What are the common causes of inner ear problems. How do inner ear disorders affect balance and hearing. What are the most effective treatments for vertigo and other inner ear issues. How can you prevent inner ear problems from developing.

Understanding the Intricate Structure of the Inner Ear

The inner ear is a complex and delicate structure that plays a crucial role in our ability to hear and maintain balance. To fully grasp the various disorders that can affect this vital organ, it’s essential to understand its anatomy and function.

The inner ear consists of three main components:

• The cochlea: A spiral-shaped structure responsible for converting sound waves into electrical signals that the brain interprets as sound
• The vestibule: Contains the utricle and saccule, which detect linear acceleration and head position relative to gravity
• The semicircular canals: Three fluid-filled tubes that detect rotational movements of the head

Together, these structures form the labyrinth, which is filled with fluid and lined with sensitive hair cells. These hair cells respond to movement and sound, sending signals to the brain through the vestibular and auditory nerves.

The Importance of Inner Ear Health

Maintaining the health of your inner ear is crucial for several reasons:

1. Hearing: The cochlea is responsible for processing sound, allowing us to hear and distinguish different frequencies
2. Balance: The vestibular system helps us maintain our equilibrium and spatial orientation
3. Quality of life: Inner ear disorders can significantly impact daily activities and overall well-being

Understanding the intricate structure and function of the inner ear provides a foundation for exploring the various disorders that can affect this vital sensory organ.

Common Causes of Inner Ear Problems

Inner ear disorders can arise from various factors, ranging from infections to age-related changes. Identifying the root cause is crucial for effective treatment and management. Here are some of the most common causes of inner ear problems:

Infections and Inflammatory Conditions

Infections are a frequent culprit behind inner ear issues. These can include:

• Labyrinthitis: An inflammation of the inner ear’s labyrinth, often caused by viral infections
• Vestibular neuritis: Inflammation of the vestibular nerve, typically due to viral infections
• Otitis media: A middle ear infection that can spread to the inner ear if left untreated

How do infections lead to inner ear problems? When pathogens invade the inner ear, they can cause inflammation and damage to the delicate structures, disrupting normal function and leading to symptoms such as vertigo, hearing loss, and tinnitus.

Age-Related Changes

As we age, our inner ear structures naturally deteriorate, leading to various issues:

• Presbycusis: Age-related hearing loss due to the gradual breakdown of hair cells in the cochlea
• Vestibular dysfunction: Reduced balance function as the vestibular system becomes less sensitive over time

Why does aging affect the inner ear? The cumulative effects of exposure to noise, environmental toxins, and natural cellular aging processes contribute to the gradual decline in inner ear function.

Trauma and Injuries

Physical trauma to the head or ear can cause inner ear problems:

• Temporal bone fractures: Can damage the inner ear structures
• Acoustic trauma: Exposure to extremely loud noises can damage the cochlea
• Barotrauma: Rapid changes in air pressure (e.g., during diving or flying) can affect the inner ear

How does trauma impact inner ear function? Physical injuries can disrupt the delicate structures within the inner ear, leading to immediate or delayed onset of symptoms such as hearing loss, tinnitus, or balance problems.

Recognizing Symptoms of Inner Ear Disorders

Identifying the symptoms of inner ear problems is crucial for early diagnosis and treatment. While symptoms can vary depending on the specific disorder, some common signs include:

Vertigo and Dizziness

One of the most characteristic symptoms of inner ear disorders is vertigo, a sensation of spinning or movement when you’re actually still. How does vertigo differ from general dizziness? Vertigo is typically more intense and often accompanied by nausea and difficulty maintaining balance.

Hearing Loss and Tinnitus

Inner ear problems can affect hearing in various ways:

• Sudden or gradual hearing loss
• Tinnitus (ringing or buzzing in the ears)
• Sensitivity to loud noises

Why do inner ear disorders cause hearing issues? Damage to the cochlea or auditory nerve can disrupt the normal processing of sound, leading to these symptoms.

Balance Problems

The vestibular system in the inner ear plays a crucial role in maintaining balance. Disorders affecting this system can lead to:

• Unsteadiness or difficulty walking
• Increased risk of falls
• Feeling of floating or heaviness

How does the inner ear contribute to balance? The vestibular system sends signals to the brain about head position and movement, which are integrated with visual and proprioceptive information to maintain balance.

