Balance is something we generally take for granted, but falls can be very
serious. Studies show that falls are the most common cause of traumatic
brain injury and that 1 in 4 people over age 65 falls at least once a year.
Our brain uses input from three systems to give us a sense of balance—our
eyes, inner ears, and joints and muscles—but generally only requires
two out of the three to help us balance our bodies, says Torrance Memorial
Physician Network neurologist Monquen Huang, MD. “For instance,
we can close our eyes and still remain standing. We can drive, not really
using our bodies—just our eyes and inner ears.”
Huang recently covered the issues surrounding balance, which becomes crucial
as we age, in a Miracle of Living lecture. Here are some of our most pressing
What's the first and most important thing for someone to do if they
are experiencing dizziness, vertigo and/or imbalance?
The most worrisome cause of dizziness/vertigo/imbalance is a stroke. If
one has symptoms such as facial weakness, arm weakness and/or slurred
speech, then one needs to call 911 immediately. But there is a whole spectrum
of reasons you might be experiencing symptoms of dizziness, vertigo or
imbalance. If you have recurrent symptoms, keep a journal to see if there
are common triggers and contact your physician.
What are the differences between those symptoms?
I use the terms vertigo and dizziness interchangeably because they can
mean different things to different people. The first thing I ask a patient
is to explain what they mean when they say they are dizzy, have vertigo
or feel imbalanced. By dizziness, patients usually mean a feeling of spinning—that
they are moving when they are indeed static. By vertigo, the patient may
mean lightheadedness, near fainting, often accompanied by nausea. And
by imbalance, I mean disequilibrium, difficulty walking or frequent falls.
Some people, from 5% to 10%, are unable to characterize the symptoms,
which is OK. I go on to take a history and physically exam them.
What are the most common causes of dizziness and vertigo?
The most common cause of both is something called benign positional vertigo,
which is triggered by certain changes in head position, such as tipping
the head up or down. Imbalance or disequilibrium may be due to nerve damage,
possibly caused by uncontrolled diabetes. Lightheadedness is often due
to orthostatic hypotension, the body unable to adjust one’s heart
rate and blood pressure quickly enough to accommodate a position change
such as standing up. The feelings of lightheadedness and unsteadiness
become more serious as we age because they increase your risk of falling.
Migraine can also contribute to dizziness, and vertigo might be stress-related.
What sort of physical exams do you do?
The first things I do are tests that help me determine if there is involuntary
eye movement, or nystagmus, such as a head thrust test. If the patient
cannot keep their eyeball looking straight ahead as their head moves,
it indicates a problem with the inner ear. I check a patient’s blood
pressure in different positions, sitting and standing, and also test sensation
at their feet with a tuning fork, and reflexes with a reflex hammer. If
they have ringing in their ears, I may refer them to an audiologist; if
their heartbeat is irregular or unable to maintain blood pressure on standing,
to a cardiologist.
So what is the treatment if there is an inner ear problem, such as benign
The treatment for benign positional vertigo is the Epley maneuver, which
is a series of head movements that reposition crystals in the inner ear
and help restore balance. One may consider medication for other causes
of inner ear problems such as vestibular neuritis.
Is it possible to improve your balance?
Poor balance is definitely an important component in reducing the risk
of falls, and I believe it can be trained. Exercise such as tai chi and
yoga are good options for balance, and Torrance Memorial offers several
balance classes taught by our physical therapy department.
Monquen Huang, MD, Torrance Memorial Physician Network, Neurology 3400
Lomita Blvd., Torrance, 310-517-7021.
You can view the Miracle of Living presentation at