We offer state-of-the-art treatment for balance disorders.

The Ohio State University Wexner Medical Center's balance disorders program offers state-of-the-art tests and treatments for patients with vestibular dysfunction (ear-related dizziness). Testing includes videonystagmography (VNG), vestibular myogenic evoked potentials (VEMP), fistula testing and, when necessary, a diagnostic hearing evaluation performed by an audiologist. Many of the conditions of ear-related dizziness are monitored by a neurotologist while being treated by our physician assistant.      

Our mission is to promote a better understanding of dizziness and related conditions through an integrated partnership between clinicians, researchers and medical staff.

Conditions

Acoustic neuroma and other cranial base tumor

An acoustic neuroma is a benign tumor that develops on the nerve that connects the ear to the brain. The tumor usually grows slowly. As it grows, it presses against the hearing and balance nerves. At first, you may have no symptoms or mild symptoms. They can include:

  • Loss of hearing on one side
  • Ringing in ears
  • Dizziness and balance problems

The tumor can also eventually cause numbness or paralysis of the face. If it grows large enough, it can press against the brain, becoming life-threatening. Acoustic neuroma can be difficult to diagnose, because the symptoms are similar to those of middle ear problems. Ear exams, hearing tests and scans can help diagnose this condition. If the tumor stays small, you may only need to have it checked regularly. If you do need treatment, surgery and radiation are options.

Source: NIH: National Institute of Deafness and Communication Disorders 


Cochlear hydrops

Cochlear hydrops is a form of Meniere’s disease that does not include dizziness as a symptom. It is believed to be excessive fluid pressure in the cochlea of the inner ear. Although an Auditory Brainstem Response (ABR) test and other tests may be performed, there is no specific test to diagnose this condition.

Symptoms include:

  • Clogged or fullness sensation in the ear
  • Distortion of sound and speech
  • Hearing fluctuations
  • Roaring sound in the ear
  • Sensitivity to high-frequency noise

Treatment consists of dietary changes and restrictions, including no alcohol, no caffeine and low salt. Diuretics may be prescribed if the response to the modified diet is good. 


Labyrinthitis/Inner ear infection

An inner ear irritation and swelling of the inner ear from a virus or bacteria that leads to vertigo and loss of hearing is called labyrinthitis. It is commonly referred to as an inner ear infection. Your inner ear is located in an area that cannot be seen on physical exam, so a diagnosis is made by history and balance and hearing test results. 

Symptoms of labyrinthitis can include:

It can take a week to a few months to completely recover from labyrinthitis. Initial treatment might include a prescription or over-the-counter anti-dizzy medication that should be used only during the period where the symptoms are at their worst (typically the first 24-72 hours). A natural compensation process where your "good" ear will start working harder to make up for the "bad" ear begins the very first week. This compensation process will be delayed if anti-dizzy medications are taken longer than necessary. 

Patients are encouraged to move about as much as safely possible to encourage the compensation process. Sometimes patients need vestibular therapy with a specialized physical therapist to hasten the compensation process. Typically, the more active you are, the faster you get better. 

Even though the vertigo typically lasts one to three days, a patient can feel off balance for much longer in situations that challenge your balance system (e.g., eyes closed in the shower, walking in a darkened room, pivoting corners, quick head movements or trying to shop in large stores). Do not drive, work with heavy machinery or work at heights if you are experiencing dizziness. 

Ototoxicity

Ototoxicity is poisoning of the cochlear nerve in the inner ear from drugs or chemicals. The nerve itself and hair cells within the ear are damaged, often creating a loss of hearing and balance. Products as common as aspirin and quinine have been known to cause ototoxicity, which reverses once consumption of these products has ceased.

The severity of symptoms usually depends on the level of toxic exposure and can be temporary or permanent. They include:

  • Blurred vision
  • Constant or fluctuating tinnitus 
  • Headache
  • Hearing loss in one or both ears
  • Loss of balance
  • Nystagmus (eye jerking)
  • Vertigo 
  • Vomiting

Treatments to relieve symptoms include ototoxicity monitoring and hearing aids. Cochlear implants have been successful in treating total hearing loss. 


Perilymph fistula

Inside the ear is a thin membrane that separates the middle ear from the fluid-filled space of the inner ear. A perilymph fistula (PLF) is a tear in the membrane that causes the fluid to leak into the middle ear.

PLF symptoms include:

  • Dizziness
  • Ear pressure
  • Inconsistent hearing
  • Motion sensitivity
  • Sound sensitivity
  • Sudden hearing loss
  • Vertigo 

PLF symptoms increase with pressure and elevation changes in airplanes and elevators and when mountain climbing, or as a result of lifting heavy objects or even just bending over, coughing and sneezing.

PLF is usually caused by a head injury and sometimes by a perforated eardrum, but even activities like being a passenger on a plane that is ascending or more likely descending, giving birth, scuba diving and weightlifting can cause PLF. 


Superior semicircular canal dehiscence syndrome (SSCD)

SSCD is an opening (dehiscence) in the bone located over the superior semicircular canal of the inner ear. This opening allows the fluid in the canal to be displaced by pressure and sound. SSCD is believed to be a developmental abnormality inherited at birth.

