Signs of balance problems

Dizziness is one of the most common complaints people bring to their doctors–its estimated that up to 40% of adults experience dizziness severe enough to report it to a physician. It is also one of the most difficult complaints to assess as it is a highly subjective sensation and may be caused by several overlapping pathophysiological processes which invariably result in balance problems. It is therefore important to recognise the different signs that could indicate a balance problem to ensure timely and appropriate intervention.


Common signs of balance problems

Dizziness often occurs with other symptoms. If you experience any of the following symptoms alongside your dizziness, it is worth getting a balance evaluation:

  • Repeated light-headedness
  • Spinning sensations/vertigo
  • Floating sensations
  • Sensations of being pushed/ pulled
  • Blurred/ double vision
  • Feeling confused/ inability to coordinate movements
  • Nausea/ vomiting
  • Unsteadiness/ disequilibrium
  • Leaning/ veering to one side when walking
  • Fullness in ears
  • Fluctuating hearing loss
  • Tinnitus
  • Brain fog
  • Anxiety/ panic attacks
  • Headaches/ migraines
  • Increased sensitivity to light and sound
  • Motion sickness
  • Neck pain


Although balance impairment may arise from a whole host of different health disorders and bodily systems, deficits in the inner ear balance system, otherwise known as the vestibular system, are often found to be involved. The following diseases/ disorders linked to the vestibular system commonly lead to balance impairment:

Benign Positional Paroxysmal Vertigo (BPPV)

The most common cause of vertigo. It is caused by misplaced calcium crystals in the vestibular system and results in short bursts of dizziness provoked specifically by head movements.

Vestibular Neuronitis

Caused by viral inflammation of the vestibular nerve leading to dizziness and imbalance.


Viral or bacterial inflammation of the inner ear nerves leading to dizziness and hearing loss.


Damage to vestibular organs that leads to imbalance and anxiety.


Head injuries may cause damage to the structures in the vestibular system leading to dizziness and imbalance.

Ototoxic Medication 

Can cause permanent damage to the vestibular system, typically resulting in imbalance, hearing loss and tinnitus. These include some types of chemotherapy drugs.

Meniere’s Disease

A progressive condition caused by inner ear fluid imbalance leading to attacks of dizziness, tinnitus, pressure in ears and increasing hearing loss. 

Superior Canal Dehiscence Syndrome

An anatomical change/ thinning in the bone overlying the vestibular end organ that leads to aural fullness, tinnitus, and sound/ pressure induced dizziness.

Vestibular Migraine 

Caused by temporary changes in brain activity that leads to motion intolerance, dizziness and visual disturbance.


Our sense of balance is intricately connected to mechanisms of the ears, eyes, brain, muscles and nerves throughout the body. Diagnosing balance disorders is therefore a complex process, typically involving a battery of tests. Our experts will begin an evaluation by initially taking a detailed medical history and performing a physical examination. They will then run a series of tests in order to determine the nature and severity of any underlying balance impairment. These tests primarily focus on recording and analysing eye movements that are generated by the vestibular (inner ear balance) system and central nervous system–which both play primary roles in a healthy functioning balance system on the whole.

A vestibular balance assessment may include the following where appropriate:

  • Audio-vestibular / Medical history and Balance evaluation questionnaires.
  • Clinical Otoscopy – Performed to inspect the condition of the outer ear and ear drum in order to detect any abnormalities or contra-indications
  • Pure Tone Audiometry – Test to identify hearing thresholds and the degree of any loss
  • Tympanometry – Test to examine the health of the middle ear and ear drum movement
  • Dix Hallpike Manoeuvre– A dynamic head positioning manoeuvre to detect an abnormality in vestibular end organ response
  • Video Head Impulse Testing (vHIT)– Test to determine the function of vestibular end organs through a series of rapid head movements
  • Vestibular Evoked Myogenic Potentials (VEMPs)– Test to measure the function of vestibular end organs involving sound stimulation and muscle tissue recordings
  • Videonystagmography (VNG)– Test to detect abnormalities in eye movements in response to different stimuli and head positions
  • Bi-thermal Caloric Testing– Test to determine the function of vestibular end organs via temperature stimulation using warm and cold air
  • Consultation and individual management plan.
  • Onward referral to ENT/ other specialists for further medical evaluation as appropriate
  • Comprehensive audio-vestibular report or e-report provided to you and/ or your referring specialist

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The service is only available at our Canary Wharf clinic and is open to self-referrals.