victoria, Australia.|