Our sense of balance is a complex process that depends on many different systems, including the inner ear, vision, proprioception (our sense of our own position in space), muscle strength, and sensation. Given the many different factors that comprise a functioning sense of balance, it’s no wonder that many balance problems are due to a combination of problems, including poor vision, poor muscle strength and coordination, medications that cause sedation and low blood pressure, poor sensation (especially on the feet), and impaired proprioception (like not being able to tell if your toe is being held up or down). Multifactorial causes of dizziness are especially common in the elderly. Furthermore, disorders of blood pressure regulation, heart disease, and some neurological diseases will cause us to feel lightheaded, like we are going to pass out (pre-syncope), and this sensation is also commonly called “dizziness” as well (although its usually treated by primary care doctors, neurologists, and cardiologists). Therefore, we believe that a dizziness evaluation must take into account not only the inner ear, but the whole body as well, with referrals as needed to other physicians such as ophthalmologists, cardiologists, geriatricians, physiatrists, neurologists, and orthopedists. Physical therapy aimed at the inner ear, general balance, muscle strength, and coordination is also very helpful for multifactorial causes of dizziness. In additional, patients with multifactorial causes of dizziness are at increased risks of falls, and there are several common-sense interventions that can reduce the risks of falls. These include making the home safe (removing anything on the floor that can cause tripping, ensuring adequate handrails on stairs and in the bathroom, removing all clutter, and ensuring proper lighting), wearing proper footwear, strength training/physical therapy, treatment of any vision problems, and vitamin D supplementation when indicated.
