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Balance Disorders

Benign Paroxysmal Positional Vertigo

The inner ear, also known as the labyrinth, is a specialized organ contained deep within the head. It is found within the temporal bone, one of the bones of the skull.

Within the inner ear, there are two functioning centers: the hearing center (termed the cochlea) and the balance center (comprised of the vestibule and semicircular canals). These centers are surrounded by bone and house specialized sense organs within a specific type of fluid.

Benign paroxysmal positional vertigo (or BPPV) is a disorder of the inner ear caused by abnormal irritation of the specialized receptors of the balance canals. Calcium carbonate crystals, called otoconia, are normal structures within the inner ear that play an important role in sensing various head movements. However, in some individuals, these crystals become dislodged from their normal location and travel into other parts of the inner ear. With subsequent head movements, such as rolling over in bed or looking upwards, these crystals stimulate specialized receptors of the balance canals, thereby inducing a feeling of vertigo.

BPPV is one of the most common causes of vertigo in patients seeking medical attention. In people over the age of 50, BPPV is extremely common. The precise cause is usually not known, but degenerative changes in the inner ear are thought to be one possible explanation. BPPV will commonly occur in patients that have sustained a head injury. Also, people who have suffered from a viral inner ear infection in the past (vestibular neuritis or labyrinthitis) are more susceptible to BPPV.

Treatment for BPPV involves specialized positioning maneuvers. These can be effective in up to 80% of cases and are very well-tolerated. In rare situations, surgical intervention may be required to help stop repeated episodes of positional vertigo.

Meniere’s Disease

Meniere’s disease (sometimes called Meniere’s syndrome or endolymphatic hydrops) is a problem caused by excessive fluid within the inner ear. Patients with Meniere’s disease experience hearing loss that changes over time, roaring or other ear noise, a sense of fullness in the ear, and attacks of vertigo (spinning) that last many minutes to hours.

The cochlea is the part of the inner ear responsible for hearing while the vestibule and semicircular canals are responsible for balance. It is believed that Meniere’s disease results when an imbalance in the amount of fluid in these specialized organs occurs. However, what actually leads to this fluid imbalance remains unknown.

Although there is no known cure, a variety of treatments are available for Meniere’s disease. Medical treatment includes the use of diuretics and avoiding potential triggers of the attacks, such as salt and caffeine within the diet. Steroids, both in pill form and as a shot given through the eardrum, are often used to help with ‘flare ups.’ A special device designed to deliver brief pulsations of air into the ear (the Meniett device) may be helpful in controlling the attacks. Surgical treatments are also available and range from procedures that decrease the fluid build up within the ear (endolymphatic decompression or shunt procedure) to those that remove the balance function completely from the diseased ear. Surgeries that remove the balance function, termed ‘ablative’ procedures, are reserved for the more severe cases that do not respond to other treatments. Injections of gentamycin (an antibiotic) through the eardrum can also serve as an alternative ‘ablative’ treatment in selected cases.

Superior Semicircular Canal Dehiscence

The inner ear, also known as the labyrinth, is a specialized organ contained deep within the head. It is found within the temporal bone, one of the bones of the skull. Within the inner ear, there are two functioning centers: the hearing center (termed the cochlea) and the balance center (comprised of the vestibule and semicircular canals). These centers are normally surrounded by bone and house specialized sense organs within a special type of fluid.

In superior semicircular canal dehiscence (SSCD), the bone over the superior semicircular canal (balance canal) is missing. The bone over the superior semicircular canal normally serves to separate the inner ear from the brain and its covering (called the dura). When this bone is absent, the dura is essentially in direct contact with the inner ear and a variety of symptoms may result. Patients with SSCD may complain of noise- and/or pressure-induced dizziness, a sense of fullness in the ear, hearing one’s own voice or heartbeat, and unsteadiness.

In some individuals, SSCD may not cause any symptoms. In these individuals, the dehiscence (which means absence of bony covering) is usually identified incidentally on a CT scan.

Treatment of SSCD is directed at those individuals who are significantly bothered by their symptoms. Surgical correction of SSCD involves plugging and/or re-surfacing the area of bony dehiscence.

Vestibular Neuritis

The inner ear, also known as the labyrinth, is a specialized organ contained deep within the head. It is found within the temporal bone, one of the bones of the skull.  Within the inner ear, there are two functioning centers: the hearing center (termed the cochlea) and the balance center (comprised of the vestibule and semicircular canals). These centers are surrounded by bone and house specialized sense organs within a specific type of fluid.

Vestibular neuritis (also known as vestibular neuronitis), is an inflammatory condition of the balance nerve. Patients with this condition have an abrupt onset of severe vertigo (a whirling sensation), often times upon awakening.  The vertigo may last for several hours to many days. Patients may have some associated ear ringing and/or pressure in the ear, but hearing usually remains normal.

Anti-nausea medications, medication to help decrease vertigo, and plenty of hydration are often necessary to help patients suffering from vestibular neuritis. Corticosteroids may also be given to help speed up the recovery process. 
Patients may have some imbalance for weeks to months after the severe episode subsides, but symptoms generally improve with time and with continued activity. In some instances, specialized balance therapy can help a patient’s gait and steadiness.

Viral Labyrinthitis

The inner ear, also known as the labyrinth, is a specialized organ contained deep within the head. It is found within the temporal bone, one of the bones of the skull. Within the inner ear, there are two functioning centers: the hearing center (termed the cochlea) and the balance center (comprised of the vestibule and semicircular canals). These centers are surrounded by bone and house specialized sense organs within a specific type of fluid.

Viral labyrinthitis is an inflammatory condition, felt to be the result of a viral infection, which affects the inner ear (or labyrinth). Patients with viral labyrinthitis have a sudden drop in hearing in one ear along with severe vertigo (spinning). Patients often complain of ringing or buzzing in the ear along with nausea and vomiting. The symptoms usually develop rather abruptly, often occurring upon awakening, and may last for several hours to days.

Treatment for the vertigo and any associated nausea or vomiting usually involves medications designed to decrease these symptoms. However, treatment for the hearing loss should be started as soon as possible. Corticosteroids can be helpful in both recovering hearing and improving the speed with which balance improves. While steroids are usually given in pill form, a special steroid injection into the middle ear space may be helpful in certain situations.

In patients with labyrinthitis, hearing loss may or may not recover. If hearing loss does persist, alternative hearing devices may be able to assist patients. Balance issues may linger for weeks to months, but generally improves over time.

Disclaimer:
The information and reference materials included on this website are intended solely for the general information and education purposes of the reader. It is not intended nor implied to be a substitute for professional medical advice or to diagnose health problems. The reader should always consult his or her healthcare provider to discuss the information presented here.