Aging & Health A to Z
Diagnosis & Tests
Your healthcare professional will take a detailed medical history and do a physical exam to identify the source of your balance problem. You may be referred to different specialists depending on the suspected source:
- an otolaryngologist or ENT (ear-nose-throat doctor) if ear problems are suspected
- a cardiologist if irregular heartbeats contribute to balance issues
- a neurologist if damaged nerves seem to be at play.
Your healthcare professional will ask you what medicines you take—including both prescription and over-the-counter products.
Check with your physician whether any of your medications might increase your risk of falling, and if a substitution might lower your fall risk.
You will then be asked for information about your symptoms, such as:
- length of time since your symptoms started and how long each episode lasts
- severity or strength of your symptoms
- how often your symptoms return
- if you have vertigo (a sensation that you or the room around you is spinning)
- if you get dizzy when you move your eyes or head
- if you have pain
- if you feel weak, light-headed, or unbalanced
- if you have ringing in your ears (tinnitus)
- if you have a feeling of fullness in your ears
- whether there was a particular event that happened before your symptoms started.
You may also be asked to undergo any of the following tests:
Dix-Hallpike test. This test will check for dizziness or side-to-side movements of your eyes when you lie on your back with your head to one side or the other, and let your head hang slightly off the examination table.
Blood pressure tests. Your blood pressure may be measured while sitting and standing, or when using a tilt table. You may also be asked to wear a 24-hour blood pressure monitor.
Blood tests. This will allow the healthcare professional to check for low blood sugar or anemia (low iron).
Electrocardiogram or echocardiogram. These tests will look for heart abnormalities.
The Valsalva maneuver. This involves taking several deep breaths and then blowing slowly out while your blood pressure and heart rate are monitored. This checks how your autonomic nervous system is working.
In rare cases, the doctor may order further tests, which are simple and painless, such as:
- magnetic resonance imaging (MRI)
- rotation tests with a computer-controlled chair or table
- computerized tomography (CT scan).
These tests can help determine if the root of the problem is in your inner ear or has a different cause.
Common Diagnoses for Balance Problems
Different symptoms help diagnose each type of balance problems.
A diagnosis of Benign Positional Paroxysmal Vertigo (BPPV) can be made if the following signs are present:
- Vertigo is the main symptom, and lasts for a few seconds to minutes.
- The vertigo is brought on by changing head position.
- A positive Dix-Hallpike test.
Labyrinthitis is suspected if you have:
- Vertigo that starts suddenly and is not related to head or body position.
- Vertigo that continues for days.
Meniere’s disease is identified by the presence of:
- Two spontaneous episodes of vertigo, each lasting at least 20 minutes and continuing for hours in many cases.
- Confirmed hearing loss.
- Tinnitus (ringing in the ears) or a feeling of fullness inside one ear.
- No other known causes for these problems.
Sudden low blood pressure (orthostatic hypotension) can be confirmed if you experience:
- Dizziness or lightheadedness lasting from a few seconds to minutes as the main symptom.
- The dizziness and light-headedness appears within one to three minutes after standing up.
- Blurred vision, reduced hearing, head or neck pain, sweating.
- A drop in blood pressure of more than 20% (or more than 20 mm Hg).
Other diagnoses may include:
- Various nervous system conditions that can cause balance problems (visual or hearing deficits, numbness or neuropathy in the feet and legs)
- Transient ischemic attacks (TIAs) or “mini-strokes”
- Inadequate oxygen to the brain (ischemic cerebral disease)
- Pinching of the vertebral artery in your spine
Ask your healthcare provider to evaluate you for fall risk and to recommend exercises and assistive devices to improve your stability and lower your risk for falling.
Updated: March 2012
Posted: March 2012