Balance is the ability to stand, sit, walk, run, change positions and bend forwards and backwards without falling. It is an innate skill coordinated in our brain with inputs from the eye (orientation in space), neck (position of the head relative to the body), peripheral nerves (signalling contact with the floor and other objects) and, most important of all, the ear. Inside the inner ear, there is a liquid called endolymph and fine hair called cilia which send signals through the eighth cranial nerve to the brain to maintain balance.

Children are born with excellent balance. They can turn somersaults, hang upside down and swing with the greatest of ease. If they develop a bad cold or ear infection, this ability may be temporarily lost or compromised. It recovers spontaneously once the infection clears up.

Older people can develop acute attacks of vertigo. The head spins or the world outside swirls. It may develop with a sudden change of position, such as getting up from bed. There are several reasons for this, which need to be ruled out one at a time. The blood pressure needs to be checked in lying, sitting and standing positions to find if there is a precipitous drop. This can occur as blood vessels become less pliant with age and the sensors in them become inefficient.

Vitamin D can fall with increasing age and this, in turn, can make the bones weak. If neck bones become weak, their alignment changes and nerve signals to the brain become affected, causing giddiness.

The endolymph in the inner ear has symmetrical calcium deposits called otoliths. If misaligned, these can interfere with the functioning of the villi, causing loss of balance.

As they get older, many people do not exercise. A sedentary lifestyle makes their muscles weak. The gait becomes slow and waddling as steps are shorter. Sudden changes in direction or speed causes loss of balance. This can lead to falls, fractures and eventually a poor quality of life.

Evaluating loss of balance involves checks for anaemia, diabetes, hypertension, lipid profile, uric acid, thyroid malfunction, Vitamin B12 levels (can cause loss of sensation in the peripheral nerves) and Vitamin D3 levels. An X-ray of the neck may also be required. Tumours on the eighth nerve can cause loss of balance but this is accompanied by deafness as well. Sometimes the condition may be due to substance abuse (alcohol, tobacco) or the side effect of medication.

Once a diagnosis is reached and the disease process treated, the giddiness may disappear.

Balance and gait have to be consistently worked on with physical exercises at least three days a week. Walk for 30 minutes every day, concentrating on posture. Stand against a wall for 30 seconds and make both shoulders touch the wall. Do the tree pose in yoga, alternating the legs. Walk a hundred steps touching heel to toe. Hold on to a chair and stand up on the toes. Stand with your back to a chair and do squats. Block both ears with fingers and say “oooh”. This stimulates the eighth nerve and keeps it functioning efficiently.

Change positions slowly, turn to your side before getting up from bed. Forgo a pillow or use a small one. Have handrails installed beside stairs as well as beside the toilet for support while getting up. Avoid wet and slippery surfaces. Reduce intake of salt and caffeine. Avoid alcohol.

The writer is a paediatrician with a family practice at Vellore and the author of Staying Healthy in Modern India. If you have any questions on health issues please write to yourhealthgm@yahoo.co.in