Derek Burnett
Derek Burnett is a Contributing Writer at Bottom Line Personal, where he writes frequently on health and wellness. He is also a contributing editor with Reader’s Digest magazine.
If you’re concerned about becoming one of the quarter of Americans 65 or older who will suffer a fall this year, it’s a good idea to educate yourself about what causes balance problems and how balance issues develop so you can stave off balance loss and avoid getting hurt.
If you stop and think about it, it’s kind of remarkable that we’re as well balanced as we normally are. We have a heavy brain case atop a relatively thin neck, and our only supports are two smallish feet (not four). We don’t creep along the ground like snakes, nor do we have a tail to help prop us up. Yet somehow we manage some pretty incredible maneuvering.
At any given moment, we’re taking in enormous amounts of highly detailed visual and tactile information, and a constant stream of lightning-fast messages bounce back and forth between our brains, ears, eyes, and muscles to keep us upright. It’s amazing how well it works…until it doesn’t. It’s an easy thing to take for granted, but consider for a moment that without the proper functioning of these systems, you wouldn’t even be able to sit up straight.
Such an intricate and comprehensive bodily system is, unsurprisingly, vulnerable to all sorts of failures. If the brain works just fine but the muscles are too weak to respond, we fall. If the muscles are fine but something is out of whack in the inner ear, we fall. If the muscles and inner ear are fine but the brain is impaired, we fall. Thus, trouble with balance can come from all over the body.
The broad term for the organs and components that help us maintain our equilibrium is the vestibular system. Within your inner ear, alongside your cochlea, sits a structure called the vestibular labyrinth, which contains five delicate organs that closely track the movements of your head. Those five organs consist of three semi-circular canals and two otoliths.
The semi-circular canals. A fluid inside each canal shifts with every head movement, causing tiny hairlike structures to bend or move, which in turn fires off a signal to the vestibular nerve, which travels to the brain, where it is interpreted. These organs can tell you that you’re leaning over, looking up with your chin in the air, shaking your head no, or nodding.
The otoliths. These tiny organs detect motion related to gravity, such as the forward and up-and-down movements of a roller coaster. Tiny crystals of calcium carbonate, called otoconia, shift against micro-hairs inside each otolith, which, as with the fluid in the semi-circular canals, trigger nerve impulses that travel to the brain.
When balance signals arrive in the brain, they are processed and checked against incoming visual information, after which signals are sent out to the muscles to maintain or correct your posture. As you might imagine, your vestibular system is not trotted out on an as-needed basis; it functions constantly and fluidly to keep you upright and safe. Micro-adjustments and new feedback happen so quickly as to appear instantaneous or even simultaneous, through reflexes.
Imagine, for example, running to catch a ball over a slightly uneven field. As you race toward your target, you keep your eyes fixed on the ball. Thanks to an ocular reflex, even though your head is rising and falling with each step, your vision does not bump up and down but remains smooth as the eyes and the inner ear “talk to each other” throughout the maneuver. Via another reflex working in parallel with the first, your muscles and inner ear carry on similar communication so that you automatically adjust to subtle changes in terrain beneath your feet.
An exhaustive discussion of all of the bodily problems that might contribute to balance issues could take up a whole book. Balance troubles can come from medications, muscle weakness and muscle loss, low bone density, chronic pain, neurological conditions, migraines, vision loss, and many other issues. For the sake of this article, we’ll look at a few common conditions directly affecting the inner ear.
Age. Our vestibular systems contain fewer and fewer nerve cells as we age and as the flow of blood to the inner ear decreases. The tiny hairs whose shifting triggers nerve signals can be damaged throughout your lifetime by infections and normal wear-and-tear, and they do not grow back. That’s why some degree of balance loss is a perfectly normal aspect of aging.
Benign paroxysmal positional vertigo (BPPV). This is the most common inner-ear disorder. Its primary symptom is vertigo, the feeling that your surroundings are spinning around you. It happens when otoconia (those tiny crystals that belong in your otoliths) move into the semicircular canals, disrupting the signaling there. Fortunately, BPPV often resolves on its own, and when it doesn’t, the crystals can usually be guided back out of the canals through a maneuver that only takes about 10 minutes.
Labyrinthitis. Inflammation of the vestibular labyrinth due to infection. Patients who have this condition experience a sudden onset of dizziness, trouble hearing, and balance problems. It’s usually not serious if it’s treated right away with medication. If left untreated, it can cause permanent hearing loss.
Vestibular neuritis. Inflammation of the vestibular nerve caused by an infection. When it first strikes, people experience a rapid onset of severe vertigo, often with vomiting. After the initial acute phase, it normally becomes chronic, with episodes continuing for weeks. Typically, treatment consists of medication to control symptoms and reduce inflammation.
Ménière’s disease. This is a rare and still somewhat mysterious illness that occurs episodically, causing vertigo, ringing in the ears, and hearing problems. It appears to be associated with an excess of vestibular fluid in the inner ear. There is no cure, but medications, surgeries, and therapies can address symptoms.
Although some age-related balance issues are to be expected, you can protect your vestibular system by taking steps to avoid the kinds of infections that can affect the inner ear, which include flu, RSV, and COVID. There also appears to be a use-it-or-lose-it aspect to a healthy vestibular system. The more you move, the better your vestibular system can manage movement. In addition to pursuing cardiovascular fitness through aerobic exercise, older adults should incorporate resistance training to shore up their muscles and bones, flexibility exercises to keep their limbs supple and responsive, and balance exercises to maintain their vestibular systems.
