What are the common causes of dizziness related to the inner ear. How does the inner ear balance system work. What are the symptoms of vertigo and other balance disorders. How can water in the ear lead to dizziness. What treatments are available for inner ear balance problems.

The Intricate Balance System of the Inner Ear

The inner ear plays a crucial role in maintaining our balance and spatial orientation. It houses a complex system of fluid-filled canals that detect different types of movement:

• Up and down motion
• Side-to-side movement
• Rotational movement in any direction
• Tilting of the head

These canals contain fluid and floating membranes with specialized sensory cells. As we move, the fluid shifts, causing the membranes to bend. This triggers the sensory cells to send signals to the brain, providing vital information about our body’s position and movement in space.

The brain integrates this sensory input from the inner ear with visual cues and proprioceptive feedback from muscles and joints. This complex integration allows us to maintain balance, coordinate our movements, and navigate the physical world with precision.

When Balance Goes Awry

If the signals from the inner ear become disrupted or misinterpreted by the brain, it can lead to a range of balance disorders. These may manifest as:

• Dizziness
• Vertigo (a spinning sensation)
• Nausea
• Unsteadiness
• A feeling of impending fall

Understanding the intricate workings of the inner ear balance system is crucial for diagnosing and treating various balance disorders effectively.

Vertigo: When the World Seems to Spin

Vertigo is a common symptom of inner ear disorders, characterized by a false sensation of spinning or movement. While vertigo itself is a symptom, there are specific conditions that can cause this disorienting experience.

Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is one of the most common causes of vertigo. It occurs when small calcium crystals, known as otoconia, become dislodged from their normal position in the inner ear. These crystals then float freely in the fluid-filled canals, causing inappropriate stimulation of the sensory cells.

Can BPPV be treated effectively? Fortunately, BPPV is often easily manageable. A series of specific head movements, known as the Epley maneuver, can be performed by a healthcare provider to guide the displaced crystals back to their proper location. This simple procedure can provide immediate relief for many patients suffering from BPPV-induced vertigo.

Risk Factors for BPPV

While BPPV can affect anyone, certain factors may increase the likelihood of developing this condition:

• Advanced age
• Head injuries
• Inner ear infections (such as labyrinthitis)
• Family history of BPPV

Understanding these risk factors can help individuals and healthcare providers identify and address BPPV more promptly, leading to faster symptom relief and improved quality of life.

The Impact of Earwax on Balance and Hearing

Earwax, also known as cerumen, is a natural substance produced by the body to protect and clean the ear canal. However, excessive accumulation of earwax can lead to various issues, including balance problems and hearing difficulties.

Causes of Earwax Buildup

Several factors can contribute to excessive earwax accumulation:

• Overproduction of cerumen by the body
• Narrow or irregularly shaped ear canals
• Use of hearing aids or earplugs
• Improper ear cleaning techniques (e.g., using cotton swabs)
• Advancing age, as earwax tends to become drier and less mobile

How does earwax affect balance? When earwax builds up to the point of blocking the ear canal, it can interfere with the normal function of the inner ear. This obstruction can alter the pressure within the ear and disrupt the delicate balance mechanisms, leading to dizziness, vertigo, and a feeling of fullness in the affected ear.

Treatment Options for Earwax-Related Balance Issues

Addressing earwax-induced balance problems typically involves safely removing the excess cerumen. Treatment options may include:

1. Ear irrigation: A gentle stream of warm water is used to flush out the earwax.
2. Cerumenolytic drops: These over-the-counter or prescription drops help soften and dissolve the earwax.
3. Professional removal: In cases of severe blockage or for individuals with other ear conditions, a healthcare provider may remove the wax under microscopic visualization.

It’s important to note that attempting to remove earwax at home with cotton swabs or other objects can often worsen the problem by pushing the wax deeper into the ear canal. Always consult a healthcare professional if you suspect earwax buildup is affecting your balance or hearing.

Meniere’s Disease: A Complex Inner Ear Disorder

Meniere’s disease is a chronic inner ear condition characterized by a triad of symptoms: vertigo, fluctuating hearing loss, and tinnitus (ringing in the ears). This disorder can significantly impact an individual’s quality of life due to its unpredictable and often debilitating nature.

Understanding the Underlying Mechanisms

The exact cause of Meniere’s disease remains unclear, but it is believed to be associated with an abnormal buildup of fluid in the inner ear. This excess fluid, known as endolymph, can distort the delicate structures within the ear, leading to the characteristic symptoms of the disorder.

