Inner Ear Disorders

About

Your body needs your ears, eyes, muscles, and joints to stay balanced. Your inner ear plays an important part in keeping you balanced. Both of your inner ears have “balance organs” with receptors that sense when your head moves. Other receptors in your inner ear sense gravity and when you speed up or slow down.

These receptors know when your head turns and when it is moving in a straight line. When your inner ears notice these types of head movements, they tell your brain to let you know which direction you are moving. Your brain then sends this information to your eyes. This keeps your vision in focus even when your head is moving.

Symptoms

Some people have inner ear problems that affect their balance. Sometimes it could mean that one or both of your inner ears have stopped sending the right signals to your brain. While not everyone will have the symptoms of an inner ear problem, the more common symptoms are:

Changes in your hearing

Your hearing may be normal one day and then you may have trouble hearing sounds clearly on other days. You may also have “tinnitus” (you hear ringing, buzzing, roaring, whooshing or other noises).

Vertigo

You may feel like you or the world is spinning or whirling, you may feel lightheaded like you are floating, or you may feel a rocking sensation. You may also feel like your head is heavy and is being pulled in one direction.

Dizziness

You may be stumbling or have trouble walking straight, you may feel clumsy or have difficulty with coordination, or you may have a hard time standing up straight and will need to look down to find the ground. You may also have to hold on to things when standing and you may be very sensitive to changes of the ground surfaces when walking.

Not being able to stay balanced.

Problems seeing

You may have trouble focusing on objects, and words on paper in front of you may seem to jump, bounce, float or appear doubled, and you may have a hard time seeing well in busy places, such as in crowds and in stores. You may also be easily bothered by light and have night blindness (trouble seeing at night).

Causes

Vestibular Neuritis: an infection and inflammation of the inner ear that may happen after a cold or virus.
Damage to the inner ear because of a head injury.
Meniere’s disease: a condition caused by too much fluid in the inner ear. You may also have hearing loss and ringing in your ears. Learn more about Meniere’s disease. [link to Meniere’s disease section below for more information].
Migraine headaches: a headache with dizziness.
Benign paroxysmal positional vertigo (BPPV): happens when crystals inside the inner ear become loose and begin collecting in the semi-circular canal at the back of the ear. Certain head movements can cause short vertigo attacks that last for seconds. Learn more about BPV [link to BPPV section below for more information].
Acoustic Neuroma: inner ear balance problems that are caused by a benign (non-cancerous) tumor. Learn more [link to Acoustic Neuroma section below for more information].
Ototoxicity: poisoning to the inner ear from certain intravenous (IV) medicines or some medicine to fight infections.
Although there are many different causes of inner ear balance problems, you should know that there are times when a cause cannot be found.

Diagnosis

Your doctor will use your medical history and information from your physical exam to choose the right tests for you. These tests will:

Look at the way your ear works and the structure of your inner ear.
Look at the way your brain works and the structure of your brain.
Test your balance.
Make sure there is nothing else causing your symptoms.

You may have to do the following tests at our Hearing and Balance Department at the Toronto General Hospital:

Electronystagmography (ENG or VNG)
Rotation Tests
Vestibular Evoked Myogenic Potentials (c and oVEMPS)
Hearing Test
Electrocochleography (ECochG)
Otoacoustic Emissions (OAE)
Auditory Brainstem Response (ABR)

Other tests that could be right for you and are done at one of the Medical Imaging Departments at the University Health Network may be:
- Magnetic Resonance Imaging (MRI)
- Computerized Tomography (CT)

Treatment

Vestibular Rehabilitation

Most people with an inner ear balance disorder do get better. Recent research shows that the best way to get better is to do special exercises to help speed up the way your body keeps its balance. Your physiotherapist will show you how to do these exercises. For these exercises to work, you must do them every day for a few minutes each time, 3 to 4 times a day. These exercises “re-train” your brain to know and understand signals from your balance system and, at the same time, pass on the information coming from your eyes, arms and legs.

Medications

Medications may also be used to help you if you are feeling dizzy or nauseous. You may not take this medicine for a long time because it could confuse your body. It could also take you longer to get better.

Diet

Changing what you eat and drink can help lower the dizziness caused by inner ear problems. Caffeine, alcohol and tobacco can all cause you to feel dizzy, or even cause dizziness if you sometimes have vertigo, balance problems and light-headedness.

To feel less dizzy or to stop your dizziness:

Have less sugar and salt.
Drink enough fluids.
Stay away from caffeine.
Drink less alcohol.