Care & Treatment
The treatment of your balance problem will depend on the cause or causes as well as on your medical history and general health. There are many approaches, and therapy is usually simple and effective.
It is important to have a thorough evaluation of your musculoskeletal system, gait, and mobility, as well as a referral for evaluation and management by physical and occupational therapists if needed. Other disciplines that may play an important role in treatment are rheumatology and physical medicine and rehabilitation.
Inner ear problems
Benign Positional Paroxysmal Vertigo (BPPV)
The Epley maneuver (also called the canalith repositioning procedure) is a series of slow head and body movements. Your healthcare provider will help you through this simple 15-minute office procedure. It is designed to reposition any loose calcium crystals that have made their way into the semi-circular canals in your inner ears. The process is highly effective, painless, and non-invasive, and only takes a few minutes, but it may need to be done a couple of times.
After returning home, you must keep the treated ear above shoulder level for the rest of the day and avoid lying flat. Keep your head slightly elevated on pillows the night of the procedure. By the next day, your symptoms should be gone and restrictions on head positioning are no longer needed.
Your BPPV will most likely resolve itself within a few days or weeks at most. Medications are not recommended for BPPV.
Your healthcare professional may prescribe motion-sickness medications such as meclizine (Antivert) to relieve the acute feelings of vertigo and dizziness, and possibly methylprednisolone to reduce inner ear inflammation. An antibiotic is sometimes prescribed. This condition can also simply resolve without any medications, so you may opt to “wait it out” if your symptoms are not severe.
Your healthcare professional may recommend you go to vestibular rehabilitation to complete vestibular exercises.
Although this is considered a chronic disease, symptoms can be minimized so that you can carry out your daily functions comfortably. As in labyrinthitis, meclinizine (Antivert) can be taken to reduce the sensation of vertigo. Diuretics (water pills) and salt restriction may help reduce the fluid build-up in the inner ear. About 1,500 mg of salt per day should be your limit. Vestibular rehabilitation may also be helpful for persistent symptoms.
Try to distribute your meals evenly throughout the day so that you eat and drink similar amounts several times each day. This can help to regulate the fluids in your body. Five or six small meals may be better than three large ones.
Sudden Low Blood Pressure (orthostatic hypotension)
Your healthcare provider will review your medications to make sure that they are not causing the drop in your blood pressure. You may be prescribed new medications to increase your blood pressure, or your medications or dosages may be altered.
Simple changes to your diet may help to avoid a drop in blood pressure after eating, such as increasing the amount of salt you put in your food, reducing or eliminating alcohol, increasing your intake of fluids, or drinking a cup of coffee and extra fluids at each meal. Further, avoiding sudden shifts in positions is important, especially after you have been in bed all night, sitting for a long time, have just used the bathroom, or after a large meal. Be sure to get up slowly and wait a few minutes until any dizziness has passed before beginning to walk.
Consider wearing over-the-knee pressure stockings which will help to prevent blood pooling in your feet and lower legs. Avoid walking or exercising in hot weather.
A physiotherapist can show you how to pump your ankles and calves and clench your fists and forearms before moving from a lying or sitting to a standing position. This will encourage blood flow to your heart and upper body. Moving slowly and keeping your head elevated when lying down are all simple ways to avoid a sudden drop in blood pressure after a change in position.
Some medications are helpful in treating orthostatic hypotension:
- fludrocortisone increases the amount of blood in your body.
- midodrine can raise blood pressure while you are standing up.
- pyridostigmine, nonsteroidal anti-inflammatory drugs (NSAIDs), and caffeine may also help, though each of these medications run the risk of undesirable side effects.
Medication-related Balance Problems
Your healthcare provider will review all the medications, both prescription and non-prescription (over-the-counter), and herbal supplements that you take. Your provider may recommend changes and dosage adjustments to avoid side effects such as dizziness and unsteadiness. Benzodiazepines, sedatives/tranquilizers, narcotics/opioids, sleeping pills, antipsychotics, blood pressure medicines, antiepileptics, and antidepressants are particularly linked to dizziness, light-headedness, and increased fall risk.
Medical Conditions and Sensory Deficits
Treatments for medical conditions such as heart disease, atherosclerosis (hardening of the arteries), arthritis, Parkinson’s disease, multiple sclerosis, diabetes, nerve abnormalities, numbness (neuropathy), and “mini-strokes” (TIAs) must be reviewed by your healthcare provider. Your provider will make sure that you are being treated appropriately, and that the dosages of medicines are what is right for you.
Your eyesight and hearing should be checked and corrected with glasses or hearing aids if needed. Cataracts, glaucoma, and macular degeneration can be treatable. Follow your healthcare provider’s recommendations.
Last Updated December 2020