What Are Vestibular Disorders?

A link between your inner ear and your brain helps you keep your balance when you get out of bed or walk over rough ground. This is called your vestibular system.

If a disease or injury damages this system, you can have a vestibular disorder. Dizziness and trouble with your balance are the most common symptoms, but you also can have problems with your hearing and vision.

Common Vestibular Disorders

Benign paroxysmal positional vertigo (BPPV): This is the most common cause of positional vertigo, a sudden feeling that you’re spinning or swaying. It happens when tiny calcium crystals in one part of your ear move into an area where they shouldn’t be. This causes your inner ear to tell your brain you’re moving when you’re really not.

BPPV can be treated through a series of head movements your doctor guides you through. These put the crystals back where they're supposed to be.

Labyrinthitis: You might know this as an inner ear infection. It happens when a fragile structure deep inside your ear known as a labyrinth gets inflamed. This affects not just your balance and hearing, but you also may have ear pain, pressure, pus or fluid coming from your ear, nausea, and a high fever.

If your labyrinthitis is caused by a bacterial infection, you may need to take antibiotics. Your doctor also might recommend steroids to help bring down inflammation or another kind of drug known as an antiemetic to help with vomiting and dizziness.

Vestibular neuritis: A viral infection somewhere else in your body, such as chickenpox or measles, can bring on this disorder that affects the nerve that sends sound and balance information from your inner ear to your brain. The most common symptoms are sudden dizziness with nausea, vomiting, and trouble walking.

To treat vestibular neuritis, your doctor may give you medicine to wipe out the virus that’s causing it.

Meniere's disease: People with this disorder have sudden attacks of vertigo, tinnitus (a ringing, buzzing, or roaring sound in their ears), hearing loss, and a feeling of fullness in the affected ear. This may be caused by too much fluid in the inner ear, thanks to a virus, allergy, or autoimmune reaction. The hearing loss gets worse over time and can be permanent in some cases.

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Some lifestyle changes can help -- like cutting down on salt, caffeine, and alcohol -- and medication can ease attacks when they happen. In rare cases, people need surgery to relieve their symptoms. Parts of the affected inner ear are cut or removed so they stop sending the wrong balance signals to your brain.

Perilymphatic fistula (PLF): This is a tear or defect between your middle ear and fluid-filled inner ear that can make you feel dizzy and may cause some hearing loss. You can be born with PLF, or it can be caused by barotrauma (increased pressure in your ear), a head injury, or heavy lifting.

Surgery can help repair perilymph fistulas. Openings or tears can be plugged with tissue taken from the outer part of your ear.

Other Vestibular Disorders

Acoustic neuroma: This tumor in your inner ear isn’t cancerous and grows slowly, but it can squeeze the nerves that control your hearing and balance. That leads to hearing loss, ringing in your ear, and dizziness. In some cases, a neuroma can press against your facial nerve and cause that side of your face to feel numb.

An acoustic neuroma can be taken out with surgery, or your doctor might treat it with radiation to stop it from growing.

Ototoxicity: Some drugs and chemicals can damage your inner ear. Others attack the nerve that connects your inner ear to your brain. Either can cause hearing loss. Sometimes, this gets better when you stop taking the drug or stay away from the chemical. In other cases, the damage can be permanent.

Enlarged vestibular aqueducts (EVA): The narrow, bony canals that go from your inner ear to the inside of your skull are called vestibular aqueducts. If these get larger than they should be, you can lose your hearing. The causes of EVA aren’t clear, but they seem to be linked to certain genes you can get from your parents.

There’s no proven treatment for EVA. The best ways to safeguard your hearing is to avoid contact sports or anything that can lead to a head injury, and stay away from fast changes in pressure, like the kind that happens with scuba diving.

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Vestibular migraine: If your brain sends the wrong signals to your balance system, that can lead to a severe headache, dizziness, sensitivity to light or sound, hearing loss, and ringing in your ears. Some people also say they get blurred vision.

If you have vestibular migraines often, your doctor may give you a drug to prevent them. Many medications, including some antidepressants, and calcium channel blockers (which relax your blood vessels), can help.

Mal de debarquement: When you move in a way you never have before, like on a boat, your brain adapts to the feeling. But sometimes, it can get “stuck” in the new motion, and you may feel off balance, like you’re rocking or swaying, even after you've stopped moving. This usually gets better in a few hours but sometimes symptoms can persist for weeks or even years.  

You may experience other symptoms including a staggering walk, trouble focusing or feeling fatigue. There’s no cure, but you may be able to manage symptoms with medications and vestibular rehabilitation.

WebMD Medical Reference Reviewed by Arefa Cassoobhoy, MD, MPH on March 22, 2019

Sources

SOURCES:

Vestibular Disorders Association: “The Human Balance System,” About Vestibular Disorders,” “Benign Paroxysmal Positional vertigo (BPPV),” “Ototoxicity,” “Acoustic Neuroma,” Vestibular Rehabilitation Therapy (VRT),” “Medication: Can Medication Help Me Feel Better?” “Dietary Considerations: Does Diet Really Matter?”

NHS Choices: “Labyrinthitis.”

Cleveland Clinic: “Vestibular Neuritis.”

American Academy of Otolaryngology-Head and Neck Surgery: “Meniere's Disease.”

National Institute on Deafness and Other Communication Disorders: “Meniere's Disease.”

American Hearing Research Foundation: “Perilymph Fistula,” “Top Ten Facts You Should Know about Vestibular Disorders.”
Royal Victorian Eye and Ear Hospital: “Vestibular Migraine.”

Whirled Foundation: “Vestibular Disorders.”

Hearing Health Foundation: “Enlarged Vestibular Aqueducts (EVA).”

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