Medically Reviewed By Heidi Moawad, M.D.
— Written By Allison Flynn Becker, MSN, RN
Updated on February 9, 2023
People with balance problems may feel uneasy or woozy, or have a sensation of spinning or floating. If you are standing, you may suddenly feel as if you are going to tip over. Balance problems are also a common reason why older adults fall.
Your sense of balance relies on signals to the brain from various structures in the body, particularly the ears. The part of the ear that assists in balance is known as the vestibular system or labyrinth. This is a maze-like structure inside the inner ear made up of bone and soft tissue.
This article looks at common conditions that can make you feel off-balance without dizziness. It also discusses how to manage this feeling and prevent falling, when to contact a doctor, and more.
What conditions can make me feel off-balance without dizziness?
Certain medications, balance disorders, or medical conditions associated with damage to the nervous system can cause problems with balance. Alcohol
Following are
Low blood pressure
Low blood pressure, or hypotension, can cause you to feel dizzy or off-balance, especially if you stand up too quickly.
Other symptoms of low blood pressure include:
- nausea
- blurred vision
- weakness
- confusion
- fainting
Your doctor can recommend treatments for low blood pressure. Treatment may depend on the cause.
Learn more about hypotension.
Benign paroxysmal positional vertigo
Benign paroxysmal positional vertigo (BPPV) is triggered by a change of position of the head. Bending down to look at something or tilting your head up or down may make you feel like you are spinning.
Other symptoms of BPPV include vertigo and nausea.
Specific exercises can help alleviate BPPV. Your doctor may recommend these exercises or refer you to a physical therapist.
Learn more about BPPV.
Ménière’s disease
Ménière’s disease occurs when there is a change in fluid volume within parts of the labyrinth in the ear. Researchers do not know exactly what causes this.
Other symptoms of Ménière’s disease include:
- vertigo
- hearing loss
- tinnitus, ringing in the ears
Learn more about Ménière’s disease.
Labyrinthitis
Labyrinthitis occurs when the labyrinth becomes inflamed or infected. Upper respiratory infection is a common cause of labyrinthitis.
Labyrinthitis can also cause temporary hearing loss.
Learn more about ear infections.
Perilymph fistula
Leakage of fluid into the middle ear can cause a perilymph fistula. A perilymph fistula can happen following:
- a head injury
- dramatic changes in air pressure
- ear surgery
- chronic ear infection
- physical exertion
In some cases, a person may be born with a perilymph fistula.
Alongside feeling off-balance and dizzy, other symptoms include nausea and unsteadiness that increases with activity.
Central nervous system problems
Damage to, or problems with, the central nervous system can cause dizziness and feelings of being off-balance.
Examples of conditions that can cause problems or damage within the central nervous system include:
- abnormal heart rhythm
- damage from alcohol use
- heart disease
- multiple sclerosis
- hydrocephalus, a buildup of fluid in the cavities in the brain
- Parkinson’s disease
- conditions that affect the brain’s cerebellum
- conditions causing decreased blood flow
- spinal cord damage
- stroke
- traumatic brain injury
- brain tumors
Peripheral nerve damage
Peripheral nerve damage can cause a diminished sensation. This makes it difficult for a person to feel where their feet are. This can make a person feel off-balance, often without being dizzy.
In severe cases, nerve damage causes impaired movement. Conditions that cause impaired movement include:
- alcoholic neuropathy
- diabetic neuropathy
- nerve damage from medications
- nutritional deficiency
- inflammatory disease
How do I manage feeling off-balance?
Balance problems can affect your ability to carry out daily activities. There are things you can do to manage feeling off-balance and prevent falling.
Here are
- Do not walk in the dark.
- Avoid wearing high heels. Instead, wear low-heeled, nonskid, rubber-soled shoes.
- Do not walk on stairs or floors while wearing something slippery on your feet, such as socks or slippers.
- Use a cane or walker.
- Add safety features, such as handrails, in your home and workplace.
Your doctor may refer you to an occupational therapist. They will help you make adaptations to your home and find ways to manage your daily activities in case you begin to feel off-balance.
Are there any medical treatments for feeling off-balance?
Treatment for balance problems depends on the cause. Your primary care doctor may be able to recommend medical treatments. In addition, they may refer you to a neurologist or otolaryngologist.
Medication
If a medical condition is causing your balance problem, treating the condition should help alleviate the balance problem.
For example, to relieve symptoms of Ménière’s disease, a doctor may prescribe anti-vertigo or antinausea medications.
Vestibular rehabilitation therapy
Some people with balance problems may never be able to completely relieve their symptoms.
However, a vestibular rehabilitation therapist
Medication changes
If a current medication is causing your balance problem, your doctor may try lowering the dosage or switching you to a different medication.
Continue taking your medications until your doctor advises you to change.
Can I prevent feeling off-balance?
There are certain things you can do to prevent feeling off-balance. For example, avoiding alcohol may help, as alcohol
If a medical condition is causing balance problems, follow your doctor’s instructions for managing the condition. This may include taking medications or seeing a specialist.
In some cases, such as if you have a balance disorder, you may not be able to completely prevent feeling off-balance. However, symptoms can be managed with medication and rehabilitative therapy. You can also take safety measures in your home and workplace to prevent falls.
Contact a doctor as soon as you begin to feel off-balance, with or without dizziness.
Your doctor will advise you on treatments and how to manage your symptoms.
Learn more about when to see a doctor for dizziness.
How do doctors diagnose the cause of feeling off-balance?
Your doctor may begin with a physical examination and a full medical history. They may ask questions such as:
- What medications do you take?
- What is the best way to describe your balance problem?
- How often do you have trouble keeping your balance?
- Do you have dizziness or spinning episodes? How long do they last?
- Do other symptoms occur at the same time as the dizziness?
- Have you ever fallen?
Your primary care doctor may refer you to a neurologist or otolaryngologist if the problem does not improve with standard therapy. They may order tests
- blood tests
- hearing test
- imaging studies of the head and brain
- videonystagmography, which measures eye movements and the muscles that control them
- electromyography
- nerve conduction study
Your doctor will be able to explain what the tests involve and answer questions you may have.
Summary
Medication side effects and some medical conditions can cause you to feel off-balance. Medical conditions include low blood pressure, Ménière’s disease, BPPV, and central nervous system problems.
Feeling off-balance is a common problem in older adults and places individuals at a higher risk of falls.
Your doctor can recommend treatments for an underlying condition and help you manage feelings of being off-balance. If you have a balance problem, take safety measures to prevent falling.
