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Dizziness &


The balance system is comprised of four main components: the eyes, inner ears, brain, and joints and muscles. The eyes send visual data to the brain while the inner ears send information on head position and motion (aside from sound) to the brain. The joints and muscles send information on body position to the brain. When one of these components malfunctions, imbalance or vertigo may occur.

Vertigo is the abnormal sense of motion when the body is not in motion. This may be characterized as a feeling of the body or room spinning or rocking sensation. This occurs when there is conflicting information transferred between the eyes, inner ear, and body.

Disequilibrium or Imbalance without any sense of spinning occurs when transmission of the signal between the body and brain is disrupted.

Syncope occurs when the body’s blow flow is disrupted which creates a sense of floating or lightheadedness and causes loss of consciousness or fainting.

Possible causes of imbalance and dizziness include

  • Infection or inflammation of the semicircular canal of the inner ear (labyrinthitis)

  • Excess buildup of inner ear fluid (such as Meniere’s Disease)

  • Shifting of inner ear crystals into the wrong location (benign positional vertigo.

  • Decreased blood flow caused by heart problems

  • Side effect of medication

  • Ototoxicity (damage to the ear caused by a drug or chemical)

  • Psychological problem (i.e. anxiety)


Why Are You Testing My Hearing When I’m Dizzy?

Because the ear is part of the balance (vestibular) system, it is important to determine how the auditory and vestibular system is functioning. A hearing evaluation provides information on the status of the ear canal, middle ear system, and inner ear function. We want to rule out inflammation of the ear canal and eardrum. We need to ensure that the eardrum is intact. Some inner ear balance problems affect the hearing and a hearing evaluation can rule out some disorders.

Protocol for a vestibular hearing evaluation includes the following: pure tone air-conduction and bone conduction thresholds, speech thresholds, speech discrimination at comfortable level and louder level (90 dB HL), tympanometry, acoustic reflex thresholds, acoustic reflex decay, and otoacoustic emission (OAE) testing. Upon completion of the dizzy hearing evaluation, more testing may be performed to include an ENG and ABR.

Specific Types of Balance/Vestibular Testing

Electronystagmography (ENG) – A group of subtests that can determine if dizziness is caused from an inner ear problem. Vestibular dysfunction and neurological problems can be identified with ENG testing. Eye movements and nystagmus (involuntary eye movements) are recorded via electrodes placed around the eyes and on the forehead.

  • Oculomotor – Evaluates movement of the eyes as they follow a target

  • Positionals – Determines if dizziness is associated with different head and body positions

  • Calorics - Warm and cool water is irrigated in each ear canal. The temperature change stimulates the balance part of the inner ear. Determines if the inner ears function equally or if there is an asymmetry (difference) between them


Auditory Brainstem Response (ABR) is an auditory evoked potential extracted from ongoing electrical activity in the brain and recorded via electrodes placed on the scalp. The resulting recording is a series of vertex positive waves of which I through V are evaluated. These waveforms assist in the identification of neurological disorders as well as provide a method of determining hearing sensitivity in newborns and other patients that are unable to participate in traditional audiological/hearing evaluations.


Repositioning maneuvers- Guided head and body movements that reposition inner ear particles into their correct location.

Physical therapy – Perform habituation exercises, gaze stabilization exercises, and gait and balance training.


Increase safety - Fall prevention, improve lighting in walkways and in the home, use assistance of cane or walker if needed, ask for others to drive


Tinnitus is the perception of sound originating in the ear(s) or head in the absence of external sound. It may occur as a ringing, buzzing, swishing, roaring or may sound like crickets. It alone is not a disease but a symptom of an underlying problem.

Possible Causes - Tinnitus can be caused from disorders of the external (outer), middle and inner ears, or from the central nervous system (brain). A blockage of the ear canal, such as from earwax or a foreign body, can cause tinnitus. Middle ear infections and problems with maintaining proper middle ear pressure can lead to tinnitus. The most common cause of permanent tinnitus is hazardous noise exposure which damages the outer hair cells of the inner ear. Side effects from medications can result in tinnitus. More serious health problems such as an aneurysm or a tumor of the ear or brain may result in tinnitus.

Statistics - Approximately 50 million Americans experience tinnitus

Possible Therapies

While hearing aids are not a cure for tinnitus, they may be able to help tinnitus patients by:

  • Improving communication and reducing stress, which makes it easier to cope with the condition.

  • Amplifying background sounds, which can make tinnitus seem less loud.


The American Academy of Otolaryngology (AAO-HNS) and the American Tinnitus Association recommends these additional tips for minimizing the effects of tinnitus on your health:

  • Avoid exposure to loud sounds and noises.

  • Get your blood pressure checked. If it is high, get your doctor’s help to control it.

  • Decrease your intake of salt. Salt impairs blood circulation.

  • Avoid stimulants such as coffee, tea, cola, and tobacco.

  • Exercise daily to improve your circulation.

  • Get adequate rest and avoid fatigue.

  • Eliminate or reduce some stress in different parts of your life; stress often makes tinnitus worse.

  • Experiment by eliminating other possible sources of tinnitus aggravation, e.g. artificial sweeteners, sugar, alcohol, prescription or over-the-counter medications.


(Do not stop taking medications without consulting with your health care professional about the possible)

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