Balance problems and hearing loss

Judith White, MD, PhD, answers a reader’s question about balance problems, which are called vestibular disorders. Dr. White is a vestibular physician at the new Cleveland Clinic Dizziness, Balance and Fall Prevention Center at the Beachwood Family Health and Surgery Center.

Q: For the past few weeks, I've felt dizzy. My family doctor thinks I might have a vestibular disorder and says I should see a specialist. What is a vestibular disorder and what can a specialist do to make it better?

A: You are not alone. Dizziness is one of the most common reasons why adults see physicians. Since dizziness (or vertigo) increases the risk of serious falls by 13 times, it is a serious condition. For people with vertigo, seeing a primary care physician is a good first step because the problem might be caused by blood pressure variations, infections and other medical issues.

Vertigo is an illusion of movement. Recall the common childhood game of spinning around quickly in place and then abruptly stopping. The world continues to spin by for a few seconds. This sensation is much more enjoyable as a childhood game than as vertigo during adulthood.

In most cases, vertigo indicates an imbalance in the vestibular portion of the inner ear and nervous system. Three tiny fluid-filled canals in the ear detect motion and gravity and help us to stay upright and focus on objects – even while our bodies and heads move. Disorders of the vestibular system often cause imbalance and may be associated with hearing loss.

The most common vestibular disorder is benign paroxysmal positional vertigo. When people with this disorder awaken and turn in bed, the room rapidly swirls around them. This is often accompanied by nausea. Any head movement worsens the symptoms.

Benign paroxysmal positional vertigo affects about 30 percent of people at some point in their life and occurs when tiny particles within the inner ear dislocate. The dislodged particles float into areas they do not belong. In the past, tranquilizers were often prescribed for patients with vestibular disorders. Newer, more effective treatments have largely replaced that practice.

New infrared recording technology, for example, enables us to pinpoint the exact location of stray particles during a simple office visit. By slowly rolling the head, we coax particles to return to the proper location. This treatment is provided by vestibular physical therapists, neurologists and otolaryngologists (ENTs) specializing in vestibular disorders.

Other vestibular disorders can cause a loss of function in one or both inner ears, a situation that may cause severe, prolonged vertigo and imbalance. Hearing loss may accompany these symptoms.

To accurately diagnose and treat your vestibular disorder, you should seek evaluation by a specialized, multidisciplinary team, such as the one at the Cleveland Clinic Dizziness, Balance and Fall Prevention Center. With appropriate treatment, most people with vestibular disorders have a good chance of recovery.