Hearing Loss Vertigo
The ear is a unique organ in the body because it is the only organ responsible for two senses. The first sense is hearing and the second is balance. The functions of these two senses are controlled from one part of the ear - the inner ear. The cochlea found in the inner ear is responsible for hearing, while the vestibular system is responsible for balance and equilibrium.
Because both senses are controlled from one part of the ear, it can affect the other if the damage is done to a part. This means that if a person suffers hearing loss, he will most likely have vertigo or balance problems and vice versa.
To clarify the relationship between hearing and balance, let's briefly examine the ear’s structure, emphasizing the inner ear.
Structure of the Inner Ear
Each ear in the human body is divided into three sections: the outer ear, located outside the ear, the middle ear, and the inner ear.
The middle and inner ear are located in hollow cavities within the skull’s temporal bone on both sides of the head.
The Outer Ear
This is the external part of the ear, and it consists of the ear lobe and the pinna. The pinna is responsible for the directing of sound waves from outside into the ear canal. The ear canal channels the waves to the eardrum, which is also known as the tympanic membrane. The eardrum separates the outer and middle ear.
The Middle Ear
The middle ear is a space filled with air, and it contains three tiny bones, which are known as ossicles. The three bones are called the incus and stapes, and malleus.
When sound waves are sent to the eardrum, the eardrum vibrates, and this vibration is transmitted to the ossicles. The ossicles amplify the sound and then transmit the vibration to the oval window located between the middle and inner ear.
The Inner Ear
The inner ear is also known as the labyrinth. It contains the cochlea, which is responsible for hearing, and the vestibular system, which is responsible for the balance.
The cochlea is responsible for hearing, and it contains the organ of Corti and is filled with fluid. The organ of Corti is a structure that contains thousands of specialized sensory hair cells.
These sensory hair cells have projections called cilia. The cluster of sensory hair cells in the organ of Corti varies in thickness; this makes the different regions of the cochlea sensitive to different wavelengths of sounds.
When sound waves get to the oval window, they cause the oval window to move in and out. This movement sends a wave through other parts of the inner ear into the organ of the Corti. When the sound gets to the organ of the Corti, the hair cells in it are deformed by the progress of the wave.
The hair cells trigger nerve impulses that are sent to the brain through the cochlear nerve. The brain interprets the impulses as sound.
The Vestibular System
The vestibular system is located close to the cochlea, and it is the point of convergence for the three semicircular canals which are oriented in 3 dimensions. It also contains the saccule and utricle.
The vestibular system is responsible for the sensation of balance and motion. It uses fluids and hair cells similar to the ones used by the cochlea. It sends information to the brain about the rotation, attitude, and linear motion of the head.
The semicircular canals have an organ containing hair, while the utricle and saccule contain a macula. A macula is an organ made up of a patch of hair cells that are covered by a gelatinous membrane. The gelatinous membrane contains otoliths (particles of calcium carbonate).
The hair cells in the semicircular canals are responsible for the detection of movement. When the head is moved, the fluid in the semicircular canals also moves. The hair cells detect the fluid’s movement and send nerve impulses to the brain through the vestibular nerve.
The vestibular nerve sends the head’s position signals concerning the rest of the body to the brain; this will allow you to maintain your balance. The vestibular and auditory nerves are paired together to control our body balance, hearing and vision.
The functions of the utricle and saccule are also similar to that of the semicircular canals. The only difference is that their function is geared at allowing you to sense your body’s position relative to gravity and help you make the required postural adjustment.
Asides from the maintenance of balance, the vestibular system also works with the visual system to ensure that objects are kept in view when the head is moved. We have a vestibular ocular reflex. A simple example is the feeling we are either moving forward or backward when stopped at a red light and the care next to us is moving in the opposite direction.
Having understood the inner ear structure and its functions, let's examine the relationship between hearing loss and vertigo.
What is Hearing Loss
Hearing loss or deafness is the partial or total inability to hear sounds. Hearing loss can be either mild, moderate, severe, or profound, and it can affect one or both ears.
People with mild hearing loss have difficulty understanding speech, especially in noisy places; those with moderate hearing loss can hear with the aid of a hearing aid, while people with severe or profound hearing loss cannot hear anything. They will need to rely on sign language and lip reading for communication.
Types of Hearing Loss
The different types of hearing loss are grouped according to the part of the ear that is affected.
1.Conductive Hearing Loss
Conductive hearing loss occurs when vibrations are no longer being passed from the outer ear to the inner ear’s cochlea.
This is often caused by an excessive buildup of earwax, malfunction of the ossicles, perforation of the eardrum, and ear infections that are accompanied by fluid buildup and inflammation.
2. Sensorineural Hearing Loss
This type of hearing loss is often due to the damaging of the hair cells in the cochlea. It occurs when there is brain damage or dysfunction of the cochlea, inner ear, or auditory nerve.
The damaging of the hair cells can be due to old age or long-term exposure to loud noise. When hair cells are damaged, they cannot be replaced; this means that the hearing loss will be permanent.
