Dizziness, vertigo and balance problems

Dizziness, vertigo and balance problems


The International Classification Committee of the Barany Society, defines vertigo as an illusion of movement, usually rotational, either of oneself or of the environment (1). It is often described as a sensation of spinning, swaying, or tilting, accompanied by nausea, vomiting, and imbalance.


According to the international guidelines of the Barany Society, dizziness is defined as the sensation of disturbed or impaired spatial orientation without a false or distorted sense of motion (1).  It can manifest as lightheadedness, vertigo, or imbalance and can be caused by various factors such as inner ear disorders, neurological conditions, or cardiovascular issues. Sometimes patients can pass out (syncope).

Common conditions that present with dizziness include: 

  • Dehydration
  • Anxiety
  • Low blood sugar
  • Medication side effects
  • Hypotension
  • Anaemia

Balance problems

Balance problems, according to the international guidelines of the Barany Society, are defined as any subjective sensation or objective abnormality in the perception of body position, head position, or movement that interferes with an individual’s ability to maintain postural stability and orientation. This can include dizziness, vertigo, unsteadiness, gait disturbances, and feeling off-balance (2).

Common conditions that present with balance problems include:

  • Inner ear problems
  • Neurological conditions
  • Muscle weakness
  • Side effects of medication
  • Aging
  • Lack of physical activity

How common is vertigo, dizziness and balance problems

It is estimated that approximately 20-30% of individuals will experience vertigo or dizziness at some point in their lives. However, the prevalence of chronic or recurring vertigo is lower, affecting around 5-10% of the population (3,4).

The risk of developing vertigo and balance problems increases with age, with studies showing that around 40% of individuals over 40 will experience these issues at some point in their lifetime. These conditions can be chronic and may significantly impact quality of life if not properly managed (4).

Balance problems are common in older people, with about 35% of individuals over 65 experiencing issues. These problems can increase the risk of falls and injuries, which can have fatal outcomes, especially in the elderly population. It is vital to address balance issues to prevent such incidents (5).

The balance system

The balance system consists of the vestibular system, which includes the inner ear and helps detect changes in head position; the visual system, which provides information about body position and movement; and the proprioceptive system, which uses sensory receptors in muscles and joints to provide information about body position and movement (6).

The vestibular system

The peripheral vestibular system, also known as the labyrinth, comprises the inner ear’s semicircular canals and otolith organs. These structures detect motion and gravity, sending signals to the central vestibular system in the brainstem and cerebellum via the vestibular nerve.

The central vestibular system processes these signals to help maintain balance, posture, and spatial orientation. Connections in the brainstem and cerebellum help integrate information from the vestibular organs with visual and proprioceptive cues (7).

The vestibulo-ocular reflex

The vestibulo-ocular reflex is a neurological mechanism that helps maintain stable vision during head movements. When the head rotates, signals from the vestibular system in the inner ear are sent to the eye muscles to coordinate movement, allowing the eyes to remain focused on a target (8).

The vestibulo-ocular reflex (VOR). Attribute: By User:Mikael Häggström - Image:ThreeNeuronArc.pngOriginal uploader was Tvil at en.wikipedia, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=2980751

Why is it sometimes challenging to manage these conditions?

Symptoms of vertigo, dizziness, and balance problems can be complex and overlap, making it difficult for a person to describe their experiences accurately. Vertigo, dizziness, and balance problems may all be related to disruptions in the vestibular system. While they can often be used interchangeably in everyday language, they refer to different sensations and symptoms (9).

It is crucial to carefully unravel what patients mean when they report these symptoms to provide an accurate diagnosis and treatment. History taking is the most essential aspect of the examination, as it allows healthcare providers to understand the unique aspects of the patient’s condition and tailor their care accordingly. Pay close attention to the finest details to provide adequate care for patients experiencing vertigo, dizziness, and balance issues.

A healthcare worker must allocate enough time to perform a detailed interview before conducting a physical examination on a patient.

The examination of a patient with vertigo, dizziness and balance problems

Diagnosing vertigo, dizziness, and balance problems begins with a comprehensive complaint history and a physical neurotological examination. Specific tailored laboratory examinations, including Video Head Impulse Testing (VHIT), Vestibular Evoked Myogenic Potentials (VEMP), and assessment of nystagmus with video nystagmography (VNG), may also be conducted. If necessary, imaging such as a magnetic resonance imaging (MRI) or computed tomography (CT) scan may be recommended to evaluate the underlying cause of the symptoms further (10).

The treatment of vertigo, dizziness and balance problems

Treating vertigo, dizziness, and balance problems depends on the specific diagnosis and the possibility of multiple conditions being present. Treatment options may include lifestyle and diet modifications, medication to manage symptoms, vestibular rehabilitation exercises to improve balance, vestibular surgery to correct underlying issues, psychological support, and other therapies tailored to individual needs. A comprehensive approach is often necessary to address these complex and interconnected conditions effectively.

Vestibular neurectomy. Vestibular division (V) and Cochlear division (C)