Balance Problems


Some chronic conditions can come together to produce balance problems.  Those conditions and their symptoms are described below.

Inner Ear Problems

Your inner ear contains many tiny structures that together make up the vestibular system (your balance control center). These structures include the fluid-filled semi-circular canals of the labyrinth in the ear. The semi-circular canals are lined with tiny hairs and also contain many nerves. The hairs and nerves work together so you automatically have a sense of the position of your head, as well as the movements of your body and the pull of gravity. There are also calcium crystals inside the labyrinth that help you sense movement and gravity.

Researchers report that the number of nerve cells in the vestibular system drops after the age of 55 years. This decline gets worse the older we get.

Conditions that Cause Vertigo

Benign Paroxysmal Positional Vertigo (BPPV)

Sometimes, the calcium crystals in your inner ear break loose. This can be caused by an ear infection, a bump on the head, ear surgery, or aging. The crystals can then travel into one of the semicircular canals. When you move your head, these misplaced crystals can shift position. If this happens, incorrect messages may be sent to your brain about your head position.

BPPV comes on suddenly and powerfully.  It is the most common cause of vertigo in older people.  Moving, standing up, turning in bed, or slightly changing your head position makes it worse. The intense symptoms usually come and go, and last for less than a minute. But they tend to reappear frequently over the course of many days. Along with vertigo, you may also experience:

  • dizziness and lightheadedness
  • unsteadiness and loss of balance
  • blurred vision
  • rapid side-to-side eye movements that are not under your control
  • nausea and vomiting
  • migraines

Labyrinthitis (acute vestibular neuritis)

Inflammation and swelling in your inner ear is called labyrinthitis. This can cause intense, constant vertigo that starts suddenly and can last for days. Its main causes are upper respiratory infections and other viral infections, but stress, fatigue, allergies, smoking, or alcohol use can raise your risk for labyrinthitis. You may also have nausea, vomiting, loss of balance or hearing loss.

This condition usually clears up on its own after a few days, but you may have to stay in bed until your symptoms disappear.

Meniere’s Disease

Meniere’s disease is much less common than BPPV or labyrinthitis. It can show up at any age, although it usually appears in adults in their 40s or 50s. It is a long-term condition caused by a buildup of fluid in the inner ear, which can result from viral infections, allergies, or any number of other factors.

Meniere’s disease can cause the following symptoms:

  • sudden feelings of vertigo lasting for 30 minutes to several hours
  • hearing loss that comes and goes, but results eventually in some permanent deafness
  • buzzing, ringing, whistling, or roaring sound in the ear (tinnitus)
  • a feeling of fullness in the ear

Vestibular Migraine

Some people who get migraine headaches also experience vertigo and other types of dizziness during the migraine or between migraine headaches.

Acoustic Neuroma

This is a benign (non-cancerous) growth on the nerve that connects the inner ear to the brain. Symptoms of an acoustic neuroma may include vertigo, hearing loss, and tinnitus in one ear.

Other Causes of Vertigo

Vertigo can also be a signal of a stroke, brain hemorrhage, or multiple sclerosis. With these serious conditions, you will have other symptoms along with the vertigo. These include severe balance problems, double vision, slurred speech, facial weakness or numbness, and others. However, a healthcare provider will quickly recognize that these symptoms are related to the conditions mentioned above.

Sudden low blood pressure (orthostatic or postural hypotension)
A sudden drop in blood pressure when you sit up or stand up is called orthostatic hypotension. This kind of low blood pressure causes lightheadedness within three minutes of sitting up or standing. It lasts from a few seconds to several minutes. Along with the feeling of faintness, you may feel nauseated and have pale or clammy skin.

When you sit up or stand up quickly after sitting or lying down, gravity makes your blood collect in your legs. For a short time period, there isn’t enough blood for your heart, your brain, and the rest of your body. 

Normally, when you stand quickly, your nerves and arteries work together to counteract the force of gravity and keep your blood evenly distributed throughout your body. Your heart beats faster, your arteries narrow, more blood circulates, and blood pressure stabilizes. But many conditions and medications common in older people can interrupt this natural process. This can cause a sudden drop in your systolic blood pressure (the upper number in your blood pressure reading).

Examples of some conditions that can bring on sudden low blood pressure include:

  • Dehydration – from not drinking enough fluids, fever, diarrhea, vomiting, medications such as diuretics (water pills), or very hot weather.
  • Heart problems – including heart failure, atherosclerosis, heart attack, slow heart rate (bradycardia), or heart valve problems.
  • Diabetes – frequent urination in uncontrolled diabetes, nerve damage.
  • Nervous system disorders – such as Parkinson's disease.

Sudden low blood pressure can also be caused by certain medications (anti-Parkinsonian drugs, some anti-depressants, medications for erectile dysfunction), long-term bed rest, age-related nerve problems, anemia (not enough red blood cells), or incorrect feedback from the nerves in your body.  Taking certain blood pressure medications can also affect your body’s response to sitting or standing up.  

Anxiety Disorders
Lightheadedness can also be linked to feelings of anxiety, especially panic attacks, hyperventilation, and other severe emotional states.

Lightheadedness or "Near Fainting" (Presyncope)
Sudden lightheadedness or feelings of faintness without losing consciousness is called presyncope.  It happens to older people quite often and can be associated with chronic physical conditions such as heart disease or diabetes. Because these feelings can bring on a fall, it’s important to be promptly evaluated if you feel faint or lightheaded.

The most common causes include sudden low blood pressure, inner ear disorders, or anxiety disorders.

See a healthcare professional or call 911 right away if you have dizziness or vertigo along with any of the following:

  • a head injury
  • a severe or unusual headache
  • fever higher than 101 degrees Fahrenheit
  • a stiff neck
  • blurred vision
  • sudden hearing loss
  • speech difficulties
  • leg or arm weakness or numbness
  • a fall
  • trouble walking
  • chest pain
  • unusually fast or slow heart rate
  • loss of consciousness


Last Updated November 2016