By Dr Ananya Mandal, MD
There are several disorders that may lead to balance problems. Diagnosis aims at detecting the cause of balance problems. Balance problems thus are symptoms of an underlying condition rather than a disease in itself.
The cause of balance problems may vary between ear infections, blood pressure changes, vision problems or even medications that may cause balance problems.
Steps in diagnosis of the conditions include:-
Complete evaluation of the problem with history of onset, duration of the balance disorders and family history.
A precipitating ear infection, vision problem or head injury or a history of intake of a balance problem causing medication is often found upon enquiring the history from the patient. This may provide valuable clues in diagnosing balance problems.
Evaluation and diagnosis may be made by a primary physician who may then request the opinion or refer to an otolaryngologist to help evaluate a balance problem. An otolaryngologist or ENT surgeon is a physician/surgeon who specializes in diseases and disorders of the ear, nose, throat, head, and neck.
Physical examination – the next step is to obtain a detailed physical examination. The general health is examined that includes blood pressure and blood sugar evaluations, fluctuations of which may lead to balance problems or dizziness and falls. The ears are examined for abnormalities, hearing difficulties and infections if any.
An electronystagmogram (ENG) is often advised. This test checks for abnormalities of the vestibular system. The caloric test may be performed as part of the ENG.
For this test each ear is flushed with warm and then cold water one at a time. When water is flushed, the eyes move rapidly from side to side. This is called nystagmus. The amount of nystagmus resulting from the test is measured. Weak nystagmus or the absence of nystagmus may indicate an inner ear disorder.
Another test for vestibular health is called posturography. The patient is asked to stand on a special platform capable of movement within a controlled visual environment. The sway of the body in response to movement and visual environment is recorded.
Blood tests for detection of abnormalities like anemia, high or low blood sugar are advised. Usually a complete blood count, thyroid function test, liver and kidney function tests, electrolytes, blood urea nitrogen, creatinine, glucose, and vitamin B12 levels are tested.
Imaging studies of the head including CT scan (Computed Tomography scan) or MRI scan (Magnetic resonance imaging scan) are performed to check for injuries and abnormalities in the brain and cerebellum part of the brain that controls balance and coordination.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)
Last Updated: May 26, 2013