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Johns Hopkins Health - Balancing Act

Winter 2010
Issue No. 7

Balancing Act

Date: January 24, 2010

If you’re older than 40 and feeling dizzy, watch out. You’re more likely than your younger peers to have a serious fall

two women running in the snow

Nearly 70 million Americans older than 40 are 12 times more likely to have a serious fall, says otolaryngologist (ear, nose and throat physician) Yuri Agrawal, M.D. That’s because of a form of inner-ear dysfunction that makes them dizzy and throws them off balance.

“It’s basically the accumulation of the effects of aging and various influences that occur over time,” she explains. Agrawal adds that just as hearing, vision, mobility and other physical functions and systems decline over time, so does inner-ear function.

Early Signs
Your balance system depends on the inner ear as well as the eyes, muscles and joints. If an inner-ear problem happens, you may have symptoms of dizziness. And that can result in a fall, or you may experience a spinning sensation called vertigo.

“Dizziness is a difficult symptom to diagnose and treat,” Agrawal says, “because there are many reasons it might be happening, including nerve dysfunction.”

Vertigo is usually more a symptom related to inner-ear dysfunction. But, by listening to a patient’s history of dizziness, a physician is better able to determine where the problem may be.

Agrawal says that such screenings aren’t well-validated in a primary care setting. Otolaryngologists are experts in performing balance assessments.

“It’s important to get proper screening and testing,” Agrawal says. That includes tests that look at the three systems—visual, touch and vestibular—that allow you to maintain balance.

Keeping the Balance
Once you’re diagnosed, treatment focuses on rehabilitation and making the home safer, rather than on medications. Balancing and walking exercises can help by training the brain to compensate for inner-ear deficits and episodes of dizziness. And modifications in the home help people avoid potentially hazardous falls.

“That could mean installing guard rails along stairs or hallways where a fall might occur,” Agrawal says. “Or making sure rooms are well-lit and removing carpeting in places where people are more prone to trip.”

It’s worth it, Agrawal adds. Falls—particularly among older people—cost nearly $1 billion a year in hospital charges.

Stats and Facts

  • Falls are the leading cause of fatal and nonfatal injuries for people ages 65 and older.
  • Dizziness is a common symptom affecting about 30 percent of people older than 65.
  • Accidental falls result in more than 1.5 million visits to the ER each year for seniors.

Learn more about inner-ear problems at, or call 877-546-1872.