What factors may contribute to the development of Meniere’s disease? While the precise etiology is unknown, several theories have been proposed:

• Circulatory problems affecting the inner ear
• Autoimmune reactions
• Allergic responses
• Viral infections
• Genetic predisposition

Research is ongoing to better understand the underlying mechanisms and potential triggers of Meniere’s disease.

Management Strategies for Meniere’s Disease

While there is no cure for Meniere’s disease, various treatment approaches can help manage symptoms and improve quality of life:

1. Dietary modifications: Reducing salt intake and avoiding caffeine and alcohol can help regulate fluid balance in the inner ear.
2. Medications: Diuretics, anti-vertigo drugs, and steroids may be prescribed to control symptoms and reduce fluid buildup.
3. Vestibular rehabilitation: This specialized form of physical therapy can help improve balance and reduce dizziness.
4. Pressure pulse treatment: Devices that deliver air pressure pulses to the middle ear may help alleviate vertigo in some patients.
5. Surgical interventions: In severe cases unresponsive to conservative treatments, surgical options may be considered to relieve symptoms or reduce fluid pressure in the inner ear.

The management of Meniere’s disease often requires a multidisciplinary approach, involving collaboration between otolaryngologists, audiologists, and other healthcare professionals to tailor treatment to each individual’s needs.

Acoustic Neuroma: When a Tumor Affects Balance

Acoustic neuroma, also known as vestibular schwannoma, is a benign tumor that develops on the vestibulocochlear nerve. This nerve is responsible for transmitting balance and hearing information from the inner ear to the brain. Although rare, acoustic neuromas can significantly impact an individual’s balance and hearing.

Symptoms and Diagnosis

The symptoms of acoustic neuroma often develop gradually and may include:

• Progressive hearing loss, typically in one ear
• Tinnitus (ringing in the affected ear)
• Balance problems and dizziness
• Facial numbness or weakness
• Headaches

How is acoustic neuroma diagnosed? The gold standard for diagnosing acoustic neuroma is magnetic resonance imaging (MRI) with contrast. This imaging technique allows healthcare providers to visualize the tumor and assess its size and location accurately.

Treatment Options for Acoustic Neuroma

The management of acoustic neuroma depends on various factors, including tumor size, growth rate, and the patient’s overall health and preferences. Treatment options may include:

1. Observation: For small, slow-growing tumors, a “wait and watch” approach with regular MRI scans may be recommended.
2. Stereotactic radiosurgery: This non-invasive treatment uses precisely targeted radiation to stop tumor growth.
3. Microsurgery: Surgical removal of the tumor may be necessary for larger tumors or those causing significant symptoms.

Each treatment approach has its own set of benefits and potential risks, which should be thoroughly discussed with a healthcare provider to determine the most appropriate course of action for each individual case.

Vestibular Neuritis: When Inflammation Disrupts Balance

Vestibular neuritis is an inner ear disorder characterized by inflammation of the vestibular nerve, which plays a crucial role in maintaining balance. This condition can cause sudden and severe vertigo, often accompanied by nausea, vomiting, and difficulty with balance and coordination.

Causes and Risk Factors

The exact cause of vestibular neuritis is not always clear, but it is often attributed to viral infections. Some potential culprits include:

• Herpes simplex virus
• Influenza virus
• Epstein-Barr virus
• Cytomegalovirus

Certain factors may increase the risk of developing vestibular neuritis, such as recent upper respiratory infections, stress, and a weakened immune system.

Symptoms and Diagnosis

The hallmark symptom of vestibular neuritis is the sudden onset of severe vertigo, which can last for several days. Other common symptoms include:

• Nausea and vomiting
• Difficulty maintaining balance
• Horizontal nystagmus (involuntary eye movements)
• Difficulty concentrating

How is vestibular neuritis diagnosed? Diagnosis typically involves a combination of clinical examination, balance tests, and sometimes imaging studies to rule out other potential causes of vertigo.

Treatment and Recovery

The management of vestibular neuritis focuses on controlling symptoms and supporting the body’s natural recovery process. Treatment options may include:

1. Vestibular suppressant medications to reduce vertigo and nausea
2. Corticosteroids to decrease inflammation of the vestibular nerve
3. Vestibular rehabilitation exercises to help the brain compensate for the altered balance signals
4. Antiviral medications in some cases, although their effectiveness is debated

Most individuals with vestibular neuritis experience significant improvement within a few weeks, although complete recovery can take several months. In some cases, residual balance problems may persist and require ongoing vestibular rehabilitation.

Water in the Ear: A Common Cause of Temporary Dizziness

While not a chronic condition like the disorders previously discussed, water trapped in the ear canal can cause temporary dizziness and discomfort. This situation often occurs after swimming, bathing, or exposure to water during other activities.

