Overview of hearing loss and balance disorders

The 3 key takeaways

• Your sense of balance is directly tied to your ears  — The vestibular system in your inner ear sends signals to the brain, eyes, joints, and muscles to  regulate balance and let you know what position your body is in.

• Balance disorders are common in older adults — They often occur later in life due to inner ear disruptions and as a side effect of many medications.
• Treatment is available — Many balance disorders can be successfully managed with a combination of medication and physical therapy.

Losing your balance can be a disorienting experience. People affected by hearing loss and balance disorders struggle with debilitating symptoms like dizziness, lightheadedness, and a general sensation that the room is spinning.

While there are multiple causes for balance disorders, most result from issues with the balance organs in the inner ear, also known as the vestibular system.

What is a balance disorder?

A balance disorder is any condition that makes you feel unsteady or dizzy, as if you are moving, spinning, or floating. This can happen when you are standing, sitting, or lying down. If you are walking, you might feel the sensation of suddenly tipping over.

While some people only experience mild spells of faintness and dizziness, others experience vertigo, an intense sensation of spinning that can last for hours or even days at a time.

What causes balance disorders?

Balance disorders often come on suddenly and with no obvious cause. Some known causes include:

• Inner ear problems. Problems with the vestibular system in your inner ear can cause you to lose your balance while walking. Inner ear abnormalities may also cause a floating sensation, heaviness in the head, and unsteadiness in the dark. In rare instances, a benign brain tumor known as a vestibular schwannoma may trigger similar symptoms.
• Head injury. It’s estimated that half of all people with traumatic brain injuries (TBI) experience dizziness and loss of balance during their recovery. The severity of these balance problems usually depends on the extent of the injury and the location of the injury.

• Ear infection. Inner ear infections like labyrinthitis cause the delicate structure called the labyrinth in your inner ear to become inflamed, triggering symptoms like hearing loss, a ringing in the ears known as tinnitus, dizziness, and vertigo.

• Medications. The side effects of several medications can impair a person’s balance and increase their risk of falling. Symptoms include blurred vision, dizziness or lightheadedness, low blood pressure, fatigue, and impaired alertness or judgment. Other medications may directly affect the inner ear, resulting in a temporary or permanent balance disorder.

• Arthritis. People diagnosed with rheumatoid arthritis (RA) can experience impaired balance as a result of muscle weakness and limited joint mobility. RA causes chronic pain, morning stiffness, joint instabilities and deformities, and deterioration of the joints that affects the body’s ability to keep itself balanced (postural control), and it’s believed to increase a person’s risk of falling while they’re performing dynamic tasks like walking or going up stairs.

• Eye problems. Experts believe approximately 20% of the nerves leading from the brain to the eyes also interact with the parts of the inner ear and brain that control balance. Vertical heterophoria is a vision disorder that affects the eyes’ ability to work together to send visual information to the brain. This forces the eyes to work extra hard to align themselves in order to see properly, and can subsequently cause issues with the balance organs in the inner ear. 
  

• Aging. Many older adults have trouble with dizziness and vertigo. These balance disorders are commonly caused by medications or underlying conditions like diabetes, heart disease, and stroke.

Symptoms of a balance disorder

Balance disorders can be chronic or temporary. Patients often complain of staggering when they try to walk, or suddenly feeling as if they might fall. These symptoms may come and go over short periods or last for a long time.

Other common symptoms of balance disorders include:

• Dizziness or vertigo. While everyone experiences dizziness differently, it’s commonly associated with light-headedness and disorientation, especially when standing up too quickly. Vertigo is an extreme feeling of spinning that can last for extended periods of time.
• Blurred vision. Disruptions to the vestibular system in the inner ear can also lead to blurred or foggy vision. This often causes people to squint in order to try and see properly, resulting in eye strain.

• Confusion. Balance disorders are disorienting, and can quickly throw off your sense of direction and location. Over time, this can result in brain fog, fatigue, and depression.

Types of balance disorders

Understanding what type of balance disorder you’re suffering from can help you get the right treatment. While you should always consult a doctor for proper diagnosis, here are some common balance disorders to look out for.

Benign paroxysmal positional vertigo (BPPV)

One of the most common causes of vertigo, BPPV is characterized by brief episodes of mild to intense dizziness triggered by a change in the position of the head.

This occurs when the calcium crystals that help regulate balance in your inner ear get dislodged from their normal place, resulting in spinning sensations when you bend down to look under something, tilt your head to look up or over your shoulder, or roll over in bed.

BPPV can result from a head injury or naturally develop from aging.

While BPPV is rarely serious, treatment requires a physical maneuver performed in an audiologist’s or physical therapist’s office. The practitioner performs the particle repositioning maneuver, or Epley maneuver, to realign the calcium crystals in the ear.

This procedure is usually effective in a single session, though some may require a second visit to fully recover.

Labyrinthitis

Labyrinthitis is the infection or inflammation of the part of the inner ear known as the labyrinth. It can be caused by a virus or bacteria, and it affects both your hearing and balance.

