With balance disorders, an accurate diagnosis is essential. International patients benefit from our many years of specialisation and state-of-the-art diagnostic and treatment technology – for a therapy that is right for you.
As former Chairman of a university ENT hospital, I make a point of taking enough time for you. Your treatment success and your well-being are our top priority.
Yours, Prof. Dr. med. H.P. ZennerVertigo and Balance Centre, private ENT clinic in Tübingen/Stuttgart
Balance disorders
Balance disorders can be caused by numerous diseases of the balance system. Together with vertigo, they have for years been among the ten most common complaints with which people visit their family doctor – accordingly, the possible causes are very diverse.
We will be glad to examine and treat you!
Possible causes of a balance disorder:
- Acute vestibular syndrome
- Age-related balance disorder, presbyvertigo
- Benign paroxysmal positional vertigo (BPPV), positional vertigo
- Bilateral vestibulopathy (bilateral vestibular hypofunction, bilateral vestibular loss)
- Semicircular canal dehiscence
- Unilateral vestibulopathy (unilateral vestibular hypofunction, unilateral vestibular loss)
- Functional balance disorder, persistent postural-perceptual dizziness (PPPD), phobic postural vertigo, chronic vestibular syndrome
- Sudden hearing loss with balance disorder (acute idiopathic sensorineural hearing loss with vestibular involvement)
- Idiopathic balance disorder, balance disorder not otherwise specified
- Labyrinthitis (toxic, bacterial, viral)
- Menière's disease, Lermoyez syndrome
- Vestibular neuritis
- Toxic vestibulopathy (adverse drug reaction, toxic chemicals)
- Trauma (e.g. labyrinthine concussion/contusion, skull base injuries)
- Tumours of the skull base and cerebellopontine angle, vestibular schwannoma (acoustic neuroma)
- Vestibular paroxysmia (neurovascular compression syndrome of the 8th cranial nerve)
- Vestibular migraine
The human sense of balance
After Zenner, H.P. In: Physiologie des Menschen. Springer-Verlag, Heidelberg
Standing and walking upright cannot be taken for granted; it is a constant, active achievement of the vestibular apparatus in the inner ear. It continually prompts the muscles of the legs and trunk to make small corrective movements so that we do not fall.
Where balance resides: in the inner ear
Each inner ear has five balance organs (vestibular organs). With their help, we can sense even with our eyes closed whether the head is turned to the right, left, forwards or backwards, and in which direction we are moving. Thus, with our eyes closed, we notice that we are walking forwards – regardless of whether the head is turned to the right (left ear in front) or to the left (right ear in front).
The performance of the vestibular organs becomes particularly clear when we stumble: before we are even aware of it, reflexes of the balance system have already activated the foot and leg muscles and prevented the fall. Without the vestibular apparatus of the inner ear, upright human gait would literally be impossible.
On each side, the vestibular apparatus consists of two so-called cupula/macula organs and three semicircular canal organs. With them we measure accelerations – above all gravity, which allows us to distinguish up from down, but also starting and braking in a car or aeroplane, travelling in a lift, a jump or a fall. For this purpose, the cupula/macula organs contain tiny balance stones. When the body accelerates, they briefly lag behind – just as a loose object slides backwards in a car that is pulling away.
If one of these organs is impaired or diseased, those affected notice it very clearly – as a balance disorder.
This is because the signals from the organs no longer match the patterns the brain has learned since childhood, and balance is thrown off.
Processing in the brain
The stimuli from the balance organs are transmitted to the brain as signals and evaluated there in a dedicated processing system for balance.
Muscle sensors
Signals arrive there not only from the ears but also from sensors in the muscles. Every skeletal muscle is equipped with numerous such sensors, which inform the brain of pressure and speed of movement – of the arms and legs, for example. This is how we perceive our posture.
This is easy to try: close your eyes and move an arm or a leg into any position. You can still sense the posture precisely – thanks to the muscle sensors. Experts call this the somatosensory system. Its signals also feed into balance processing; together with the information from the vestibular organs, the brain can thus tell whether we are standing, lying down or lying on our side.
Eyes
When the eyes are open, visual impressions also contribute to the perception of position and movement – but only as long as it is light enough.