How Water in the Ear Affects Balance

When water becomes trapped in the ear canal, it can:

• Create a feeling of fullness or pressure in the ear
• Muffle sounds, leading to temporary hearing changes
• Interfere with the normal function of the eardrum and inner ear structures
• Potentially lead to infection if not addressed promptly

These effects can collectively contribute to a sense of imbalance or dizziness, especially when moving the head or changing positions.

Safe Removal of Water from the Ear

To safely remove water from the ear and alleviate associated dizziness, consider the following methods:

1. Tilt the head to the side and gently pull on the earlobe to help water drain out
2. Use gravity by lying on your side with the affected ear facing down
3. Create a vacuum by pressing your palm against your ear and pushing in and out
4. Use a hairdryer on the lowest setting, held at arm’s length, to evaporate the water
5. Try over-the-counter ear drops designed to help dry water in the ear

It’s important to avoid inserting any objects into the ear canal, as this can push the water deeper or potentially cause injury.

Preventing Water-Related Ear Issues

To minimize the risk of water becoming trapped in the ear and causing dizziness, consider these preventive measures:

• Wear well-fitting earplugs or a swim cap when swimming or participating in water activities
• Tilt your head to each side after swimming or bathing to allow water to drain naturally
• Use a towel to dry the outer ear thoroughly after water exposure
• Consider using alcohol-based ear drops after swimming to help evaporate any remaining water

By understanding the potential impact of water in the ear and taking appropriate precautions, individuals can reduce their risk of experiencing water-related dizziness and discomfort.

Feeling Off-Balance? The Problem Might Be in Your Ears

If you’re feeling a little unsteady on your feet, it’s not just in your head. It might actually be in your ears.

We’ve all experienced dizziness after a boat trip, an amusement park ride or spinning in a circle as a kid. But if you feel like you’ve just gotten off a roller coaster even if you’ve hardly moved, you could have a balance problem related to your inner ear. Here’s how it happens.

Your inner ear has three canals that sense different types of movement: up and down, side to side, turning in any direction and tilting. These canals are filled with fluid; within that fluid are floating membranes with tiny cells that send signals to your brain. That special sensory information, combined with what you see and feel, helps you navigate the physical world. The brain ultimately interprets all of this incoming sensory information and translates it into coordination, balance and movement. If those incoming signals are thrown off, you can experience dizziness, nausea or a feeling that the world is spinning. You may even feel like you’re about to fall down. Several different conditions can cause your inner ear–balance system to become off-kilter, but thankfully they can be managed with help from a doctor.

Vertigo

Vertigo is really the name of the symptom describing this dizzy, off-balance feeling, but something called benign paroxysmal positional vertigo (BPPV) is a diagnosis in itself. With BPPV, small calcium crystals in your inner ear become dislodged, causing your brain to receive the wrong signals about your movements. So when you turn your head or change positions, you might experience a sudden spinning spell. It usually occurs in older people, but head injuries, an inner ear infection called labyrinthitis or having a family member with BPPV can also increase your risk. BPPV is usually easily treated with a special series of movements your health care provider can perform to help get the crystals back in place.

Earwax

Everyone has earwax, but some people have more than others. If it builds up, it can block the ear and cause hearing problems as well as balance issues. Older people tend to be more at risk for earwax buildup, but it can also happen if you stick anything, like a cotton swab, in your ear; this can impact the wax instead of removing it. Your primary care doctor may use irrigation or give you drops to moisten earwax buildup so it will dislodge. If it is severe or if you have other ear issues, you may need a specialist to remove it under a microscope, which can be done in the office.

Meniere’s disease

Named after the physician who first described it, Meniere’s disease occurs when fluid builds up in the inner ear, causing sudden attacks of vertigo as well as ringing in the ear (tinnitus), hearing loss or a feeling of fullness in the ear. Doctors aren’t sure what causes it, but some proposed theories include problems with circulation, allergy or autoimmune reactions, infection or genetics. While there’s no cure for Meniere’s disease, treatments can be effective at controlling the symptoms. Medications, diet and lifestyle changes and, in severe cases, surgery, can help.

Acoustic neuroma

Technically called vestibular schwannoma, acoustic neuroma is a benign tumor that causes balance problems, along with vertigo, tinnitus, hearing loss on the affected side or ear fullness or pressure.

“Acoustic neuromas cause balance disturbance in many cases because the tumor grows around the vestibular, or balance, portion of the eighth cranial nerve, which carries sensory information from the inner ear,” says Joni Doherty, MD, PhD, an otolaryngologist and neurotologist at Keck Medicine of USC and assistant professor of clinical otolaryngology – head and neck surgery at the Keck School of Medicine of USC.