3. Mixed Hearing Loss
The combination of both conductive and sensorineural hearing loss is referred to as mixed hearing loss.
The causes of both conductive and sensorineural hearing loss are responsible for this type of hearing loss, and the symptoms are also the same.
Hearing Loss Causes
Several factors can cause hearing loss. Let's examine some of them.
As you grow older, your hearing weakens; this is why age is the most common cause of hearing loss in adults between the age of 20 to 69.
The major reason for the ears’ weakening is the extended exposure to loud noise over the years. This, coupled with the natural aging process of the body, can deteriorate to hearing loss.
Hearing loss caused by age can't be reversed, but the use of hearing aids and cochlear implants can help you to hear.
2. Exposure to Loud Noise
This is another major cause of hearing loss. Constant exposure to occupational noise from heavy tools and equipment used in factories can damage the ear.
Engaging in recreational activities like snowmobiling, motorcycling, and car racing which are associated with high noise levels, can also cause hearing loss. Likewise, noises in clubs, bars, and musical concerts.
Most people who are constantly exposed to loud noises cover their ears to muffle the noise. But the muffled noise can still cause hearing loss over time.
3. Meniere's Disease
This disease affects the inner ear and is characterized by sensitivity to loud sounds, tinnitus, and vertigo.
Meniere’s disease is a known cause of sensorineural hearing loss, and when it starts, it is irregular, but over time the hearing loss becomes permanent.
4. Ototoxic Medications
These are medications used to treat other ailments that can have adverse effects on your ears.
Drugs like aspirin, ibuprofen, antimalarial drugs, antibiotics, ethacrynic acid, and chemotherapy drugs can cause hearing loss.
Hearing loss caused by Ototoxic drugs is often temporary.
5. Autoimmune Inner Ear Disease
This disease occurs when the antibodies in the ear begin to attack the inner ear. The inner ear hair cells are the major target of this attack.
As stated earlier, the inner ear hair cells are responsible for hearing and balance; this is why a major symptom of autoimmune inner ear disease is dizziness and progressive hearing loss.
6. Other Causes/Genetics
Other possible causes of hearing loss are ear infection, non-cancerous growth or tumor in the ear, earwax blockage, ear stroke, pressure changes, and ear injury.
Diseases like chickenpox, Lyme disease, meningitis, diabetes, and mumps can also cause hearing loss.
Hereditary causes of hearing loss can be non-specific or related to other medical conditions.
Hearing Loss Vertigo
Various symptoms often characterize hearing loss; these symptoms include the following: difficulty understanding words when there is background music, muffling of speech and sound, frequently asking others to speak slowly or repeat themselves, turning up TV and radio volume, and withdrawal from conversations and social settings.
Another major symptom of hearing loss that most people with hearing loss especially hearing loss caused by damage in the inner ear, is vertigo.
What is Vertigo?
Vertigo is not a condition; rather, it is a symptom. It is the feeling or sensation that you or the environment around you is spinning, which is often referred to as dizzy spells.
In some cases, vertigo may be mild and barely noticeable, but in other cases, it can be so severe that you won't be able to maintain your balance to carry out your daily activities.
The feeling of lightheadedness can be aggravated by a sudden movement of the head or a sudden shift in the head’s position. If an inner ear problem causes vertigo, you will not lose consciousness.
Even though Vertigo is a symptom that signals that something is wrong, it is often accompanied by other symptoms.
People with vertigo often have the following symptoms:
- Unstable feeling: Spinning, swaying, tilting, and lack of balance is often felt. You may also feel like you are being pulled in one direction.
- A feeling of nausea and vomiting
- Difficulty to stand or walk
- Jerking or abnormal movement of the eyes
- Ringing in the ear (tinnitus)
- Hearing Loss
Causes of Vertigo
As stated earlier in the structure of this article’s inner ear section, the inner ear is responsible for hearing and balance. In most cases, anything that affects the ear will also affect your balance.
This is because of the proximity of both inner ear structures responsible for hearing and balance to each other.
The root cause of most vertigo cases is often traced to the inner ear.
Below are some of the causes of vertigo.
1. Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is one of the most common causes of vertigo. It happens when the canaliths (tiny calcium particles found in the ear) in the otolith organs are removed from their normal location and moved into one of the semicircular canals in the inner ear.
This makes the semicircular canals very sensitive to changes in head positions that it will naturally ignore. This is hypersensitivity to head movement is what causes vertigo.
Abnormal rhythmic eye movements and migraines often accompany vertigo caused by BPPV.
The cause of BPPV can be known or unknown. When the cause is unknown, it is referred to as idiopathic BPPV.
Some known causes of BPPV are a severe or minor blow to the head, ear damage during surgery, laying on your back for a long period, and disorders that damage the inner ear.
BPPV is common in people aged 50 and above, but it can occur at any age, especially for people who have head injuries or other disorders in the inner ear. It is more prevalent in women than in men.
Asides from the discomfort associated with loss of balance, which can increase your risk of falling, BPPV rarely causes complications.