Diagnosing Inner Ear Disorders: Advanced Techniques and Tests

Accurate diagnosis of inner ear disorders is essential for effective treatment. Healthcare providers use a combination of physical examinations, patient history, and specialized tests to identify the specific problem. Here are some advanced diagnostic techniques used in evaluating inner ear function:

Audiometry and Tympanometry

These tests assess hearing function and middle ear health:

• Pure tone audiometry: Measures hearing thresholds across different frequencies
• Speech audiometry: Evaluates the ability to understand speech at various volumes
• Tympanometry: Assesses the function of the middle ear and eardrum

How do these tests help in diagnosis? They provide detailed information about the type and degree of hearing loss, helping to pinpoint whether the issue originates in the inner ear or elsewhere in the auditory system.

Vestibular Function Tests

These tests evaluate the balance and vestibular system:

• Electronystagmography (ENG) or Videonystagmography (VNG): Records eye movements to assess vestibular function
• Rotational chair testing: Evaluates the vestibulo-ocular reflex
• Posturography: Assesses balance control under various sensory conditions

Why are vestibular function tests important? They help identify specific abnormalities in the balance system, allowing for targeted treatment approaches.

Imaging Studies

Advanced imaging techniques can provide detailed views of the inner ear structures:

• CT (Computed Tomography) scans: Offer detailed images of the bony structures of the ear
• MRI (Magnetic Resonance Imaging): Provides high-resolution images of soft tissues, including the inner ear and auditory nerve

How do imaging studies contribute to diagnosis? They can reveal structural abnormalities, tumors, or other lesions that may be causing inner ear symptoms.

Innovative Treatments for Inner Ear Disorders

Advancements in medical science have led to a range of innovative treatments for inner ear disorders. The choice of treatment depends on the specific condition, its severity, and individual patient factors. Here are some cutting-edge approaches to managing inner ear problems:

Vestibular Rehabilitation Therapy (VRT)

VRT is a specialized form of physical therapy designed to improve balance and reduce dizziness-related problems. It involves:

• Customized exercise programs to retrain the brain’s ability to process balance information
• Gaze stabilization exercises to improve visual focus during head movements
• Balance training to enhance overall stability and reduce fall risk

How effective is VRT in treating inner ear disorders? Studies have shown that VRT can significantly improve symptoms in many patients with vestibular disorders, often leading to better quality of life and increased independence.

Medication Therapies

Various medications can be used to manage symptoms and treat underlying causes:

• Antivirals: For inner ear infections caused by viruses
• Steroids: To reduce inflammation in conditions like sudden sensorineural hearing loss
• Antivertigo medications: To alleviate symptoms of vertigo and dizziness

What factors influence the choice of medication? The specific diagnosis, severity of symptoms, and potential side effects all play a role in determining the most appropriate medication regimen.

Surgical Interventions

In some cases, surgery may be necessary to address inner ear problems:

• Cochlear implants: For severe to profound hearing loss
• Endolymphatic sac decompression: For Meniere’s disease
• Vestibular nerve section: For severe, intractable vertigo

When is surgery considered for inner ear disorders? Surgical options are typically reserved for cases where conservative treatments have failed or when there’s a specific structural abnormality that needs correction.

Preventing Inner Ear Problems: Lifestyle and Environmental Factors

While not all inner ear disorders can be prevented, certain lifestyle choices and environmental precautions can help reduce the risk of developing these conditions. Here are some key strategies for maintaining inner ear health:

Protecting Your Ears from Noise Exposure

Excessive noise is a leading cause of hearing loss and can damage the delicate structures of the inner ear. To protect your hearing:

• Use ear protection in noisy environments, such as concerts or when using power tools
• Keep the volume at a moderate level when using headphones or earbuds
• Take regular breaks from prolonged exposure to loud sounds

How much noise is too much? Exposure to sounds above 85 decibels for extended periods can potentially damage hearing. For reference, normal conversation is about 60 decibels, while a rock concert can exceed 120 decibels.

Maintaining Overall Health

General health practices can contribute to inner ear health:

• Exercise regularly to improve blood flow to the inner ear
• Manage stress, which can exacerbate symptoms of some inner ear disorders
• Maintain a healthy diet rich in vitamins and minerals essential for ear health

Why is overall health important for inner ear function? The inner ear relies on good blood flow and proper nutrition to function optimally. Additionally, conditions like high blood pressure and diabetes can increase the risk of inner ear problems.

Avoiding Ototoxic Substances

Certain medications and chemicals can be harmful to the inner ear. To minimize risk:

• Be aware of potentially ototoxic medications and discuss alternatives with your healthcare provider when possible
• Avoid exposure to industrial chemicals known to be harmful to hearing
• Limit alcohol consumption, as excessive alcohol use can affect balance and hearing over time

What are some common ototoxic substances? Some antibiotics, chemotherapy drugs, and high doses of aspirin can potentially damage the inner ear. Always consult with a healthcare professional about the potential side effects of any medication.

