Dear Dr. Gott: I have been having balance problems for almost a year. I've seen an ear doctor for possible vertigo, a cardiologist for possible heart/circulation problems and a general practitioner with my concerns. I have to hold on to the wall to turn around when I take a shower and always feel pressure at the base of my neck. I tend to feel off balance even when walking. I have no other sensation when I'm sitting, and I sleep quite well.

Please help with at least a suggestion, because I have had no diagnosis from any of the five doctors I've seen. I even saw a neurologist, who only suggested physical therapy. I'm hoping for a response.

Reply: It's time for a second – or sixth – opinion. Something is being missed, and I am concerned about the complaint of constant pressure at the base of your neck.

There are a number of balance disorders that can be caused by a variety of medical conditions. Commonly, the first consideration is the inner ear and Meniere's disease, followed by but not in any specific order: haematoma from a fall, brain tumours, poor vision, advanced age and medication-induced problems. Normal balance requires three systems working in harmony – visual, somatosensory and vestibular. When one fails to function properly, balance can be dramatically affected.

Meniere's is an inner-ear abnormality associated with fluid volume changes. It presents with acute dizziness, the sensation of pain or pressure in the affected ear, tinnitus, roaring sounds and fluctuations in the ability to hear. If this were your case, it is likely only one ear would be affected, a relatively straightforward sign.

Tumours of the spine are abnormal masses causing minimal symptoms until they grow large enough to affect neurological functioning. I must state that not all tumours are cancerous. Numerous benign growths such as chordomas, schwannomas and acoustic neuromas can occur, presenting with loss of balance, dizziness, double vision and more. Diagnosis is commonly made through CT, MRI or cerebral angiography of the affected area. The good news is that enormous advances have been made in recent years and tumours that were once inoperable are now successfully removed.

Medications such as sedatives, antihistamines, tranquilizers, antiseizure drugs and those for hypertension carry the potential for causing dizziness and balance problems. If you are on any of these drugs, speak with the prescribing physician to determine whether they could be causing your balance problems. Did your physician or physicians add one more to the package about a year ago when your symptoms first began? Keep in mind that some drugs interact unfavorably with others, so perhaps a combination of drugs is to blame.

Caffeine, alcohol and tobacco products can also be contributors. If you indulge in these products, consider a trial of elimination or cutting back to see whether your symptoms disappear. It would certainly be a sad thing to know that chocolate, coffee or soda has provided you with a year of agony. And, at long last, make an appointment with a new otolaryngologist and neurologist.