Internal Medicine

Dizziness caused by the ear

Synonyms

Peripheral vertigo, spinning vertigo, vestibular vertigo, vertigo

introduction

The term "vertigo" is understood to mean a disorder of the sense of balance. Affected people find it increasingly difficult to interpret their own posture in the room. In most cases, dizziness is accompanied by pronounced nausea, vomiting and visual disturbances.

What is the expression of dizziness caused by the ear?

In addition, most of those affected describe a tendency to fall to one side of the body. For this reason, dizziness, regardless of the mechanism by which it develops, can be very stressful for those affected.

In general, two important forms of vertigo must be distinguished:

central dizziness and
peripheral dizziness.

While the causes for the development of central vertigo cannot be found in the area of the ear, a change in the ear can usually be detected in peripheral balance disorders.

In this context, patients speak of either a so-called vertigo or a vertigo. The occurrence of fluctuating vertigo is typical of the central genesis of the imbalance. In the case of impairments in the area of the ear, however, a so-called vertigo develops.

Regardless of the exact form and cause of the vertigo, the affected patients usually experience great suffering. Especially due to the pronounced unsteadiness of walking, everyday life and the ability to be self-sufficient can be significantly restricted.

People who frequently suffer from dizzy spells or who notice persistent dizziness should urgently consult an ear, nose and throat specialist. Only after extensive diagnostics can the cause of the occurrence of the imbalance be determined and appropriate treatment initiated.
Since there is usually a neurological cause to be found in so-called vertigo, a neurologist can also be consulted.

Read more on this topic at:

Types of vertigo
Balance disorders & dizziness

Possible causes of the dizziness

There can be a variety of causes for dizziness that develops in the ear. What all possible causes have in common, however, is the fact that there is damage in the area of the equilibrium organ in the ear (more precisely in the inner ear) or directly on the equilibrium nerve.

The most common causes of dizziness that develop in the ear at a glance:

Meniere's disease
Sudden hearing loss
benign paroxysmal positional vertigo
Vestibular neuritis (Inflammation of the equilibrium nerve)
Irritation of the organ of equilibrium

Dizziness from Meniere's disease

Meniere's disease (or Meniere's disease) is one of several diseases that affect the inner ear or the organ of equilibrium and thus cause dizziness.
The cause of this disease is an increased amount of fluid in the inner ear. The special fluid here is called endolymph and is both produced and broken down by the cells of the inner ear, although the breakdown is disturbed in Menière's disease.

The inner ear is responsible for hearing as well as for the sense of balance, which is why both functions are disturbed in Menière's disease: The affected person suffers

suddenly occurring vertigo,
Tinnitus and
Hearing loss as well
Nausea, often with vomiting.

These symptoms last for minutes or even hours. Menière's disease is a chronic disease for which a causal treatment is not yet possible. Attack-like seizures can, however, be treated and prevention of these seizures attempted.

The treatment takes place via the administration of light sedatives (for example bromazepam or diazepam). In addition, drugs against nausea and vomiting (dimenhydrinate or scopolamine) are used in an acute Menière attack. The direct cause of the occurrence of this form of dizziness, which develops in the ear, can be treated with the help of glucocorticoids.

Read on under:

Tinnitus
Symptoms of Meniere's disease
Therapy for Menière's disease
Meniere's disease

Positional vertigo through the inner ear

Benign paroxysmal positional vertigo is a disease of the inner ear that is characterized by sudden attacks of vertigo. The dizziness attacks are perceived by those affected as if their surroundings were rotating. From a medical point of view, one speaks of the so-called rotational vertigo.

The cause of the positional vertigo is a detachment of the so-called otoliths, which are normally anchored in the semicircular canals of the inner ear and perceive the position of the head due to their fixed position. The detachment disrupts this function of the sense of balance and triggers attacks of dizziness.

For diagnosis and therapy, so-called positioning maneuvers are used, in which the head is moved following the structure of the semicircular canals. On the one hand this can trigger dizziness, on the other hand such maneuvers bring the otolith pieces into a position that does not irritate the organ of equilibrium.

Find out more at: Positional vertigo

Crystals in the organ of balance

The most common form of dizziness in the ear in adults is caused by small crystals that form inside the organ of equilibrium. The disease known under the name "benign paroxysmal positional vertigo" (benign positional vertigo) can lead to severe symptoms in the affected patient and thus be very stressful.