The Future of Inner Ear Treatment: Emerging Technologies and Research

The field of otolaryngology is constantly evolving, with new technologies and research paving the way for improved diagnosis and treatment of inner ear disorders. Here’s a look at some exciting developments on the horizon:

Gene Therapy and Regenerative Medicine

Researchers are exploring ways to regenerate damaged hair cells in the inner ear:

• Gene therapy approaches to stimulate hair cell regeneration
• Stem cell treatments to replace damaged inner ear structures
• Targeted drug delivery systems to improve treatment efficacy

How could these advancements impact inner ear treatment? If successful, these approaches could potentially restore hearing and balance function in cases previously considered irreversible.

Advanced Implant Technologies

Next-generation implants are being developed to address various inner ear disorders:

• Improved cochlear implants with better sound quality and speech recognition
• Vestibular implants to restore balance function in patients with bilateral vestibular loss
• Auditory brainstem implants for patients who cannot benefit from cochlear implants

What makes these new implants different from current models? They aim to provide more natural and comprehensive restoration of inner ear function, potentially improving quality of life for patients with severe inner ear disorders.

Personalized Medicine Approaches

The future of inner ear treatment may involve highly individualized therapies:

• Genetic testing to identify predispositions to certain inner ear disorders
• Tailored treatment plans based on an individual’s genetic profile and specific symptoms
• Predictive models using artificial intelligence to optimize treatment strategies

How could personalized medicine improve outcomes for patients with inner ear disorders? By tailoring treatments to an individual’s unique genetic and physiological characteristics, healthcare providers may be able to achieve better results and minimize side effects.

As research continues to advance our understanding of inner ear disorders, new and more effective treatments are likely to emerge. Staying informed about these developments can help patients and healthcare providers make the best decisions for managing inner ear health.

What You Should Know to Get Started

Written by WebMD Editorial Contributors

• Exercises to Help Bell’s Palsy
• Safety Considerations

While there’s not a known cause for Bell’s palsy, it affects between 30,000 and 40,000 Americans every year. It can affect anyone, but most people with Bell’s palsy fall between the ages of 20 and 40. Researchers think that it might be caused by a virus, and it is associated with a variety of pre-existing conditions.

Bell’s palsy is the unexpected weakening of the facial nerve or temporary facial paralysis. There is no cure, but most people regain their facial strength and expression between 2 weeks and 6 months after symptoms begin.

During Bell’s palsy, one side of the face becomes weak or paralyzed. To help speed up the recovery process, many people choose to do physical therapy for Bell’s palsy.

Facial exercises and physical therapy for Bell’s palsy help to increase muscle strength and to regain facial coordination from this temporary facial paralysis. Most exercises should be done three or four times a day in short sessions, with up to 30 repetitions per exercise.

Facial Stimulation

Before you begin the facial exercises, it’s important to warm up and stimulate your muscles first.To correctly do these facial exercises, experts suggest sitting in front of a mirror so that you can clearly see your face and watch your muscle movements.

• Step 1: Begin by trying to move every part of your face slowly and gently.
• Step 2: Use your fingers to gently lift your eyebrows. One side will lift higher than the other, but don’t apply too much force to the side that is drooping.
• Step 3: Using your fingers, gently massage the different parts of your face, including your forehead, nose, cheeks, and mouth.

Nose and Cheek Exercises

After warming up, you can work on the area of your cheeks and nose. This area is important since any stiffness or weak muscles in this zone can affect the strength of the entire face as you recover.  

• Step 1: Using your fingers, gently push up the skin next to your nose on the affected side while trying to wrinkle your nose.
• Step 2: Try to scrunch up your face, focusing on the cheeks and nose.
• Step 3: Flare your nostrils and try to take some deep breaths through your nose. You can cover your unaffected nostril to force the affected muscles to work harder.
• Step 4: Puff up your cheeks and blow the air out. Repeat this 10 times.

Mouth Exercises

The next area that you can work on is your mouth, including your lips and tongue. Many people with Bell’s palsy find it difficult to eat and drink since muscle movements are limited. Some also find that they dribble or aren’t able to control their saliva, which can be stressful.

These exercises for Bell’s palsy can help you to regain better control of your mouth. You can repeat them 30 times each, up to 4 times a day.

• Step 1: Open your mouth as if you are going to smile and then close it. Then do the opposite and practice frowning.
• Step 2: Gently pucker your lips and let them relax.
• Step 3: Try lifting each corner of your mouth individually, one at a time. You can use your fingers to help lift up the affected side.
• Step 4: Stick out your tongue and then aim it down toward your chin.

Eye Exercises

People with Bell’s palsy may have difficulty closing their affected eye, which can be bothersome and makes it difficult to sleep. These facial exercises help you to regain control and function of the muscles surrounding the eyes.