Although uncommon, the incidence of acoustic neuroma is on the rise, most likely due to early detection via magnetic resonance imaging, Doherty adds. Some experts estimate that one in 1,000 people per year develop an acoustic neuroma. Microsurgery can remove the tumor; radiation therapy or a wait-and-watch approach are also options.

Vestibular neuritis

If the inner ear becomes infected, usually from a virus, it can cause this inner ear condition. When the vestibular nerve swells from the infection, the signals to the brain are thrown off and result in vertigo, dizziness, balance problems, nausea and even difficulty concentrating. There are medications to control symptoms; often a steroid will also be given. Physical therapy to “retrain” the brain may be recommended if symptoms persist.

Topics

balance

dizziness

Dr. Joni Doherty

earwax

infection

inner ear

tumor

vertigo

Tina Donvito

Tina Donvito is a freelance writer covering health, culture, travel and parenting.

Inner ear problems and vertigo

Understanding the balance system

The inner ear plays a key role in helping the body keep its balance. To do this, the inner ear senses head and body position, and motion. It also works with other parts of the body, such as the eyes.

The body relies on the inner ear for balance signals. Signals sent to the brain from the inner ear, eyes, and other areas help the body stay balanced. With inner ear problem, the brain may be getting the wrong signals. This can lead to vertigo or the sensation of feeling of off balance, often dizzy.  

Benign positional vertigo 

The most common cause of vertigo is called benign positional paroxysmal vertigo (BPPV). It happens when crystals in the ear canals shift into the wrong place. Vertigo usually occurs when you move your head in a certain way. This can happen when turning in bed, bending, or looking up.

It causes vertigo that lasts for seconds. Vertigo can occur several times a day, depending on body position. This often doesn’t cause hearing loss and may go away on its own. However, with treatment it may go away sooner.

Infection or inflammation

Sometimes the semicircular canals swell and send incorrect balance signals. This problem may be caused by a viral infection. Depending on the cause, your hearing can be affected.. 

The inner ear has a system of fluid-filled tubes and sacs called the labyrinth. Inside the inner ear, the cochlea gathers information about sound. The vestibular organs gather information about motion and changes in space. These all help to create a sense of balance.

When one of the nerves or the labyrinth is infected, it can become inflamed and irritated. This can cause it to not work normally. It may cause hearing loss in one ear. The brain now has to make sense of the information that doesn’t match between the normal nerve and the infected one. This can causes vertigo.

Infection or inflammation:

• Causes vertigo that lasts for hours or days. The first episode is usually the worst.

• Can cause hearing loss.

• Often goes away on its own. But it may go away sooner with treatment.

Ménière disease

Ménière disease is a balance disorder, but often less common. Although it can happen to anyone,  Ménière disease is most often found in people in their 40s and 50s. It happens when there is too much fluid in the ear canals. This causes increased pressure and swelling, affecting balance and hearing signals. It’s caused by an abnormality in part the inner ear called the labyrinth. Fluid buildup here can cause a severe spinning feeling (vertigo) and affect the hearing.

Too much endolymph buildup in the labyrinth can interfere with the normal balance and hearing signals between the inner ear and the brain.

This fluid buildup in the chambers in the inner ear may be caused by several things, including allergies, abnormal immune system response, head injury, migraine headaches, or a viral infection. Symptoms include a severe spinning feeling (vertigo), nausea, vomiting, loss of hearing, ringing in the ears, headache, loss of balance, and sweating.

There is no cure for Ménière disease but treatment can help manage symptoms. Common treatment includes behavior therapy, hearing aids, medicine, diet changes, and surgery.

Questions and answers on the topic

Questions and answers on the topic – Otoneurology, dizziness

Questions:

• Hello!
  Please tell me why there is a sharp dizziness and vomiting.
  Tinnitus is heard and pressure rises.

  Answer to the question

• Hello!
  I had a knock in my right ear. Now a constant feeling of congestion.
  When I touch, I feel dizzy.
  Recently had an attack of nausea and vomiting.
  Now I don’t feel sick and I don’t vomit, but I don’t touch my ear, otherwise everything floats before my eyes.
  What is it and how to treat it?

  Answer to the question

• Hello, dear doctors.
  Please help me figure it out.
  When dizzy, is vision ALWAYS involved in this process? Or sensations in the body, head and / or legs (falling, swaying, etc.), without changing before the eyes – can this also be dizziness?
  Best regards, Julia.