The direct cause of this form of dizziness in the ear are small calcareous crystals that emerge from the so-called posterior atrial sac (technical term: Utricle) and get into the semicircular canals. In most cases, these lime crystals can be found in the area of the posterior semicircular canal. For this reason, the affected patients feel pronounced vertigo.

The causal crystals are removed using special positioning exercises that must be carried out several times a day. The prognosis for benign paroxysmal positional vertigo is generally considered to be very good. The one-off occurrence of a causal crystal does not necessarily mean that the person concerned experiences repeated attacks of dizziness.

Read on below: Exercises for positional vertigo

Dizziness from inflamed equilibrium nerve

An inflammation of the nerves (neuritis) on the organ of equilibrium (medical Vestibular organ) usually leads to a loss of function of the sense of balance on the affected side.
The cause of this vestibular neuritis can usually not be clearly identified. It is believed, however, that vestibular neuritis is caused by a viral infection of the nerve.

The affected people complain of sudden dizziness, as if the surroundings were rotating around them (vertigo). Accompanying symptoms such as nausea and vomiting are typical of vestibular neuritis.
Even if these symptoms cause a high level of suffering for the affected person, this disease can be treated very well and without long-term damage.

Dizziness from sudden hearing loss

In addition to Menière's disease, sudden hearing loss is one of the most common causes of dizziness that develops in the ear.

The sudden hearing loss, too, typically occurs in full health. Affected patients usually notice a significant reduction in hearing performance in one ear. The occurrence of noises in the ears (tinnitus) and dizziness are also part of the classic picture of sudden hearing loss.

The exact cause of the development of this form of dizziness that develops in the ear has not yet been determined. It is sometimes assumed that the sudden hearing loss is provoked by several factors. Above all, a lack of blood flow to the inner ear should play a decisive role.

Sudden hearing loss is a serious disease that can be a major burden for the patient concerned. In addition, with this form of dizziness that occurs in the ear, it must be noted that there is currently no treatment that has been proven to help against the symptoms. In some cases, however, the symptoms can be alleviated by administering high doses of glucocorticoids to the venous system.

Dizziness from fluid in the inner ear

Dizziness that develops in the ear can be attributed to increased production of fluid in the inner ear. The increase in this fluid in the inner ear is usually directly related to what is known as "Menièr’s disease" (technical term: Menière's disease).

Menière's disease is a disease that can mainly be observed in people between the ages of 40 and 60. Affected patients describe pronounced vertigo due to the increasing amounts of fluid in the inner ear. The attacks of vertigo, which are typical of Menière's disease, usually appear suddenly, when you are in good health and are very stressful for those affected.

In addition to the pronounced vertigo, the increasing fluid causes hearing loss (especially in the low-pitched range) and noises in the ears (tinnitus). A strong feeling of pressure on the affected ear is also not uncommon.

This form of dizziness in the ear, which can be traced back to increased fluid in the ear, usually has to be treated with medication. In this form of dizziness in the ear, the symptomatic therapy of the accompanying symptoms is in the foreground. Betahistine is also one of the standard drugs in the treatment of Menière's disease. The prognosis for this type of dizziness that occurs directly in the ear is considered to be very good.
In general, approximately 90 percent of patients on drug therapy can be expected to remain seizure free for several years.

Stones in the organ of equilibrium

Small stones, so-called otoliths, are responsible for the perception of acceleration, gravity and uniform rotary movements in all organisms. These stones are usually made of calcium carbonate.
Even in healthy people who do not complain of dizziness in the ear, these stones are located in the balance organ of the inner ear.

Various anatomical structures are assigned to the human organ of equilibrium. In addition to the so-called Saccule, form the utricle and three spatially differently arranged Semicircular canals the human organ of equilibrium.

In healthy people who do not suffer from dizziness in the ear, small stones can only be found in the sacculus and utriculus. However, these can peel off in the event of trauma, for example, and get into the semicircular canals.

The result is an irritation of the sensory cells in the affected semicircular canal that occurs with every head movement. In most cases, these lime crystals can be found in the area of the posterior semicircular canal. For this reason, the affected patients feel pronounced vertigo. In medical terminology, the disease that develops in this way is called "benign positional vertigo".