• Step 1: Practice raising your eyebrows up and down. You can use your fingers to lift the affected eyebrow. 
• Step 2: Look down and close your eye while gently massaging the eyelid and eyebrow.
• Step 3: Alternate opening your eyes wide and then gently squeezing them shut. 

Exercises for Bell’s palsy are considered to be quite safe to do at home, unsupervised. However, you shouldn’t overexert yourself or your muscles. Don’t worry about completing all of the exercises if your muscles are telling you to stop.

Also, you don’t want to force the two sides of your face to work against each other. If during your exercises for Bell’s palsy you see that muscles are moving or pulling, you should stop. Relax your muscles and take a rest.

Top Picks

Inner Ear Problems: Causes of Dizziness (Vertigo)

Benign positional vertigo (BPV)

This is the most common cause of
vertigo. BPV is also 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. Because BPV comes on quickly, you should think about if you are safe to
drive or do other tasks that need your full attention.

BPV:

• Causes vertigo that lasts for
  seconds. Vertigo can occur several times a day, depending on body position.

• Doesn’t cause hearing
  loss.

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

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 (labyrinthitis). Or
your
hearing can remain normal (neuronitis).

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.

You may need vestibular
rehabilitation if you have balance problems that don’t go away.

Meniere’s disease

This condition is uncommon. It
happens when there is too much fluid in the ear canals. This causes increased pressure
and swelling. It affects balance and hearing signals.

Meniere’s disease may:

• Cause vertigo that last for
  hours

• Cause hearing problems that
  come and go. The problems are usually in one ear and get worse over time.

• Cause buzzing or ringing in
  the ears (tinnitus)

• Cause a feeling of fullness
  or pressure in the ear

• Cause any of these lasting
  symptoms: vertigo, hearing loss, tinnitus, or ear fullness

Other causes of vertigo

Vertigo can also be caused by:

• A head injury
• Certain medicines
• Migraines
• Brain problems, such as a stroke or bleeding in the
  brain

Disease of the inner ear: Labyrinthitis and its treatment

Labyrinthitis is an inflammatory disease of the inner ear that develops due to infection. Also the cause is injury to the ear. Symptoms are:

1. Dizziness;
2. Loss of coordination;
3. Tinnitus;
4. Low level of hearing.

Diagnosis includes otoscopy, X-ray, computed tomography, audiometry, impedancemetry, vestibulometry, electronystagmoraphy, caloric and pressor tests, laboratory tests to identify the underlying pathogen. Labyrinthitis is treated with medication, but complications may require surgery. For patients who have suffered this disease, hearing rehabilitation is necessary: ​​prosthetics or cochlear implantation.

Due to the internal localization of the labyrinth, infection provokes the occurrence of labyrinthitis due to the presence of harmful bacteria and toxins from various infected areas. The most common cause of inflammation is otitis media. The inflammatory course in the middle ear is characterized by swelling and infiltration of the membranes, as a result of which microbial toxins penetrate through them, which exit the tympanic openings. That is why serous inflammation of the inner ear develops.

Progressive serous labyrinthitis provokes an increase in pressure in the labyrinth, which causes a breakthrough of the connecting membranes into the tympanic cavity. Harmful bacteria penetrate into the ear through the formed cavities, which cause the active progression of purulent labyrinthitis.

With labyrinthitis, dizziness has a system classification. Complaints of patients are based on the sensation of objects circling or their body in a strict direction. There are cases when systemic dizziness is combined with non-systemic, while the patient feels hesitation when walking, but is not able to control it. In chronic labyrinthitis, dizziness can manifest itself as attacks that can last from several minutes to several hours. Intense dizziness is accompanied by nausea and sometimes vomiting, excessive sweating and flushing of the face.

One of the complications is complete hearing loss due to damage to the auditory receptors. Purulent labyrinthitis leads to massive damage to receptors, therefore, auditory activity is disturbed, which leads to deafness.

Diagnosis is carried out by an otolaryngologist, otoneurologist, traumatologist and infectious disease specialist. After a complete examination, drug treatment is prescribed. Such therapy involves taking anti-inflammatory drugs and drugs that improve blood circulation. Purulent labyrinthitis requires surgical intervention. Sanitation of the affected area and labyrinthotomy are carried out. After that, prosthetics or cochlear implantation may be required. It is also necessary to undergo periodic examination and consultation with specialists in order to prevent relapses and complications.

