Hearing Loss & Balance

Balance is essential to how we are able to move through space.

It prevents us from falling and provides awareness about physical position. Balance is managed by the vestibular system which you may be surprised to learn, is housed in the inner ear. The inner ear is also a major component of the auditory system - the sensory system for hearing. Sometimes, hearing and balance challenges can overlap but can also occur independently. The National Institute on Deafness and Other Communication Disorders estimates that nearly 40% of people in the U.S. will experience dizziness and/or balance related challenges during their lifetime.

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Understanding the Balance System

The vestibular system sends the brain information related to balance, motion, head position, and overall spatial awareness. This complex system also relies on other sensory inputs including visual cues to understand physical position. The vestibular system consists of a network of canals, the otolith organs, and the vestibulocochlear nerve. There are three loops that comprise the semicircular canals which track specific movements:

First canal: head moving or nodding up and down
Second canal: side to side motions
Third canal: tilting left and right movements

These tubes or canals contain hair cells and fluid which act as sensory cells. They send the brain information, through the vestibulocochlear nerve, about movement and physical position. This includes information about where your body is in relation to gravity - standing up, sitting down, moving left, or right etc. Damage to any of these components or processes can affect balance and contribute to the development of balance disorders.

Balance Disorders

The National Institutes of Health estimates that 8 million people live with balance issues that are chronic. A balance disorder is a medical condition that affects one’s ability to maintain balance and/or is characterized by vertigo. Vertigo is the experience of feeling like everything around you is spinning, producing dizziness. These dizzy spells can come and go or be longer-lasting.

Various health issues or conditions can cause challenges with balance or even a balance disorder. Common causes include the following:

Hearing loss
Inner ear disorders: Meniere’s disease, benign paroxysmal positional vertigo (BPPV), vestibular neuronitis, labyrinthitis, etc.
Head injuries
Viral or bacterial infections
High or low blood pressure
Medical conditions like Alzheimer’s and multiple sclerosis

Common symptoms produced by balance disorders include:

Dizziness, vertigo
Feeling unsteady and like you are going to fall
Feeling faint or lightheaded
Changes with vision, vision becomes blurry
Nausea, motion sickness
Headaches
Confusion or disorientation

These symptoms can be intermittent or chronic which impact well being on a daily basis.

Link Between Hearing Loss and Balance

Hearing loss and balance can be related and unrelated. This means that hearing loss and balance disorders can occur together because they share the same underlying cause. But one does not necessarily cause the other. The cochlea - critical for hearing - and the labyrinth - critical for balance - are both housed in the inner ear. There are conditions that can impact both organs, producing hearing loss and balance issues. An example of this is Meniere’s disease which is an inner ear disorder. This condition occurs when fluid accumulates in the inner ear which can lead to hearing loss, dizziness, and tinnitus (ringing noise in the ears). Additionally, head injuries can also damage these integral components in the inner ear; impacting both hearing and balance.

Treating Balance Disorders

Treatment for a balance disorder depends on the underlying cause. The first step is to be thoroughly assessed so the underlying condition causing balance issues can be diagnosed. To do this, you may be referred to a specialist which can include an otolaryngologist, also referred to as an ENT doctor. These healthcare providers specialize in assessing, treating, and managing conditions related to the ears, nose, and throat. You may also be referred to an audiologist who specializes in ear related conditions. Various diagnostic tools can be used to identify an underlying cause of a balance disorder. Tests can range from hearing to blood or imaging evaluations.

Treatment, informed by the underlying cause, can include the following:

Medications: this would be used to treat bacterial infections causing inflammation, and could include antibiotics. Other medications could include steroid and antiviral treatments.
Vestibular rehabilitation: Vestibular Rehabilitation Therapy (VRT) involves performing exercises of specific movements (with the eyes, head, body) without triggering vertigo.
Canalith repositioning procedure (CRP): this treatment is for BPPV and involves positioning the head in specific ways that reposition the crystals that become dislodged in the inner ear.

These treatment options can effectively alleviate symptoms caused by balance disorders, allowing people to move through daily life more safely and easily.