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.