Dizziness and tinnitus

S.Ya.Kosyakov, GZ Piskunov

Dizziness

Introduction
Dizziness is a general term characterizing a large number of symptoms. In general, it means an abnormal sensation of movement, it can also mean imbalance, pre-syncope, blackout, disorientation, weakness and other sensations. Symptoms can vary in intensity from mild and short in duration to severe rotational attacks accompanied by nausea and vomiting.

For a more precise definition of symptoms, the following definitions are used:
Dizziness: a general term describing the symptoms of imbalance and stability.
Loss of balance: difficulty in maintaining balance, especially when standing and walking.
Pre-syncope: A “switching off” sensation, similar to that experienced when holding one’s breath for a long time.
Systemic dizziness: sensation of rotation, whirling, twisting of surrounding objects.
The ability to maintain balance is the result of a complex interaction of various organs and systems. The brain is the main center for processing all information about balance, coming from the senses to the muscles that maintain balance.
Information in the form of nerve impulses comes from the main systems: visual, vestibular, proprioceptive and tactile (joints and feet). Visual information is the most important for the brain and signals movement in relation to surrounding objects.
Anatomy
There are two components of hearing: mechanical and electrical (neural). The mechanical component ensures the delivery of a sound wave through the external auditory canal, the movement of the tympanic membrane and three auditory ossicles in the middle ear. The inner ear is represented by a cochlea, consisting of two halves, interconnected and filled with liquid. The cochlea is responsible for the electrical component of hearing and converts the mechanical signal into electrical, which in turn enters the brain.
Another part of the inner ear is responsible for balance and the vestibular system. Three semicircular canals are located in mutually perpendicular planes. Depending on the direction of movement of the head, fluid moves in the channels, the resulting electrical impulse is transmitted to the brain through the vestibular nerve, transmitting information about the direction of movement. The inner ear fluid is renewed daily. The source of its origin is the cerebrospinal fluid, absorption occurs in the endolymphatic sac. In Meniere’s disease, the suction capacity of the endolymphatic sac deteriorates. Increased pressure in the inner ear leads to dizziness and hearing loss.
In close relationship with the ear, there is a facial nerve. The facial nerve carries out the movements of the facial muscles and provides taste discrimination with the tip of the tongue. When it is damaged, the eye closes poorly, liquid pours out of the corner of the mouth, and mimic movements on the side of the lesion are impossible.

Balance function
Balance function is provided by the interaction in the brain of nerve impulses coming from the inner ear, cervical muscles, muscles and joints of the lower extremities. Violations in any of these systems can lead to a subjective feeling of dizziness and unsteadiness. General disorders of body functions (for example, low or high blood pressure, myopia, and many others) can lead to dizziness, affecting the coordination of impulses in the brain.

The brain’s response to distorted or uncoordinated impulses can lead to false sensations of movement (dizziness), which in turn leads to unsteady gait and falls.
Dizziness is often accompanied by cold sweats, nausea and vomiting.
Visual and muscle and joint signals (tactile and proprioceptive) to the brain warn us that we are on the right track or that our head is tilted. The brain interprets this information, along with information from the vestibular system, and instructs the muscles to maintain balance accordingly. Dizziness occurs when sensory information is distorted. Some people experience dizziness when they are in a high place, for example. This is partly due to the inability to focus on nearby objects. Standing on the ground, a person can sway slightly. A person maintains balance, identifies his position of the body relative to something. When a person is in a high place, it is difficult for a person to correlate the position of his body relative to objects far away and, accordingly, it is more difficult to maintain balance. As a result, anxiety, fear, dizziness can occur, which sometimes makes a person sit down.
It is believed that motion sickness, a disorder that occurs when rolling, in a car, flying occurs when the brain receives conflicting sensory information about the movement and position of the body. For example, when reading while riding in a car, the inner ear perceives the movement of the vehicle, but the gaze is fixed on a stationary book that does not move. As a result, sensory conflict can lead to the typical symptoms of motion sickness, dizziness, nausea, and vomiting.
Another form of vertigo occurs with repeated rotation and sudden stop. Rotation causes movement of the endolymph. The movement of the endolymph causes impulses, which in turn tell the brain that we are moving, but other sensory systems tell us that we have stopped, so the patient feels dizzy.

