Ear Dizziness

Ear dizziness, one of the most common types of dizziness, results from disturbances in the blood circulation or fluid pressure in the inner ear chambers, from direct pressure on the balance nerve, or physiologic change involving the balance nerve.  Inflammation or infection of the inner ear or balance nerve is also a major cause of ear dizziness.

The inner ear mechanism is about the size of a pea, and is extremely sensitive.  There are two inner ear chambers:  One for hearing (cochlea), and one for balance (vestibule and semicircular canals).  These chambers contain a fluid which bathes the delicate nerve endings.  These nerve endings are stimulated when there is movement of the fluid.  Nerve impulses are then transmitted to the brain the hearing and balance nerves.  The nerves pass through a small bony canal (internal auditory canal) accompanied by the facial nerve.

Any disturbance in pressure, consistency or circulation of the inner ear fluids may result in acute, chronic, or recurrent dizziness, with or without hearing loss and head noise.  Likewise, any disturbance in the blood circulation to this area or infection of the region may result in similar symptoms.  Dizziness may also be produced by over stimulation of the inner ear fluids, such as one encounters when he spins very fast and then stops suddenly.

Central Dizziness

Central dizziness is usually an unsteadiness brought about by failure of the brain to correctly coordinate or interpret the nerve impulses which it receives.  An example of this is the “swimming feeling” or unsteadiness that may accompany emotional stress, tension states, and excessive alcohol intake.  Circulatory inefficiency, tumors, or injuries may produce this type of unsteadiness, with or without hearing impairment. A feeling of pressure or fullness in the head is common.  Occasionally true vertigo(spinning) may be caused by central problems.

Neck Dizziness

Neck dizziness(cervical vertigo) results form abnormal or uncoordinated nerve impulses being sent to the brain from the neck muscles.

The neck muscles are constantly sending nerve impulses to the balance centers of the brain to help maintain equilibrium.   Spasm (tenseness of the muscles may result in an abnormal nerve discharge, leading to unsteadiness or dizziness.  This spasm may result from injury, arthritis of the spine, or from pressure on nerves in the neck.

Muscle-Joint Dizziness

Muscle-joint dizziness is relatively uncommon.  Any disturbance of sensation rising from the muscles and joints in the limbs (such as occurs in the muscular dystrophies and other abnormalities) produces this type of unsteadiness.  Such an example of is the unseadiness experienced when one tries to walk on a leg that has “gone to sleep”.

Visual Dizziness

Eye muscle imbalance or errors of refraction may produce unsteadiness.  An example of this is the unsteadiness which may result when one attempts to walk while wearing glasses that belong to another individual.

Another example of visual dizziness is that occasionally produced if one is seated in a car looking out the side window at passing objects.  The eyes respond by sending a rapid series of impulses to the brain indicating that the body is rotating.  One the other hand, the ears and the muscle-joint systems send impulses to the brain indicating that the body is not rotating, only moving forward.  The brain, receiving these impulses (from the eyes indication rotation, from the ears and muscle-joint systems indication forward motion) sends out equally confusing orders to various muscles and glands that may result in sweating, nausea and vomiting.  When one sits in the front seat looking forward, the eyes, ears, and muscle-joint systems work more uniformly and one is less likely to develop car sickness.

A visual disturbance may be caused by dizziness from other sources.  Intermittent  ability to focus the eyes, difficulty reading or intermittent blurring of vision, although at times the result of anxiety or tension, may result from small reflex movements of the eye called nystagmus.  This nystagmus is common during severe dizziness.

Meniere's Disease

Meniere's Disease is often a common cause of repeated attacks of dizziness. It is due to increased pressure of the inner ear fluids. Fluids in the inner ear chambers are constantly being produced and absorbed by our circulatory system. Any disturbance in this relationship results in over-production or under-absorption of the fluids. This leads to increased fluid pressure (hydrops) in the inner ear that in turn produces dizziness. This may or may not be associated with fluctuating hearing loss and tinnitus. Typically this only occurs in one ear but it is possible to have in both.

A thorough evaluation is necessary in most cases of Meniere's disease to determine the cause of the increased fluid pressure. Causes of Meniere's disease may me related to circulatory, metabolic, toxic, allergic or emotional factors.

Symptoms

Meniere's disease is characterized by attacks of dizziness, which can vary in duration from a few minutes to several hours. Hearing loss and head noise will typically accompany the attacks. The attacks of dizziness may occur suddenly or without any warning. Violent spinning, whirling and falling, associated with nausea and vomiting, are common symptoms. A sensation of pressure and fullness in the ear is also typical of Meniere's disease.

Attacks of dizziness may recur at irregular intervals. The individual may be free of symptoms for years at a time. If the attacks do recur, they are usually less severe and of shorter duration than the initial attack. In between attacks the individual tends to remain free of symptoms.

Occasionally, hearing impairment, head noise, and ear pressure will occur without the dizziness. This type of Meniere's disease is called cochlear hydrops. Similarly, episodic dizziness and ear pressure may occur without hearing loss and tinnitus: this is called vestibular hydrops. Treatment of both of these is the same as it is for Meniere's disease.

Treatment

Treatment of Meniere's disease may be medical or surgical. It is aimed at improving the inner ear circulation and controlling the fluid pressure changes of the inner ear chambers. At times it is necessary to cut the balance nerve or remove the inner ear structures.

Medical treatment of Meniere's disease varies with each individual patient according to the suspected cause and magnitude and frequency of the symptoms. It is effective in decreasing the frequency and severity of attacks in 80% of patients. Treatment my consist of medication to stimulate the inner ear circulation, decrease the inner ear fluid pressure or prevent inner ear allergic reactions.

Various vasodilating drugs are used to stimulate the inner ear circulation and are prescribed together with anti-dizziness medications. Vasoconstricting substances have and opposite effect and, therefore, should be avoided. Such substances are caffeine and nicotine.

Diuretics or "water pills" may be prescribed to decrease the inner ear fluid pressure.

Meniere's disease may be caused or aggravated by metabolic or allergic disorders. Special diets or drug therapy are indicated at times to control these problems.

On rare occasions we may use streptomycin injections, which selectively destroy balance function. This treatment is reserved for patients with Meniere's disease in their only hearing ear or with Meniere's disease in both ears.