Why do I sometimes lose my balance?

The sense is located in the middle ear, where there is fluid that works in a similar way to a tool used in construction to determine whether a wall is straight

There are a range of reasons why we may feel off-kilter, some more serious than others.
There are a range of reasons why we may feel off-kilter, some more serious than others.DAMIAN LUGOWSKI (Getty Images/iStockphoto)

It is difficult to explain what a sense of balance is because even we, in the medical profession, do not wholly understand it. But, basically, it allows us to know the position we are in: whether that’s lying down, standing, sitting or bending. Our sense of balance is located in the middle ear where there is fluid that works in a similar way to a tool used in construction to determine whether a wall is straight. The middle ear is the one that tells the brain: “At this moment you are completely straight, or now you are leaning over.”

When the middle ear fluid is not balanced, it gives a person the impression they are losing their balance and might fall. But there are times when alcohol or certain drugs have been consumed and our perception of balance is lost, even though the middle ear fluid is perfectly balanced. What happens in this case is that the brain is not able to interpret the signals properly.

We have different sensors in the body, for pain, touch and temperature. And we also have kinesthetic sensors that allow us to know the position our bodies are in. Any change to these sensors makes it hard to know whether we are standing or sitting. And to complicate things further, the part of the brain that decodes all body movement integrates all the information from the receptors on top of the information provided by the middle ear, and tells us what position we are in.

So why do we sometimes lose our sense of balance? Well, it depends. A typical example in women, who tend to have low blood pressure at childbearing age, is standing up abruptly or standing upright after being bent over for a period of time. In these instances, orthostatic hypotension occurs, which is a rapid reduction in blood flow to the head that produces a feeling of dizziness and loss of balance. This has happened to all of us at one time or another. It also happens to men, but it is more frequent in women. In this case, the loss of balance is caused by blood pressure and has nothing to do with the middle ear.

A loss of balance can also happen without movement. In this case, the middle ear is involved and a frequent trigger is vertigo. We could be sitting or lying down and get a spinning sensation, indicating that the middle ear mechanism is not working properly. This could also be due to a wax plug generating internal pressure that prevents the middle ear fluid from moving properly. Or it could be due to other conditions, some as serious as a tumor.

That is why it is important that we accurately identify when a loss of balance occurs. Does it happen after taking a certain medication? Benzodiazepines or sleeping pills often generate unsteadiness the day after taking them. Does it happen after a period? Menstruation means lower blood pressure. Is it a loss of hearing? This could be down to a wax plug. Or is there a spinning sensation after turning suddenly, indicating a possible cervical impingement? Basically a health professional will be able to clear up any doubts; a few simple tests will be able to indicate whether it is the inner ear, a wax plug or vertigo. If it looks as if something else is going on, there will be a referral to a specialist.

It is also important to know that the sensation of losing our balance becomes more frequent with age. The aging process begins very gradually from the age of 30. And we age according to our genetics and lifestyle. Usually our organs age at different rates. The skin is the first to feel the ravages of time, but the sense organs are the next to be affected, particularly sight and hearing, which starts from the age of 45 onwards.

After 45, the whole ear – which is a very sophisticated mechanism – becomes much thicker. Normal age-related hearing loss is called presbycusis. What happens is that things we used to take in our stride, such as walking quickly or doing fancy dance moves, start to become more difficult. But these are normal changes and we adapt accordingly as the body is very wise.

Carmen Sarabia Cobo is a nurse and PhD in Psychology, a professor at the University of Cantabria, specialist in neuropsychology, dementia and old age. She coordinates the Nursing research group at IDIVAL.

Coordination and editing: Victoria Toro

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