Causes of dizziness
Vertigo can be classified into types depending on the part of the vestibular system that is not working properly. Violations can occur at the level of the inner ear, brain, eyes and limbs (muscles of the back, neck, legs and joints react to maintain our position).
Inner ear vertigo
Part of the inner ear (cochlea) is used for hearing, the other part is used for balance (maze). If there are disturbances in the labyrinth or in the nerve connecting it to the brain, then this leads to dizziness. Various types of disorders in the inner ear can lead to vertigo, including Meniere’s disease, labyrinthitis, positional vertigo, vestibular neuronitis, and nerve tumors. Typically, these disorders cause balance disorders, a sensation of rotation of objects and nausea. Also, these phenomena may be accompanied by tinnitus and hearing loss on the corresponding side.
Vertigo of the central nature
Vertigo of the central nature is usually caused by disturbances in the area of ​​the brain responsible for balance. Symptoms may include fainting spells, confusion, unsteadiness, and sometimes loss of consciousness. Causes of central vertigo include low blood sugar, low blood pressure, stroke, multiple sclerosis, migraines, head injuries, tumors, and aging. Treatment of this type of dizziness is usually associated with the elimination of problems leading to disruption of the brain.
Musculo-articular vertigo
This type of vertigo is rare. If there are diseases of the muscles, joints or the sensitivity of the lower extremities is impaired, then difficulties arise in the reaction of the body to movement and in maintaining an upright position. Musculoskeletal vertigo can be caused by atrophic muscle changes (muscular dystrophy), severe forms of diabetes, arthritis, joint implantation, and trauma. Symptoms: Usually unsteadiness and imbalance.
Visual dizziness
Eye muscle instability and poor vision can impair balance function. The brain relies on visual information to maintain balance. Motion sickness in a car or at sea are examples of visual vertigo because the eyes are constantly fixed on a moving object and “confuse” the vestibular part of the brain. This leads to dizziness, nausea and vomiting.
Dizziness is not a fatal condition and may improve with treatment, but balance disorders may remain.

Diagnosis of dizziness
Dizziness can be caused by various disorders in the body. Based on the history of the disease and examination data, the doctor selects the necessary amount of examination to obtain a more complete picture of the disease. The usual set of examinations includes a study of hearing and vestibular function, computed tomography and nuclear magnetic resonance, blood tests, and ultrasound examination.
The most commonly used test for vertigo is electronystagmography (ENG). This test measures inner ear endurance and eye coordination. The method includes observing eye movements while blowing cold and warm air into the external auditory canal. This usually causes a brief feeling of dizziness. It is important not to take drugs before the study that could affect the test results (for example, Valium, alcohol, etc. ). When prescribing such an examination, it is necessary to find out from the doctor the effect of the drugs taken on the test results.
Transcranial dopplerography is another test specific to the investigation of vertigo of vascular origin. It is a safe, fast way to see blood flow disturbances in balance areas of the brain.
Computed tomography (CT) of the temporal bones and, in some cases, magnetic resonance imaging (MRI) may also be performed.
The purpose of these examinations is to achieve confidence in the absence of life-threatening pathology and to determine the exact location of the violation. This is the basis for effective treatment. The scope of the examination is determined by the doctor in each case. Several tests are needed to diagnose the cause. Perseverance and understanding are necessary for both the doctor and the patient, which is also the basis for effective treatment.

Most common types of vertigo
Benign paroxysmal positional vertigo (BPPV)
BPPV is the most common type of vertigo. With this disease, dizziness occurs only when the position of the head changes (usually when turning in bed, tilting the head backward or forward). This type of vertigo is caused by microcrystals that float in the fluid of the inner ear and cause a sensation of rotation. The most common cause of BPPV is head trauma or viral infections, but sometimes it starts without any apparent cause.
The treatment of BPPV consists of certain exercises to return the crystals to a place where they will not cause dizziness. When at rest, in a certain position, for 48 hours, they often lock in place. Exercise can reduce symptoms. If these actions are ineffective, then surgical treatment (eg, occlusion of the posterior semicircular canal) may be necessary.

Vestibular neuronitis
Neuronitis (inflammation of the nerve) usually occurs with a viral infection, may affect the centers of balance or the vestibular nerve. When this happens, the balance centers in the brain are overstimulated, resulting in significant imbalance and systemic vertigo. Fortunately, vestibular neuronitis usually subsides over time and does not recur. Drugs such as betaserc help in the initial stages and reduce the severity of the main symptoms, later vestibular rehabilitation exercises can speed up the healing process. In some cases of persistent course, surgical treatment is recommended.
Ménière’s disease (Endolymphatic hydrops)
Ménière’s disease is the result of disorders in the inner ear due to increased pressure in the endolymphatic space. This is usually due to an increased concentration of sodium in the fluids of the inner ear. In addition to an imbalance that lasts for hours, patients may experience fluctuations (fluctuations) in hearing, tinnitus, and a feeling of fullness in the diseased ear. Sometimes the lesion affects both ears.
The cause of this violation is not completely known. Sometimes seizures can be caused by excessive salt intake, excitement, weather changes, and other reasons.
Treatment usually includes salt restriction and the use of diuretics, fluid restriction, the use of sedatives, and certain other vestibular depressants. Betaserc is the only drug designed for long-term treatment of vertigo. Treatment helps to reduce the severity of seizures, but a complete cure of the disease cannot be achieved. Vestibular rehabilitation exercises can speed up the recovery process and increase the patient’s resistance to vestibular disorders. All prescriptions of drugs should be carried out only by a doctor.
In severe cases of Meniere’s disease, there are surgical treatments. The list of these methods is long and more often they are destructive for the structures responsible for balance.

