Feeling Off-Balance? The Problem Might Be in Your Ears

If you’re feeling a little unsteady on your feet, it’s not just in your head. It might actually be in your ears.

We’ve all experienced dizziness after a boat trip, an amusement park ride or spinning in a circle as a kid. But if you feel like you’ve just gotten off a roller coaster even if you’ve hardly moved, you could have a balance problem related to your inner ear. Here’s how it happens.

Your inner ear has three canals that sense different types of movement: up and down, side to side, turning in any direction and tilting. These canals are filled with fluid; within that fluid are floating membranes with tiny cells that send signals to your brain. That special sensory information, combined with what you see and feel, helps you navigate the physical world. The brain ultimately interprets all of this incoming sensory information and translates it into coordination, balance and movement. If those incoming signals are thrown off, you can experience dizziness, nausea or a feeling that the world is spinning. You may even feel like you’re about to fall down. Several different conditions can cause your inner ear–balance system to become off-kilter, but thankfully they can be managed with help from a doctor.

Vertigo

Vertigo is really the name of the symptom describing this dizzy, off-balance feeling, but something called benign paroxysmal positional vertigo (BPPV) is a diagnosis in itself. With BPPV, small calcium crystals in your inner ear become dislodged, causing your brain to receive the wrong signals about your movements. So when you turn your head or change positions, you might experience a sudden spinning spell. It usually occurs in older people, but head injuries, an inner ear infection called labyrinthitis or having a family member with BPPV can also increase your risk. BPPV is usually easily treated with a special series of movements your health care provider can perform to help get the crystals back in place.

Earwax

Everyone has earwax, but some people have more than others. If it builds up, it can block the ear and cause hearing problems as well as balance issues. Older people tend to be more at risk for earwax buildup, but it can also happen if you stick anything, like a cotton swab, in your ear; this can impact the wax instead of removing it. Your primary care doctor may use irrigation or give you drops to moisten earwax buildup so it will dislodge. If it is severe or if you have other ear issues, you may need a specialist to remove it under a microscope, which can be done in the office.

Meniere’s disease

Named after the physician who first described it, Meniere’s disease occurs when fluid builds up in the inner ear, causing sudden attacks of vertigo as well as ringing in the ear (tinnitus), hearing loss or a feeling of fullness in the ear. Doctors aren’t sure what causes it, but some proposed theories include problems with circulation, allergy or autoimmune reactions, infection or genetics. While there’s no cure for Meniere’s disease, treatments can be effective at controlling the symptoms. Medications, diet and lifestyle changes and, in severe cases, surgery, can help.

Acoustic neuroma

Technically called vestibular schwannoma, acoustic neuroma is a benign tumor that causes balance problems, along with vertigo, tinnitus, hearing loss on the affected side or ear fullness or pressure.

“Acoustic neuromas cause balance disturbance in many cases because the tumor grows around the vestibular, or balance, portion of the eighth cranial nerve, which carries sensory information from the inner ear,” says Joni Doherty, MD, PhD, an otolaryngologist and neurotologist at Keck Medicine of USC and assistant professor of clinical otolaryngology – head and neck surgery at the Keck School of Medicine of USC.

Although uncommon, the incidence of acoustic neuroma is on the rise, most likely due to early detection via magnetic resonance imaging, Doherty adds. Some experts estimate that one in 1,000 people per year develop an acoustic neuroma. Microsurgery can remove the tumor; radiation therapy or a wait-and-watch approach are also options.

Vestibular neuritis

If the inner ear becomes infected, usually from a virus, it can cause this inner ear condition. When the vestibular nerve swells from the infection, the signals to the brain are thrown off and result in vertigo, dizziness, balance problems, nausea and even difficulty concentrating. There are medications to control symptoms; often a steroid will also be given. Physical therapy to “retrain” the brain may be recommended if symptoms persist.

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