Some of SSCD symptoms can be brought on by coughing, loud noises, sneezing and straining and can include any or all of the following:

  • Autophony (increased, sustained volume of your own voice)
  • Sound hypersensitivity
  • Conductive hearing loss
  • Vertigo 
  • Oscillopsia (the perception that still objects are moving)

Many patients are able to manage symptoms by avoiding the things that aggravate their condition, like loud noises. For others, surgical repair of the dehiscence (plugging of the canal with fibrous tissue) can be very beneficial. However, hearing loss can be a risk for those who have had prior SSCD surgery. 


Vestibular neuronitis

Viral infection or, less commonly, bacterial infection can inflame the nerves connecting the inner ear to the brain, resulting in vestibular neuronitis.

Vestibular neuronitis is very similar to labyrinthitis. However, vestibular neuronitis typically does not cause hearing loss. The symptoms can vary in severity:

  • Dizziness to a violent spinning sensation (vertigo) 
  • Imbalance
  • Impaired concentration
  • Nausea
  • Vision problems
  • Vomiting

Medications help control nausea and dizziness. Antibiotics, antiviral drugs or steroids may also be prescribed. Rehabilitation exercises that retrain the brain to adjust to vestibular imbalance may also be necessary in long-term cases.

Chronic benign paroxysmal positional vertigo (BPPV) may also develop from the neuronitis.   


Tests

Vestibular testing is a series of different tests that help determine issues with the part of the inner ear responsible for balance. These tests can help identify the cause of symptoms, leading to more appropriate treatment. Some of these tests include: 

Videonystagmography (VNG/ENG) – Videonystagmography is a battery of tests that use recording and analysis of eye movements to help determine the cause of a patient’s dizziness or imbalance. The recordings provide useful information on the function of various parts of the balance system, including the balance organs and nerves within in the ears, the portions of the balance system within the central nervous system (CNS) and the parts of the CNS responsible for generation and control of eye movements. Recordings are usually accomplished through the use of goggles equipped with infrared cameras, although under certain circumstances, electrodes placed around the eyes are used.

Testing is performed with the patient in an exam chair in a darkened room. During the test, eye movements are recorded while the patient follows patterns on a light bar, moves into different positions and undergoes irrigations in each ear with warm and cool fluids. The test findings provide information on whether symptoms result from dysfunction within the ear, the CNS or both, thereby helping the referring provider determine the cause. The duration of the test is usually between 60 and 75 minutes.


Vestibular Evoked Myogenic Potential (VEMP) testing – VEMPs are muscle (myogenic) responses triggered by stimulation of the otolith organs. These organs are part of the inner ear balance system and are responsible for detecting both linear movements (forward/backward, side-to-side, up/down) and gravity and how the head is oriented with respect to it. To help determine the cause of a patient’s dizziness or imbalance, VEMP testing is used to assess the function of the otolith organs and their related signal pathways through the vestibular nerve and the central nervous system. VEMP testing is also used to determine whether an abnormal opening (dehiscence) or thinning of the bone that surrounds the inner ear is responsible for the patient’s symptoms. 

VEMP responses are measured through electrodes placed over the neck muscles and sometimes over the muscles beneath the eyes. During the test, the response is generated by presenting a repeated loud “popping” sound to an ear while the patient tenses the neck muscles by raising or turning the head, or by tensing the eye muscles by gazing upward. The duration of the test is usually between 30 and 60 minutes.

Treatments

Epley maneuver

BPPV is treated by putting the patient in various physical positions, called Epley maneuvers, to move the displaced otoliths. These head and body movements take about five minutes and often deliver immediate results. However, in some cases, it can take 24-72 hours to be symptom free. If the patient has a relapse, he or she can be successfully treated again. There is relatively little risk to this procedure.

Gentamicin injections

Gentamicin injections (“gent injections”) are used to chemically destroy the inner ear. Gentamicin is a strong antibiotic given through an IV that is used for patients who have life threatening infections. This antibiotic has a side effect known as ototoxicity (poisonous to the ear) but this side effect has been found to be helpful in Meniere’s patients when it is injected directly through the numbed eardrum and allowed to travel into the inner ear structures of the Meniere’s ear.

Some patients require numerous gent injections over a period of many weeks or months and frequently a severe attack occurs as a result of the inner ear “dying off," which is the intended goal of the treatment. The gent injections are only intended to control vertigo. They will not improve hearing, tinnitus or ear fullness. Gent injections are not recommended for all Meniere’s patients. If gent injections are recommended for your treatment, you should discuss the pros and cons with your physician.

Intra-tympanic steriod injections

Sometimes an injection of a steroid through the eardrum after it is numbed will temporarily settle down a period of increased Meniere’s activity. This can be done in our office by your ENT specialist.

Our Experts

KarenSmith

Karen Smith

PA-C

Karen Smith, physician assistant, graduated from the University of Nebraska with a Master of Science degree in Physician Assistant Studies with an emphasis in Neurotology in 2006. Prior to coming to Ohio State, she worked as a PA in San Antonio caring for patients with ear-related issues, including vertigo.

SaulStrieb

Saul Strieb, AuD

Audiologist & Vestibular Laboratory Coordinator

Saul Strieb, AuD, obtained his bachelor’s degree from the University of Chicago and his master’s degree in Audiology from the University of Maryland. He received his doctoral degree in Audiology from the University of Florida in 2009. He served as an audiologist at the Washington Hospital Center from 2001 through 2011, before joining the staff of the OSU Department of Otolaryngology -- Head and Neck Surgery in 2011. His clinical interests include hearing aids, BAHA, vestibular assessment and treatment of benign paroxysmal positional vertigo.

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