Being balanced means moving freely
Going for a morning walk, taking the stairs with ease, picking up your grandchild, exploring new cities… Good balance gives us confidence and independence in every moment of daily life.
The good news is that balance is a skill that improves with practice, just like a muscle. When the cause of dizziness is correctly identified, most conditions can be treated, and with exercises tailored to you, you can keep your balance strong at every stage of life.
How does balance work?
Balance depends on the brain combining information from three sources at the same time:
- The balance organ in the inner ear (vestibular system): It sits right next to the hearing organ and senses every movement of your head and its position relative to gravity.
- The eyes: They keep track of where you are in relation to your surroundings.
- The soles of the feet and the joints: They sense the ground beneath you and the position of your body.
The brain processes this information in a fraction of a second and sends it to your muscles. When there is a problem in any link of this system, dizziness, unsteadiness or a feeling of insecurity can appear.
Research shows how important balance is:
- In a large population survey in the United States, a change on balance testing was found in about 35% of adults over 40. People with dizziness were 12 times more likely to fall.
- According to a Cochrane analysis combining 59 controlled trials, regular exercise reduces the number of falls by 23%; functional balance exercises have the strongest effect.
- For balance problems that originate in the inner ear, vestibular rehabilitation has been shown to be safe and effective in improving dizziness and balance.
In short, balance is a skill that can be trained and improved.
How does balance change over the years?
Over the years, the capacity of the balance cells in the inner ear, sharpness of vision, sensation in the feet and muscle strength can change. An inactive lifestyle speeds up this change. When someone who experiences dizziness moves less for fear of falling, the balance system also gets less practice. This vicious circle can be broken with the right assessment and exercise.
Dizziness does not always have a single cause. One of the most common causes is the displacement of tiny crystals in the inner ear (benign paroxysmal positional vertigo). It causes dizziness lasting a few seconds when you get out of bed or turn your head, and it often resolves with simple maneuvers. Inner ear inflammation, Ménière’s disease, vestibular migraine, certain medications, changes in blood pressure and heart rhythm, vision problems and neurological conditions can also affect balance.
Important: If sudden dizziness comes with difficulty speaking, facial drooping, weakness in an arm or leg, double vision or a severe headache, go to the emergency department without delay.
Signs you may notice
- A sensation that the room is spinning or that you are spinning
- Brief dizziness when getting out of bed, lying down or turning your head
- Staggering or a feeling of being pulled to one side while walking
- Difficulty keeping your balance in the dark or on uneven ground
- Needing to hold on to walls or furniture while walking
- Blurred vision when you turn your head quickly
- Discomfort in crowded, busy places or between supermarket aisles
- Ear fullness, ringing or a change in hearing that comes with dizziness
- A fall in the past year, or going out less for fear of falling
If you notice any of these, a balance assessment is the first step toward moving with confidence.
What can be done?
The treatment plan is tailored to you, based on the cause of your dizziness, your examination findings and your needs in daily life.
- Comprehensive ENT and balance assessment: Along with an ear examination and a hearing test, the function of the balance organ is assessed with tests of eye movements, positional tests and, when needed, video recording of eye movements.
- Maneuvers for displaced ear crystals: Displaced crystals are moved back into place with simple maneuvers that guide the head into specific positions. Many people feel significant relief in the same session.
- Vestibular rehabilitation: With personalized eye–head movement, balance and walking exercises, the brain learns to rebalance the information coming from the inner ear. The exercises are taught in the clinic and continued regularly at home.
- Medical treatment: Depending on the underlying cause, medication, dietary changes for Ménière’s disease or management of triggers for vestibular migraine are planned. Your current medications are also reviewed.
- Teamwork: When needed, we work together with neurology, cardiology, ophthalmology and physical therapy.
Daily tips to keep your balance strong
- Move every day: Regular walking is the most natural exercise for the balance system.
- Train your balance: Stand on one foot while holding on to a chair or counter; walk heel-to-toe along a line. Always do these exercises close to a safe support.
- Choose an activity you enjoy: Tai chi, dancing and Pilates improve balance in an enjoyable way.
- Get out of bed slowly: Sit up first, wait a few seconds, then stand.
- Make your home safe: Use non-slip mats, secure rugs and leave a small light on in the hallway at night.
- Wear suitable shoes: Choose shoes with non-slip soles that hold the foot well.
- Keep your glasses up to date: Seeing well is one of the three pillars of balance.
- Drink plenty of water and review your medications: Some medications and dehydration can cause dizziness.
- Have your hearing checked, too: The hearing and balance organs sit side by side in the inner ear; when one changes, it is worth assessing the other as well. See also Hearing and Cognitive Vitality.
Frequently asked questions
Which doctor should I see for dizziness?
Because the balance organ is located in the inner ear, the first assessment can be done by an ENT specialist. When needed, a neurology or cardiology consultation is appropriate.
What are “ear crystals,” and can they be treated?
This is the displacement of tiny crystals in the inner ear whose job is to send the brain information about head movements in three dimensions; it causes brief dizziness with head movements. It often resolves quickly with simple maneuvers done in the clinic.
Do balance exercises work at any age?
Yes. Controlled trials show that regular functional exercises for balance strengthen balance at any age and reduce the number of falls.
Should I take dizziness medication all the time?
These medications are used for a short time to ease attacks. Long-term use of some medications can slow the brain’s adaptation to a new balance, while others can be used for much longer periods. Talk with your doctor about the ideal duration for the medication prescribed for you.
Is a balance examination painful?
No. The tests are based on observing your eye movements and your balance; some positional tests can cause brief dizziness, but they are not painful.
When is dizziness an emergency?
If it comes with difficulty speaking, facial drooping, weakness in an arm or leg, double vision or a severe headache, call emergency services right away (112 in Türkiye).
If you are experiencing dizziness or unsteadiness, contact us for a comprehensive ENT and balance assessment.
The information on this page is for general guidance only; an examination is needed for an individual diagnosis and treatment plan.