Vestibular Balance Disorders

When people think of having issues with their ears, they most likely worry about hearing loss or pain caused by earaches — but not balance problems.

However, if your inner ear becomes infected or is damaged, you may experience dizziness, imbalance or vertigo (sensation the room is spinning). That’s because the inner ear is home to the vestibular system, which is a sensory system that controls your balance and spatial awareness.

With vestibular disorders, you can have symptoms that affect both balance and hearing, so these conditions can be very troublesome and greatly impact your quality of life. You’ll want to see an ear, nose and throat (ENT) doctor, who specializes in vestibular conditions, to help diagnose and manage your inner ear issues.

Those specialists can be found at The Ohio State University Wexner Medical Center in Columbus, Ohio, where many of the best neurotologists in the state and region work and conduct their research. Our Department of Otolaryngology — Head and Neck Surgery is ranked one of the best ENT programs in the country, so if you’re experiencing a vestibular disorder, we’re a top choice for your care.

Conditions that cause vestibular dysfunction

A vestibular disorder is any condition that affects the inner ear or areas near it. The inner ear is important, because not only does it help our brains make sense of the sound vibrations we hear, but it’s also responsible for controlling our balance. It’s made up of the cochlea, semicircular canals and the vestibule.

Some of the vestibular conditions we treat at the Ohio State Wexner Medical Center include:

• Benign paroxysmal positional vertigo – This is the most common form of vertigo, and it usually occurs with a rapid movement of the head.
• Meniere’s disease – This occurs because of an abnormality with the fluid in your inner ear — either the amount of the fluid or the composition of the fluid.
• Labyrinthitis – This is an inner ear infection that causes inflammation of the labyrinth, which contains the cochlea (hearing) and the vestibular system (balance).
• Vestibular neuritis – Also an inner infection, vestibular neuritis affects the vestibular nerve, which carries signals from the nerve to the brain to help with balance.
• Cholesteatomas – These growths of tissue that develop behind the eardrum typically cause hearing loss but, in some cases, can lead to vertigo.
• Vestibular migraine – Some types of migraine headaches can cause symptoms of vertigo, dizziness and imbalance, as well as motion and sound sensitivity.

Sometimes taking certain medications can bring about vestibular symptoms. When chemicals or drugs poison the inner ear, it’s often referred to as ototoxicity. Talking to your doctor can help you understand which medications might affect the inner ear and cause vestibular symptoms.

How do you test for dizziness and balance disorders?

Vestibular testing involves several diagnostic procedures to determine the causes of dizziness and imbalance. Usually, these tests have a particular focus on conditions affecting the portions of the inner ear and central nervous system involving balance and visual stability. Determining the causes allows our vestibular experts to select the most appropriate treatments.

Some of our state-of-the-art testing methods include:

Videonystagmography (VNG)

The VNG test uses recording and analysis of how eye movements respond to a variety of stimuli to determine the cause of dizziness and imbalance. We perform a VNG test while you sit in an exam chair in a darkened room, usually wearing goggles equipped with infrared cameras. Under certain circumstances, we use electrodes placed around the eyes (electronystagmography or ENG).

The test findings provide information on whether symptoms result from dysfunction within the ear, the central nervous system or both, to help determine the cause of symptoms. The test usually takes 60 to 75 minutes.

Vestibular-evoked myogenic potentials (VEMPs)

VEMPs are muscle responses believed to be triggered by stimulation of the otolith organs of the inner ear. We use VEMPs testing to determine whether an abnormal opening or thinning of the bone that surrounds the inner ear is contributing to your symptoms.

We measure cervical VEMPs responses through electrodes placed on the neck while you lift and turn your head in response to loud popping noises. We measure ocular VEMPs through electrodes placed under the eyes while you gaze upward and listen to the same stimulus. The test usually takes 45 to 60 minutes.

Video Head Impulse Test (vHIT)

Using high-speed video recording through infrared goggles, vHIT tests for problems with the balance organs and their pathways to the brain. During the test, you’ll stare at a target while the examiner moves your head quickly. Defective eye movement patterns can suggest very specific areas of dysfunction within the inner ear balance organs and nerves. The test takes approximately 15 minutes.

Vestibular disorder treatment

Treatment for vestibular conditions often involves treating the underlying cause of your symptoms. Depending on what that cause is will direct our approach to your treatment plan. How severe your symptoms are will also play a role in managing your inner ear disease.

Treatments for a vestibular disorder could include:

• Medications – There are over-the-counter medications (antinausea, motion sickness) and prescriptions (steroids) that can help treat vestibular conditions or manage symptoms.
• Injections – Sometimes steroids are injected into the eardrum to settle symptoms. Other times an antibiotic, such as gentamicin, is injected through the eardrum to help with vertigo.
• Epley maneuver – Symptoms like vertigo can be managed by putting your head and body into various positions over the course of five to 10 minutes. These exercises often deliver immediate results and can either be done by your health care provider or at home if you’ve learned the steps in physical therapy.
• Surgery – If your symptoms persist despite trying medications and other less-invasive techniques, you might be a candidate for surgery to repair inner ear function. Types of surgeries include a mastoidectomy and placement of an endolymphatic shunt in the inner ear, or removal of the balance organs (labyrinthectomy).
• Vestibular rehabilitation – We have a Vestibular Rehabilitation Program in which vestibular physical therapists can provide balance retraining therapy and teach you exercises to cope with dizziness and vertigo in your daily life.