The good news it can often be treated with vestibular exercises and not medications.
2. Meniere’s Disease
The actual cause of Meniere's disease has not yet been discovered, but it is believed to be caused by a change in pressure and buildup of fluid in the ear. It causes tinnitus, vertigo, and hearing loss.
Meniere's disease often affects only one ear. It can occur at any age, but it is more common among young and middle-aged adults.
The dizziness spells caused by Meniere disease often occur without warning and stop spontaneously. They often last about 20 minutes to several hours but not more than 24 hours. Just like vertigo, hearing loss is also spontaneous at the initial stage, but it becomes permanent after a while.
If the vertigo is severe, you may have nausea. Feeling fullness or pressure in the affected ear is also very common.
Certain factors like improper fluid drainage, viral infection, or an abnormal immune response can cause the buildup of fluid and result in Meniere's disease.
It can be treated with vestibular exercises, medication, and rarely, surgery.
3. Vestibular Neuritis or Labyrinthitis
Labyrinthitis is a problem that occurs inside the inner ear when the part of the ear that is responsible for balance becomes swollen and inflamed.
While vestibular neuritis is the inflammation of the vestibular nerve, it is responsible for transmitting balance signals from the inner ear to the brain.
The actual causes of labyrinthitis and vestibular neuritis are not yet known. Still, it has been discovered that they often occur after a viral infection or, in rare cases, a bacterial infection. Middle ear infections and upper respiratory infections like flu have also been identified as triggers.
The presence of infection triggers the inflammation of the vestibular nerve. When the nerve is inflamed, it begins to send wrong signals about body movement to the brain. Because this is a false signal, other senses like vision are unable to detect the movement, and they get confused. It is the confusion in signals that causes vertigo.
The symptoms of both labyrinthitis and vestibular neuritis are similar. Vertigo is the resultant effect or either inflammation. Vertigo can last for weeks or months, depending on the degree of inflammation.
Labyrinthitis can cause tinnitus (ringing in the ears) and hearing loss which is often temporary.
4. Other Causes
Vertigo can be caused by other factors like brain problems such as bleeding in the brain or stroke, migraine headaches, certain medications, and head or neck injury.
More often than not, vertigo will go away without any treatment because your brain will devise a way to rely on other mechanisms to maintain balance.
But if vertigo doesn't disappear on its own, the following treatment options are available depending on the cause of vertigo.
This is often recommended if you have recurrent bouts of vertigo. It is a therapy aimed at strengthening your vestibular system.
Since the vestibular system is responsible for sending signals about head and body movements relative to gravity to the brain, strengthening will reduce vertigo’s reoccurrence. The therapy also trains your other senses to compensate for vertigo. Many of these vestibular exercises can be done at home or with the help of a medical professional such as your ENT doctor, audiologist, or even a physical therapist.
If inflammation or infection causes vertigo, steroids and antibiotics may be given to you to reduce and heal the infection.
To combat vertigo caused by Meniere's disease, diuretics may be prescribed. The diuretics will reduce the pressure caused by the fluid buildup.
Medication can also be given to give you relief from other symptoms associated with vertigo, such as nausea and motion sickness.
3. Canalith Repositioning Maneuvers
This is often used to treat BPPV. It entails moving your head and body, filling specific movement guides. This is aimed at moving the calcium deposits out of the semicircular canal into an inner ear chamber where the body can absorb them.
This procedure is safe and effective but should be done with the guidance of a doctor or therapist. Due to the movement of the canaliths, the vertigo symptoms may worsen during the process.
If the vertigo is caused by a tumor or an injury to the neck or brain, surgery may be needed for vertigo to disappear. When the underlying problem responsible for the vertigo is handled, vertigo will disappear.
5. Lifestyle Changes
Depending on the cause of your vertigo, your doctor may advise you to make some changes to your routine to relieve the symptoms.
You may be advised to do the following:
- Sleep with your head raised in two or more pillows.
- Avoid bending down to pick items
- Do certain exercises to correct the symptoms.
- Slowly and carefully move your head during the day.
- Slowly get out of bed and sit on the edge of the bed for a minute before standing up.
- Do exercises that trigger vertigo. This will enable your brain to get used to it and also reduce the symptoms.
- Avoid stretching or extending your neck.
Both vertigo and hearing loss can badly affect your life, but with the proper medical attention, you will be able to go about your normal activities without much trouble.
You should visit your doctor the moment you notice vertigo or difficulty hearing. Prompt medical attention is key because if the situation is not handled on time, it may degenerate, and the damage will become permanent. Don't try to self-medicate at home; always seek professional medical advice.
Have you experienced hearing loss vertigo? How did you get rid of it? Share your experience with us.
Drew Sutton M.D.
Drew Sutton, MD is a board-certified otolaryngologist. He has extensive experience and training in sinus and respiratory diseases, ear and skull base surgery, and pulmonary disorders. He has served as a Clinical Instructor at Grady Hospital Emory University for more than 12 years.