Special positioning exercises that have to be performed consistently several times a day are considered the only effective treatment method. By systematically repositioning the head, the causative stones can possibly be removed from the semicircular canal and thus the dizziness can be eliminated. In general, it can be assumed that the prognosis for benign positional vertigo is very good.

Accompanying symptoms with dizziness

The most common accompanying symptoms of dizziness caused by the inner ear include nausea and vomiting:
If the organ of equilibrium fails, incorrect information is passed on to the brain from here, which contradicts the information from the other sensory organs. Since this phenomenon also occurs with poisoning, the "emergency system" vomiting is switched on in order to remove the supposed toxic substance from the body.

Find out more at: Dizziness and nausea

Another common symptom of dizziness is hearing impairment, i.e. hearing loss or tinnitus. The reason for this is the proximity of these two sensory functions:
Both the sense of hearing and the sense of balance are dependent on a functioning inner ear that consists of semicircular canals (sense of balance) on the one hand and the cochlea (sense of hearing) on the other. If one element of the inner ear fails, the physical proximity can also affect the other, for example in the event of a spreading inflammatory reaction.

Nausea from dizziness

Dizziness that occurs directly in the ear is in most cases accompanied by other complaints. With almost all causes for the occurrence of this dizziness, the affected patients also notice pronounced nausea.

In addition, hearing impairments and noises in the ears (tinnitus) are the most common symptoms associated with dizziness in the ear. In the typical forms of vertigo, the cause of which is to be found directly in the ear, a strong impairment of the organ of equilibrium can be demonstrated. Since in this way incorrect information about the position of the body in space is sent to the brain, most of the affected patients develop pronounced nausea.

The most common reasons for the development of dizziness in the ear, which is accompanied by severe nausea and vomiting, include benign paroxysmal positional dizziness, Menière's disease and inflammatory processes in the area of the equilibrium nerve (vestibular neuritis). In addition, severe dizziness, nausea and vomiting can occur in the course of a sudden hearing loss.

Since most diseases that lead to dizziness are associated with severe nausea, drugs to relieve nausea and vomiting are among the standard medications.

Earache and dizziness

Ear pain can also be an accompanying symptom of dizziness. The most common cause of these two symptoms occurring together is inflammation of the inner ear:
This can lead to increased sensitivity and pain in the inner ear structures. In addition, the natural ventilation structures can become blocked, as a result of which the eardrum is stressed by the overpressure or underpressure.

If the earache first occurs and the dizziness occurs much later, it is possible that an inflammatory reaction has spread to the inside of the ear. In this case, a doctor should be consulted immediately.

also read: Earache - Causes & Therapy

Ear pressure and dizziness

Pressure on the ears is usually caused by a ventilation problem in the middle ear.
Normally, ventilation is ensured here through a connecting channel between the middle ear and the nasal cavity. If clogged, however, pressure can be applied to the eardrum, the only flexible membrane in the middle ear space.

Ear pressure or the underlying ventilation disorder is a common symptom of ear inflammation. You should therefore look specifically for other symptoms, such as fever or difficulty swallowing. Hearing disorders can also be associated with inflammatory reactions.

You might also be interested in: Acute otitis media

Tinnitus with dizziness

The term tinnitus describes a noise that is usually only perceptible to the person concerned and that occurs without any external stimulus, usually in the form of a ringing, humming or beeping sound. More rarely, there are also types of tinnitus that can be traced back to muscle or bone noises and which can therefore also be heard by the examiner.

Tinnitus often has no apparent cause, but it can also occur together with dizziness: In the latter case, tinnitus is usually an indication of a functional disorder of the inner ear, in which the necessary structures of both the sense of balance and hearing are located.
Menière's disease, described above, is a common diagnosis, but inflammation of the nerves in the inner ear or autoimmune diseases can also cause dizziness and tinnitus less often.

A new, longer-lasting tinnitus should therefore be clarified by a doctor in any case.

Learn more at: Tinnitus

Dizziness and balance

If there is dizziness in the ear, a significant impairment of the balance can usually be detected. The position of the body in space (equilibrium) is determined by visual impressions as well as by position receptors in the joints and the balance organ in the ear. If the balance in one ear is impaired, this leads to severe dizziness in the ear in the affected patient. The balance can be influenced in different ways.

