Balance Problems

Diagnosis & Tests

Your healthcare professional will take a detailed medical history and do a physical exam to identify the source of your balance problem.

The physical exam will evaluate the way you walk to determine gait abnormalities (problems with the way you walk) and test your balance. They will ask you information about previous falls, what you were doing when you fell, and any related symptoms. They may ask you about your home environment, which may be contributing to the risk of falling. Your healthcare provider will ask you what medicines you take, including both prescription and over-the-counter products.

You may be referred to different specialists depending on the suspected source of the balance problems:

  • an otolaryngologist or ENT (ear/nose/throat specialist) if ear problems are suspected
  • a cardiologist if irregular heartbeats contribute to balance issues
  • a neurologist if there is concern about damaged nerves
  • a physical therapist if there is a concern about arthritis and impaired gait or for evaluation for assistive devices and fall prevention programs
  • a pharmacist to review medications to minimize potential adverse effects that can lead to problems with balance
  • an optometrist or ophthalmologist to evaluate for vision problems contributing to problems with balance

Check with your healthcare provider whether any of your medications might increase your risk of falling and if a substitution or alternative therapy 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
  • if you have any problems using your arms or legs
  • 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 lying, sitting, and standing, or when using a tilt table. You may also be asked to wear a 24-hour blood pressure monitor.
  • Blood tests.  These will allow your provider to check for low blood sugar or anemia (low red blood cell counts).
  • Electrocardiogram or echocardiogram. These tests will look for heart abnormalities.
  • The Valsalva maneuver. This involves taking several deep breaths and then blowing out slowly while your blood pressure and heart rate are monitored. This checks how part of your nervous system is working.

In rare cases, the healthcare professional 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 if there is a different cause.

 

Last Updated December 2020