Evaluation of balance disorders

概述 
理论 
急症 
诊断 
资源 

最后审阅： 19 Nov 2025

最后更新： 16 Jul 2025

Balance disorders are common and may significantly impact upon quality of life and independence. Impaired balance may result in falls with resulting morbidity and mortality, particularly in older people.

Epidemiology

Estimates of dizziness and vertigo in the community range from 17% to 30% and from 3% to 10%, respectively.[1] The prevalence of balance problems at age 70 years is reported to be 36% in women and 29% in men.[2]

Symptoms of dizziness or vertigo may constitute between 1% and 15.5% of primary care consultations.[3] Among the most commonly reported etiologies in primary care are vestibular/peripheral (5.4% to 42.1%), benign paroxysmal positional vertigo (4.3% to 39.5%), cardiovascular disease (3.8% to 56.8%), psychogenic (1.8% to 21.6%), Meniere disease (1.4% to 2.7%), neurologic disease (1.4% to 11.4%) vestibular neuritis (0.6% to 24%), and no clear diagnosis (up to 80.2%).[3]

鉴别诊断

常见

Vestibular neuritis/labyrinthitis
Meniere disease
Vitamin B1 (thiamine) deficiency
Ototoxic vestibulopathy
Benign paroxysmal positional vertigo (canalithiasis)
Hemorrhagic stroke
Ischemic stroke
Alcohol-related cerebellar degeneration
Vestibular migraine
Idiopathic Parkinson disease
Peripheral neuropathy

完整详情

不常见

Vestibular schwannoma (acoustic neuroma)
Sequential bilateral vestibular neuritis
Idiopathic bilateral vestibular hypofunction
Congenital bilateral vestibular hypofunction
Degenerative (age-related) inner ear disease
Autoimmune inner ear disease
Superior canal dehiscence (SCD)
Meningitis
Mal de debarquement syndrome
Spinocerebellar ataxia
Multiple sclerosis (MS)
Cerebellitis/brainstem encephalitis
Wernicke encephalopathy
Posterior fossa tumor
Chiari malformation
Central pontine myelinosis
Paraneoplastic syndrome
Vitamin E deficiency
Celiac disease
Primary cerebellar degeneration
Secondary parkinsonism
Normal pressure hydrocephalus
Corticobasal degeneration
Progressive supranuclear palsy
Multiple system atrophy (MSA; striatonigral degeneration, Shy-Drager syndrome)
Spinal cord trauma
Guillain-Barre syndrome (GBS)
Spinal spondylosis
Spinal cord tumor
Neuromyelitis optica (NMO)
Subacute combined degeneration of the cord
Syphilis, tabes dorsalis
Tuberculosis of the spine (Pott disease)
HIV infectious myelopathy
Human T-lymphotropic virus (HTLV)-1 infectious myelopathy
Systemic lupus erythematosus (SLE) inflammatory myelopathy
Anxiety disorder
Drug toxicity

完整详情

撰稿人

作者

Adrian Priesol, MD, FRCPC

Assistant Professor of Laryngology

Harvard Medical School

Medical Director of Auditory Evoked Testing

Massachusetts Eye and Ear Infirmary

Boston

利益声明

AP declares that he has no competing interests.

Nurhan Torun, MD, FRCSC

Assistant Professor in Ophthalmology

Director of Neuro-ophthalmology

Beth Israel Deaconess Medical Center

Harvard Medical School

Boston

利益声明

NT declares that she has no competing interests.

同行评议者

Joel A. Goebel, MD, FACS

Professor and Vice-Chairman

Department of Otolaryngology-Head and Neck Surgery

Director

Dizziness and Balance Center

Washington University School of Medicine

Saint Louis

利益声明

JAG has been reimbursed for conference speaking and clinical research support by NeuroCom Intl, Inc. and for conference speaking by MicroMedical Technologies, Inc.

Stephen P. Cass, MD

Associate Professor

Department of Otolaryngology

University of Colorado

Aurora

利益声明

SPC declares that he has no competing interests.

Daniel J. Costello, MD

Instructor in Neurology

Department of Neurology

Massachusetts General Hospital

Boston

利益声明

DJC declares that he has no competing interests.

Doris Bamiou, MD, MSc, PhD

Clinical Senior Lecturer & Consultant in Audiovestibular Medicine

UCL Ear Institute

UCL

London

利益声明

DB declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Goebel JA. 2015 Equilibrium Committee Amendment to the 1995 AAO-HNS guidelines for the definition of Ménière's disease. Otolaryngol Head Neck Surg. 2016 Mar;154(3):403-4. 摘要

Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngol Head Neck Surg. 2017 Mar;156(suppl 3):S1-47.全文摘要

Expert Panel on Neurologic Imaging:, Sharma A, Kirsch CFE, et al. ACR appropriateness criteria(®) hearing loss and/or vertigo. J Am Coll Radiol. 2018 Nov;15(11s):S321-31.全文摘要

Expert Panel on Neurologic Imaging:, Salmela MB, Mortazavi S, et al. ACR appropriateness criteria(®) cerebrovascular disease. J Am Coll Radiol. 2017 May;14(5s):S34-61.全文摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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Evaluation of balance disorders

小结

Epidemiology

鉴别诊断

常见

不常见

撰稿人

作者

Adrian Priesol, MD, FRCPC

利益声明

Nurhan Torun, MD, FRCSC

利益声明

同行评议者

Joel A. Goebel, MD, FACS

利益声明

Stephen P. Cass, MD

利益声明

Daniel J. Costello, MD

利益声明

Doris Bamiou, MD, MSc, PhD

利益声明

Peer reviewer acknowledgements

Disclosures

参考文献

关键文献

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

患者教育信息

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