Symptoms include mild to severe vertigo, hearing loss, a feeling of pressure in the ear, tinnitus, ear pain, nausea, mild headaches, and blurred vision.

Most cases of labyrinthitis are resolved within a few weeks through a combination of bed rest and medication to help you cope with the vertigo.

In some cases, you may also need additional medication to fight the underlying infection.

Ménière’s disease

This inner ear disorder most commonly develops in people ages 20 to 40, though its cause is still unknown.

Ménière’s disease causes sudden and severe vertigo, fluctuating hearing loss, tinnitus, and a feeling of fullness or congestion in the ear. In most cases, this condition only affects one ear.

While some people with Ménière’s experience single attacks of dizziness over long periods of time, others experience attacks closer together over several days.

Episodes may come on suddenly or after brief periods of tinnitus or muffled hearing. There’s currently no cure for Ménière’s, but the symptoms can be minimized by cutting back on certain foods including salt, caffeine, chocolate, and alcohol.

Smoking should also be avoided. Doctors may also prescribe medications, pressure pulse treatment on the middle ear, and in extreme cases, surgery to relieve dizziness.

Vestibular neuronitis

An inflammation of the vestibular nerve caused by a virus, vestibular neuronitis causes vertigo, nausea, and in some cases difficulty walking.

This condition may occur as an isolated episode of intense vertigo that lasts 7 to 10 days, but many people experience additional attacks of milder vertigo in the weeks following this initial period.

Symptoms of vestibular neuronitis usually go away on their own without treatment, though a doctor may prescribe drugs like meclizine or lorazepam to relieve your vertigo.

Perilymph fistula

A tearing of the membrane that separates the middle and inner ear, which causes fluid inside the inner ear to leak out into the middle ear. Symptoms include dizziness, unsteadiness, and nausea.

A perilymph fistula can occur after a head injury, sudden changes in air pressure such as those experienced while flying or diving, heaving lifting, strong nose blowing, ear surgery, or as a result of chronic ear infections.

A perilymph fistula typically requires surgical treatment to prevent further deterioration of hearing and balance function.

The procedure is done in-office and takes about 30 minutes, with a recovery window of two weeks with no strenuous activity.

Mal de Debarquement syndrome (MdDS)

Translating to “sickness of disembarkment,” this balance disorder is characterized by the illusion of rocking, swaying, or bobbing after you’ve stopped moving.

Many people experience this after cruises and other extended ocean travel, or after prolonged sessions on an exercise machine like a treadmill. MdDS typically goes away on its own after 24 hours, but in rare cases it can affect people for much longer periods of time.

A doctor can prescribe you motion sickness medication to help you manage the symptoms of MdDS until they subside.

In more severe cases, the doctor may also recommend you to a vestibular rehabilitation therapist, who you can work with to help manage your MdDS episodes.

Superior Canal Dehiscence Syndrome (SCDS)

A rare condition that causes an opening to form in the bony wall that normally encloses the part of your inner ear called the superior semicircular canal. This causes problems like hearing loss, autophony (the sensation of hearing your voice or other sounds you naturally make, like breathing or blinking, louder than normal), heightened sensitivity to sounds, and pulsatile tinnitus (tinnitus that you hear in time with your pulse).

SCDS can also contribute to balance issues including vertigo and oscillopsia, the sensation that stationery objects around you are moving.

Most cases of SCDS can be treated simply by avoiding known vertigo triggers like strenuous exercise, heavy lifting, and noisy environments. When noisy environments can’t be avoided, ear plugs are recommended.

Working with a vestibular physical therapist can also help you improve your balance and reduce your risk of falling.

The only true way to get rid of SCDS is to plug up the opening through surgery, but this is only necessary in severe cases.

Assessing your balance

If you’re unsure your balance problems require medical attention, try asking yourself the following questions.

If the answer to any of them is “yes,” see a doctor.

• Do I feel unsteady?
• Does it feel like the room is spinning around me, even for a brief period of time?
• Do I feel as if I’m moving even when I’m standing or sitting still?
• Have I been losing my balance and falling more often than usual?
• Do I feel like I’m falling even when I’m not?
• Do I feel lightheaded or like I might faint?
• Do I notice any changes in my vision?
• Do I ever feel like I lose my sense of time or location?

How can I help my doctor make a diagnosis?

You can help your doctor make a more accurate diagnosis by answering a few additional questions about your symptoms before your appointment.

These include:

1.  I would best describe my dizziness as:
   • the room spinning from left to right, or right to left
   • something that only occurs when I perform a specific motion
   • Something that occurs even when i’m completely still
   • Accompanied by hearing loss, tinnitus, pressure in one or both ears, or a headache
2. Does anything help relieve my dizziness?
3. How often do I feel dizzy or lose my balance? When I do feel dizzy, how long do episodes last?
4. Have I ever fallen?
   • When and where did I fall?
   • What caused me to fall?
   • How often have I fallen?

In addition to answering these questions, you should also write down the names of any medications you’re currently taking.

This includes prescription medications, over-the-counter medications like aspirin, allergy medicine, and sleeping aids, vitamin supplements, and homeopathic medicines.