How are imbalance and dizziness connected?

When a person has a dizziness disorder, they will often feel off balance when on their feet.  Imbalance  or unsteadiness can be as simple as  just feeling “off”, or slightly uncertain of your balance.  As imbalance worsens, you might begin to fear that you will fall, and you may bump into doorways or have to touch counters in the house to steady yourself.  A more severe imbalance can cause you to stagger from side to side when walking or have to walk with your feet wide apart to maintain balance.  Most people will start using support aids like a cane or walker when this stage is reached.  In the most severe cases, you might be unable to walk unless someone is physically holding you up.   People with this very severe imbalance will be confined to a wheelchair or their bed.

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Dizziness: Video camera vision

The inner ears are busy sensors.  We depend on them for hearing, they let us feel motion sensations, and they help control balance.  One of the most important things they do is something most people aren’t aware of:  they keep the eyes focused while we are in motion.

Imagine playing a game of ping pong.  You have to keep your eyes on the moving ball while at the same time you jump back and forth to intersect it for your shot.  This requires two major systems that control eye movements to be perfectly coordinated.

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Dizziness: Tilting and elevator feelings

Elevator, tilting and rocking sensations that occur when the body is not moving are a form of vertigo.   When going up or down in an elevator, the feeling of rising or dropping is created by gravity sensors in the inner ear, the otolith organs.  If these sensors malfunction, they can cause an identical elevator-like sensation.  This can make you feel like you are suddenly hurtling toward the center of the earth, or as if you are taking off into space strapped to the nosecone of a rocket.  This is so disorienting that it can make you immediately crash to the floor.

These sensors also detect tilting sensations and can create feelings that you are rocking forward and back, or side-to-side.  As I discussed in the blog on mal de debarquement syndrome, this can be set off by traveling on a boat and the feeling is exactly like the wave action is continuing in the head after disembarkation.  Rocking can be found in a few other vestibular diseases, and it can occur in people with migraine even without a history of boat travel.

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