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Balance and Dizziness

Your auditory system is an incredibly complex and important process to the rest of your body. Did you know our ears play a crucial role in balance? At Santa Cruz Ear, Nose and Throat Medical Group, our professionals understand this important connection and ensure you have optimal hearing health.

Our balance and equilibrium system (the vestibular system) helps us stay upright when standing and know where we are in relation to gravity. Signals to the brain from our eyes, inner ear and sensory systems (e.g. skin, muscles, joints) control balance. Injury, disease, certain drugs or the aging process can affect one or more of these components.

The semicircular canals are the inner ear structure that controls balance. The three semicircular canals are situated at different angles and lie at right angles to each other. Each canal is lined with cilia (microscopic hairs) and filled with a fluid called endolymph. The three main parts of the semicircular canals are the horizontal, posterior and superior. The superior controls head rotation, the posterior canal detects movement and rotation on the sagittal plane and the horizontal senses on a vertical basis.

As the head moves, cilia in the semicircular canals send nerve impulses to the brain through the acoustic nerve. The nerve impulses are processed in the brain to help us determine where we are in space or if we are moving. Damage to one or more of the semicircular canals can result in balance loss and diminished hearing capabilities.

Meniere’s Disease

Meniere’s disease (also known as idiopathic endolymphatic hydrops) is a group of intermittent symptoms that includes vertigo (spinning sensation), hearing loss, tinnitus (a ringing, buzzing or roaring sound in the ear) and a sensation of fullness in the affected ear. Episodes typically last anywhere from 20 minutes up to 24 hours. They can occur as frequently as several attacks each week or they can be separated by weeks, months and even years.

Hearing loss is often intermittent, occurring mainly during the vertigo attacks. Loud sounds may seem distorted and uncomfortable. Usually the hearing loss involves mainly the lower pitches, but over time it often affects all pitches and after months or years of the disease, often becomes permanent. Tinnitus and fullness of the ear may come and go with fluctuation in hearing, occur during or just before attacks, or be constant.

Meniere’s disease is one of the most common causes of dizziness originating in the inner ear. With most patients only one ear is involved, but in about 15 percent of cases, both ears may be affected. Meniere’s disease typically starts between the ages of 20-50 years, affecting men and women in equal numbers.

Causes of Meniere’s Disease

Although the exact cause is unknown, Meniere’s disease likely results from an abnormal volume of fluid in the inner ear; fluid builds up due to either excess production or inadequate absorption. With some patients, especially those where both ears are involved, allergies or autoimmune disorders may play a role in causing Meniere’s disease.

Treatment Options

No cure currently exists for Meniere’s disease, however, medical treatments that can help manage the disease include:

  • A diuretic (water pill) in conjunction with a low salt diet
  • Anti-vertigo medications
  • Intratympanic medication injections
  • An air pressure pulse generator
  • Vestibular rehabilitation therapy (VRT)
  • Surgery

Because Meniere’s disease affects each person differently, your otolaryngologist can suggest strategies to help reduce your symptoms and help you choose the treatment option that is best for you. For many people, careful control of salt in the diet and the use of diuretics adequately controls symptoms.

Videonystagmography (VNG) Testing

Videonystagmography (VNG) is a series of tests used to determine the causes of a patient's dizziness or balance problems. If the vestibular portion of the inner ear does not cause dizziness, other causes include the brain, medical disorders such as low blood pressure or psychological problems such as anxiety. The VNG battery of tests helps to confirm whether dizziness is due to an inner ear disease and is one of the only tests currently available that can decipher between a unilateral (one ear) and bilateral (both ears) vestibular abnormality.

VNG testing documents a person’s ability to follow visual targets with their eyes and how well the eyes respond to information from the vestibular system. Testing is performed placing video goggles over the eyes and recording eye movements to gain information about the brain's ability to coordinate balance and react to changes in position, and to determine inner ear function.

VNG is a non-invasive evaluation and includes four main tests:

  1. Saccade - evaluates rapid eye movements
  2. Tracking - evaluates movement of the eyes as they follow a visual target
  3. Positional - measures dizziness associated with positions of the head
  4. Caloric - measures responses to warm and cold water or air irrigated through a small, soft tube in the ear canal

Eye movements are recorded and displayed them on a computer screen. Appointments usually last about one-and-a-half hours and testing is often covered by insurance. Call our office to schedule your visit today!