Hearing Link

Common balance disorders

Balance problems are usually caused by one of four things:

  • Disturbances in the inner ear itself, this is known as a peripheral balance problem and may be down to viral or bacterial infections, blood circulation affecting the inner ear, certain medications and aging
  • Changes in the connecting nerves of the inner ear and the way the brain receives the signals from the inner ear this can be caused by head injuries and disorders such as multiple sclerosis and migraines
  • Systemic disorders of the body for example thyroid problems and the effects of diabetes
  • Blood flow problems such as low blood pressure or cardiac arrhythmia

Diagram of the human earA labelled diagram showing a cutaway of the different parts of the human ear, from the outer ear through the middle ear to the inner ear.

Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo (BPPV) causes short episodes of vertigo or dizziness when moving your head in certain directions. Getting out of bed and rolling over in bed are two common “problem” motions.

Also some people feel dizzy and unsteady when they tip their heads back to look up although symptoms can vary or come and go. Small crystals of calcium carbonate (sometimes called “ear rocks”) break loose from their correct position in the balance organ and collect as debris within another part. With head movements, these crystals move, sending false signals to the brain about how you are moving.

  • About 20% of all dizziness is due to BPPV
  • The most common cause of BPPV in people under age 50 is head injury
  • About 50% of dizziness in older people is due to BPPV
  • In half of all cases, there is no known reason for the onset of BPPV

Tests for BPPV are a form of positional testing where you are asked to lay flat on a clinical bench and the tester will observe your eyes for a phenomenon called nystagmus (which is an involuntary eye movement). Sometimes this also includes videonystagmography which is a test where a pair of video goggles records these eye movements.

Treatment is usually by returning the debris to its correct location with a particle-repositioning manoeuvre. These include the Epley and the Semont-liberatory manoeuvres and Brandt Daroff exercises.These are very effective in treating BPPV. Some are performed in hospital balance clinics and others as a set of home exercises.

If you have had an Epley manoeuvre performed you may feel tired in the evening, you may also feel a little unwell or unsteady. This is normal and will pass after a short period of time, but for this reason you should not drive yourself home from the hospital.

More about the Epley manoeuvre and Brandt Daroff exercises from NHS Choices.

More about BPPV from the Menieres Society.

Labyrinthitis – inflamation of the labyrinth

Labyrinthitis is an inner ear infection. It causes a delicate structure deep inside your ear called the labyrinth to become inflamed, affecting your hearing and balance. Inner ear infections are not the same as middle ear infections, which are the type of bacterial infections common in childhood that affects the area around the eardrum.

Symptoms may include:

  • Labyrinthitis (inflammation of the labyrinth)
  • Dizziness/vertigo
  • Nausea/sickness
  • Tinnitus (ringing in ears)
  • Hearing loss

No specific balance tests exist to diagnose labyrinthitis, however a test battery of videonystagmography, caloric testing and posturography can be helpful alongside a strong history.

Medications are often prescribed to control nausea and to improve dizziness during the severe stage. Other illnesses are usually ruled out and a diagnosis made as a result of symptoms.  If treated promptly, many inner ear infections cause no permanent damage. In some cases, however, permanent loss of hearing or damage to the vestibular system can occur.

If symptoms of dizziness or imbalance continue for several months, vestibular rehabilitation exercises may be prescribed in order to teach the brain to adjust to the imbalance (known as compensation).  An important part of a successful recovery is to keep moving, despite the symptoms.

Many people diagnosed with labyrinthitis only experience the balance symptoms without hearing loss. This is actually known as vestibular neuronitis rather than labyrinthitis. However, both terms are often used to describe the same diagnosis.

Visit the NHS Choices website to find out more about labyrinthitis:

More about labyrinthitis from the Menieres Society.

Vestibular neuritis (or neuronitis) – inflammation of the hearing nerve

Vestibular neuritis, also known as neuronitis, is an infection of the vestibular nerve in the inner ear. It causes the vestibular nerve to become inflamed, disrupting your sense of balance. Infections of the inner ear are often caused by viruses and less commonly by bacterial infections. Although the symptoms may be similar, the treatments are very different, so correct diagnosis by a doctor is essential.  An inner ear viral infection may be caused by a general viral illness or the infection may be just in the inner ear.  Usually, only one ear is affected.

Symptoms can be mild or severe, ranging from mild dizziness to a violent spinning sensation.  They may also include nausea, vomiting, unsteadiness and imbalance, difficulty with vision, and impaired concentration.  Sometimes the symptoms can be so severe that they affect the ability to sit up, stand, or walk.

The onset of symptoms is usually very sudden, interrupting routine daily activities.  After a period of gradual recovery over several weeks, some people are completely free of symptoms while others do not recover fully and continue to have chronic dizziness, which is referred to as a lack of compensation.

No specific balance tests exist to diagnose vestibular neuritis, however a test battery of videonystagmography, caloric testing and posturography can be helpful alongside a strong history.

Medications are often prescribed to control nausea and to improve dizziness during the severe stage. Other illnesses are usually ruled out and a diagnosis made as a result of symptoms.  If treated promptly, many inner ear infections cause no permanent damage. In some cases, however, the vestibular nerve fails to recover, resulting in chronic vestibular neuronitis.

If symptoms of dizziness or imbalance continue for several months, vestibular rehabilitation exercises may be prescribed in order to teach the brain to adjust to the imbalance (known as compensation).  An important part of a successful recovery is to keep moving, despite the symptoms.

Visit the NHS Choices website to find out more about vestibular neuronitis.

Ménière’s disease

Ménière’s disease is a rare disorder that affects the inner ear. It can cause vertigo, tinnitus, hearing loss, and a feeling of pressure deep inside the ear.

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