Therapy for dizziness

The therapy for dizziness that occurs in the ear depends largely on the underlying cause.
For this reason, extensive diagnostics before starting therapy is particularly important. Basically come

drug measures,
operative interventions,
Physio and psychotherapy in question.
In some cases, a combination of these treatment pillars can also be useful.

Is the dizziness related to inflammation of the equilibrium nerve (so-called Vestibular neuritis), medicinal products for the symptomatic treatment of dizziness, nausea and vomiting must be used. In this way, the symptoms can be effectively alleviated and the patient's well-being increased. In addition to the administration of these drugs, targeted physiotherapeutic training should help strengthen the balance organ and treat dizziness in the long term.

People whose dizziness in the ear is due to Menière's disease can also be treated symptomatically with drugs for dizziness, nausea and vomiting during the acute Menière attack. In the case of particularly pronounced attacks of dizziness, these drugs should not be administered orally, but rather through the vein. With this disease, too, special training of the balance organ can help to reduce the frequency of acute attacks of vertigo.
In addition, therapy for this form of dizziness that develops in the ear includes the administration of betahistine. This drug is also able to effectively reduce the frequency of acute attacks of dizziness.

Surgical treatment may be useful for people who, despite drug therapy, suffer from frequent attacks of dizziness. One possible surgical measure to treat this form of dizziness that occurs in the ear is to sever the equilibrium nerve on the affected side. Alternatively, it is also possible to reduce the pressure in the area of the inner ear (so-called Saccotomy).

If the dizziness in the ear is related to a sudden hearing loss, it must be noted that there is currently no therapy that has been proven to be effective for this clinical picture. In everyday clinical practice, however, attempts are made to alleviate the acute symptoms with high-dose cortisone. Depending on the severity of the symptoms, the cortisone can be administered either in tablet form or by infusion. In the case of a slight sudden hearing loss that only marginally affects hearing and does not lead to dizziness in the ear, however, no therapy is usually required.

If the vertigo in the ear is benign paroxysmal positional vertigo, a completely different treatment strategy must be chosen. Since the complaints in these cases are mostly caused by small stones in the posterior semicircular canal of the organ of equilibrium, these stones must be diverted through special positioning maneuvers.

Further information on this topic can be found at: Medication for dizziness

Diagnosis of vertigo through the ear

The diagnosis of dizziness is usually divided into several steps.

At the beginning, the patient concerned should describe the existing symptoms and any accompanying symptoms as precisely as possible in a detailed doctor-patient discussion (anamnesis).
The type of vertigo plays a decisive role in determining whether it is a so-called central vertigo or vertigo that occurs in the ear. While central disturbances of balance are typically noticeable as a fluctuating vertigo, so-called peripheral disturbances of balance (cause, for example, in the ear), result in vertigo.
In addition, during this doctor-patient conversation it must be clarified whether the patient also suffers from hearing loss and / or noises in the ears (tinnitus).
Furthermore, it should be determined whether the dizziness only occurs when turning the head or the body axis or whether it persists at rest. Dizziness caused by a sudden change in position indicates a benign paroxysmal positional vertigo. If dizziness persists even at rest, Menière's disease or an acute sudden hearing loss may be the cause.
This doctor-patient conversation is usually followed by an exploratory examination of the ears, nose and throat.
The hearing performance of the patient can be roughly compared with the so-called Weber and Rinne tuning fork test be tested (see hearing test). If the result is abnormal, hearing ability (Air and bone conduction) can be determined more precisely with the help of audiometry.
Furthermore, rapid, twitching eye movements (so-called Nystagmus) be an indication of the presence of dizziness and help isolate the cause of the imbalance.
Under certain circumstances, further diagnostic measures, for example imaging methods such as magnetic resonance tomography, must then be added.

How long does ear dizziness last?

The duration of ear dizziness depends heavily on the cause. A sudden attack of dizziness in Menière's disease should only last a few minutes to hours; if you are vertigo, the dizziness attacks are even shorter.

Nerve inflammation in the inner ear, on the other hand, tends to cause long-lasting dizziness.