Vascular vertigo
The correct functioning of the balance system requires not only the flow of information to the inner ear, but also the appropriate transmission of impulses along the nerves to the brain. If not enough blood is supplied to the areas of the brain responsible for balance, even for a short time, then dizziness may occur.
Causes of vascular vertigo are different. The phenomena of osteochondrosis in the cervical spine can lead to compression of the arteries going to the brain, atherosclerotic plaques can narrow the arteries, also causing a decrease in blood flow. Often the blood pressure in the vessels going to the brain can temporarily decrease when standing up abruptly, especially in elderly patients receiving blood pressure-lowering drugs. Special examinations such as MRI or Doppler sonography help in the diagnosis of such diseases.
Another fairly rare cause of dizziness is Perilymphatic fistula
The inner ear is a fluid-filled space located in the temporal bone. If there is an outflow of fluid from the structures of the inner ear, then hearing loss may occur, which may be either greater or less, and dizziness.
The most common leakage of fluid occurs through the membranes of the windows of the inner ear, which can occur after exercise or injury. In some cases, there are congenital disorders that characterize an enlarged connection between the inner ear and the brain (“dilated vestibular aqueduct”). Sometimes this can be seen with a special X-ray examination – computed tomography. Sometimes the membrane rupture heals on its own, sometimes minor surgery is required. Perilymphatic fistula or as it is also called – labyrinth fistula can result from chronic inflammation of the middle ear, especially with cholesteatoma. Cholesteatoma is a compacted skin scales. In the presence of a hole in the tympanic membrane, the skin grows into the middle ear cavity, and its waste products, like the formation of a pearl, form a lump of cholesteatoma, which presses on the walls of the middle ear cavities and destroys the bone in particular, the semicircular canal. Therefore, the treatment of chronic otitis media is very important, and if the hole is located in the upper part of the tympanic membrane (epithympanitis), it must be surgical without fail, because. most often in these cases find cholesteatoma.

Tumors
Rarely, vertigo can be caused by tumors. Most tumors are benign. Acoustic neuroma is a benign tumor of the vestibular nerve. The presence of a neuroma can lead to unsteadiness, hearing loss, and noise. The most effective method of treatment is surgical.

Treatment of dizziness
All questions about the treatment of dizziness and in particular the use of drugs should be discussed with your doctor. Treatment in each case is selected individually and depends on age, severity of dizziness, concomitant diseases and many other factors.

Tinnitus
Tinnitus is a very common symptom. Noise can be constant or periodic, of varying severity and of varying frequency. Noise can be subjective (audible only to the patient) or objective (audible to others), and may or may not be associated with hearing loss.
Noise is a symptom, not a disease, and can occur with various diseases, such as pain in the arm or leg are symptoms of various diseases. Noise appears when the auditory nerve is irritated for various reasons.
Noise may or may not be accompanied by hearing loss. Hearing is measured in decibels (dB). A hearing level between 0 and 25 dB is considered normal for listening to spoken language.
Mechanisms of hearing
To understand the possible causes of tinnitus, it is necessary to have some understanding of the mechanisms of hearing. The mechanism of auditory perception is provided by five main components: the outer ear, middle ear, inner ear, pathways and the brain.
Outer ear
The outer ear consists of the auricle and external auditory meatus. These structures collect sound waves and transmit them to the eardrum.
Middle ear
The middle ear is located between the eardrum and the inner ear. This space contains three auditory ossicles: the malleus, anvil, and stirrup. The vibrations of the tympanic membrane are transmitted through the auditory ossicles to the fluids of the inner ear.
The middle ear is lined with a mucous membrane identical to the nose and contains mucous glands and blood vessels. The tympanic cavity is connected to the posterior parts of the nose by the Eustachian tube.
The Eustachian tube serves to maintain equal pressure between the middle ear and the outer atmosphere. A clicking or stuffy sensation with a change in height is a demonstration of the ventilating function of the Eustachian tube.
Inner ear
The inner ear is encased in a dense bony capsule and contains fluids and auditory cells. The cells are covered with a delicate membrane with microscopic blood vessels. In the inner ear, fluid vibrations resulting from the movements of the stirrup are converted into electrical impulses in a nerve. Electrical impulses originating in the inner ear are transmitted to the brain via the auditory nerve. The auditory nerve to the brain is located in a small bony canal along with the vestibular and facial nerves.
Brain The auditory nerve, reaching the brain, is divided into many internal connections. In the brain, nerve impulses are recognized as recognizable sounds.