  Answer to question

• I have had tinnitus for almost half a year.
  What investigations are required for the initial appointment with an otoneurologist?
  Thank you
  Answer to the question
• Hello, please tell me, I did an MRI of the head and blood vessels, as I am worried about constant headaches and now for another month my head is spinning and swimming in my eyes.
  On MRI, they wrote me a decrease in pneumatization of the right mastoid process.
  What does this mean?
  I have never had problems with my ear.
  Answer to question
• Hello.
  My dad is being questioned about Meniere’s disease, does it say on your website that you are doing some kind of tests to confirm the diagnosis?
  Answer to question
• Noise in the left ear, stuffy ear, feeling of pulsation or water transfusion, dizziness, incoordination, heavy head. He did an ultrasound of the vessels in the neck – everything is normal, now they are sent for an MRI of the brain and vessels of the head. However, I see no reason to do this MRI, because it seems to me that I have a cold in my inner ear. Since I work outside in the summer in the heat, I drink cold water. How is it treated? (ringing in your ears as if you are going to faint)
  Answer to question
• Hello.
  For a year now, I have been experiencing dizziness (constantly shakes, and it is impossible to focus on anything, a feeling of sinking, as if the ground is moving out from under my feet), ringing in the ears, and congestion, it seems to me that my hearing has become worse, I am 23 years old. Uzdg of neck vessels, biochemistry and complete blood count are normal. The neurologist at the reception did not see any abnormalities.
  ENT gives a referral to an Audiologist, tell me what examinations do I need to undergo?
  And were they sent to the Audiologist correctly?
  Answer to question
• Hello.
  Six months dizziness. Ringing, whistling in the ears. The head presses: the back of the head, forehead, temples, crown of the head.
  Feeling that the inside of the skull scratched . .. 5 neurologists, 3 ENT and 3 therapists
  passed … brain MRI. Head ct. Ultrasound and X-ray of the neck. Ultrasound of blood vessels….
  In general, I have cervical chondrosis. And the narrowing of the right vertebral artery … my condition is gradually deteriorating.
  Vision began to flicker. Yesterday suddenly there was a strong ringing in a head. The pressure rose to 150/90 … and immediately the sound in the left ear became some kind of ragged. As if the membrane had burst … since childhood, I have a hearing loss of 2 degrees. The left ear hears worse.
  Never complained about his ears. They didn’t get sick … a week ago I visited an audiologist. There, everything is without pathologies and they recommend going to the neurologist again …. I’m at a dead end.
  Tell me what should I do? Who else to pass? What kind of doctor do you need?….thank you.
  Answer to question
• Please tell me.
  Constantly dizzy. Lying and sitting, feeling of rocking, lying as if on waves.
  Otoneurologist ruled out, ear crystals in place. He prescribed audiometry, vestibulometry, electrocochleography, impedancemetry.
  These studies are expensive. You can’t just do an MRI of the temporal bones (auditory nerves). Head MRI is normal. I did an MRI of the neck, the doctor says there can be no dizziness from the neck. Still knocks often in the right ear.
  Answer to question
• Hello, doctor!
  In May, dizziness began, abruptly, almost to the point of fainting. Then neurology drop pills. The state does not completely go away, as if I am shaking, but it is not visible from the outside.
  Doctors say osteochondrosis, instability of the cervical vertebrae, narrowing of the right vertebrae. arteries.
  Could my condition be due to my ear?
  Didn’t go to Laura’s. How to understand and understand what is the reason. Thank you.
  Answer to question
• Sickness in transport, in the cinema (nausea, vomiting).
  The inability to go to the cinema is especially unpleasant (vomits every session).
  Who should be contacted with this problem: an otoneurologist or a neurologist?
  Have you had any patients with this problem?
  Answer to the question

Ask a question

Ear diseases can cause dizziness by rotation of objects

What should I do if I feel dizzy?

Try to identify your disease by the symptoms described below and go to the page with a description of the methods of its treatment.

What causes dizziness?

In addition to the primary function of perceiving sounds, the human hearing aid plays an important role in maintaining balance. The anatomical structures and organs responsible for this process are located in the inner ear.
In some diseases of the inner ear (Ménière’s disease), dizziness of a certain nature occurs – according to the type of rotation of objects.
In addition, dizziness may be a sign of certain brain diseases (atherosclerosis, etc. ). Therefore, doctors of two specialties take part in the diagnosis and treatment of diseases that cause dizziness – a neurologist and an ENT doctor.

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Hello, when cleaning the ears with chopsticks, there is blood (a little) from two ears at the end.