Tinnitus
Most tinnitus is audible only to patients – it is a subjective noise. Noise heard by the patient himself and by someone else is called objective.
Objective murmur may result from muscle spasms in the middle ear or auditory tube, or from abnormalities in the blood vessels surrounding the ear.
Muscular tinnitus
The tinnitus may be the result of a spasm of the muscles attached to one of the auditory ossicles or the result of a spasm of the muscles attached to the auditory tube.
There are two muscles in the middle ear: the stapedius, which is attached to the stirrup, and the tensile eardrum muscle, which is attached to the malleus. Typically, these muscles contract rapidly in response to loud noises or fear.
Sometimes one or two of these muscles begin to contract rhythmically for no apparent reason. These contractions can cause repetitive noises in the ear. The annoying clicking usually goes away on its own. Tinnitus of a muscular nature as a result of spasm of various muscles of the pharynx is quite rare, but sometimes it can be If the muscle spasm is prolonged, then drug treatment (muscle relaxants) or surgical treatment (crossing spasmodic muscles) is used.

Tinnitus of a vascular nature
There are two large blood vessels closely connected with the middle and outer ear: the jugular vein and the carotid artery. These are large blood vessels that supply the brain with blood and carry out its outflow. It is not normal to hear your own heartbeat or the sound of blood flowing through these large vessels. Sometimes this phenomenon can occur with high fever, middle ear infection, after intense physical exertion. Circulation noise in these situations is temporary and not audible to others. Sometimes the circulation noise becomes audible to others. This can occur due to the thickening of the wall of the blood vessel, the presence of a bend or narrowing in the vessel. Further examination is necessary to identify the cause and choice of treatment for this pathology.

Tinnitus due to the outer ear
Closure of the external auditory canal with sulfur, foreign body, edema leads to hearing loss and pressure on the eardrum. This often results in a pulsating type of noise.
Tinnitus due to the middle ear
Dysfunction of the middle ear can be the result of an allergic reaction, infection, trauma, scarring, and limited mobility of the auditory ossicles. These disorders often lead to hearing loss and tinnitus. However, there is no direct relationship between the degree of hearing loss and noise intensity.
Inner ear tinnitus
Any condition that disturbs the balance of fluid pressure in the inner ear can lead to tinnitus. This may be the result of an allergic reaction, infection, circulatory disorders, which lead not only to changes in the fluids of the labyrinth, but also in the membrane structures of the inner ear.
Tinnitus due to damage to the pathways
The pathways are the most delicate structures of the hearing mechanism. Hair cells convert fluid vibrations into nerve impulses. The slightest swelling and disturbance of interference in the hair cells, regardless of the cause, lead to dysfunction and irritation. This can occur for various reasons: allergic reaction, infection, edema, systemic diseases, both acute and chronic, toxic exposure, sudden loud noises and in sensitive subjects, trauma, drug exposure, minute changes in blood supply and nutritional changes.
Changes in pressure can cause swelling both outside and inside the nerve as it travels through the bone tunnel to the brain. In these cases, tinnitus occurs on one side. Because If the bone tunnel cannot stretch, then due to compression, not only the auditory and vestibular functions suffer, but also the facial nerve.
Rupture or spasm of a small vessel occurring anywhere in the auditory pathway causes compression and circulatory failure. Accordingly, under such conditions, a sudden noise with a complete or partial loss of auditory function may occur. If the thrombus is small, then it can resolve with minimal consequences.
Tinnitus of a brain nature
Any disorders resulting from edema, pressure or circulatory disorders in hypertension, atherosclerosis, as a result of the consequences of trauma, may involve one or more pathway complexes at their entry and exit in the brain. In such situations, the symptoms are usually localized on one side, in addition, the development of symptoms and signs may tell the doctor the location and extent of the lesion.
Tinnitus accompanying hearing loss
Tinnitus may or may not be related to hearing loss. In the coexistence of tinnitus and hearing loss, the intensity of tinnitus is not an indicator of the further development of hearing loss. Many patients with the appearance of tinnitus are afraid of the progression of hearing loss. However, these are often unrelated things.
All questions about tinnitus treatment should be discussed with your doctor.
Thus, the treatment of dizziness and tinnitus is a complex task, which can be successfully solved only by the joint efforts of the doctor and the patient. Qualitative diagnosis of hearing plays a very important role in such treatment. Consistency in identifying the causes of these conditions, in treatment and rehabilitation is an essential condition for success.