Inner Ear Imbalance: Causes and Symptoms of Dizziness

Poor vestibular function in the inner ear?

Hello Dr.
Hsu: At the end of December last year, one morning I woke up feeling extremely dizzy, accompanied by nausea.
I experienced dizziness whenever I lay down to rest or changed positions, which lasted for a few seconds before stopping.
This symptom persisted for about a week.
During this time, I consulted doctors who diagnosed it as benign paroxysmal positional vertigo (BPPV) and advised that it would resolve on its own without much concern.
Indeed, after a week, I no longer felt dizzy with those movements.
However, two weeks later, I experienced dizziness again with the same movements, but the symptoms were very mild and not as severe as the first occurrence.
Therefore, I chose to visit a major hospital for further evaluation.
The doctor ordered several tests, including hearing tests and vestibular assessments.
The results were reported as normal, and the doctor mentioned that my inner ear balance was somewhat impaired.
I inquired about one of the vestibular tests, the caloric test, where I felt very dizzy when cold water was injected into my right ear, but only experienced mild dizziness when the same was done to my left ear.
The doctor explained that this indicates normal function in the right ear and reduced sensitivity in the left ear, which could be the cause of my dizziness.
After returning home, I researched this condition online, and I would like to ask Dr.
Hsu whether my symptoms are indicative of Meniere's disease, vestibular neuritis, or another condition.

Xiao Hei Zhu, 20~29 year old female. Ask Date: 2011/03/03

Dr. Xu Jiazhen reply Otolaryngology

Hello, if you have undergone a complete evaluation for vertigo and it has been confirmed as benign paroxysmal positional vertigo (BPPV), it can generally be managed effectively.
Therefore, it is not accurate to suggest that there are other underlying conditions, so there is no need to worry; the likelihood of it developing into another disease in the short term is low.
You mentioned that the results of the caloric test for the inner ear were less than ideal on one side; there are many factors that can influence this.
Additionally, I do not believe that one single test result can overturn the overall findings, as medical evaluations for vertigo are not definitive based on a single test alone.
I recommend that you return to the hospital where you had the vertigo assessment and discuss these concerns with your attending physician.

Reply Date: 2011/03/03

More Info

Hello! Thank you for sharing your detailed symptoms and medical history. Based on your description, it seems you are experiencing episodes of dizziness and imbalance, which can be quite distressing. Let's break down your situation and explore the potential causes and implications.

From what you've described, your symptoms began with a sudden onset of severe dizziness and nausea, which improved after about a week but then returned in a milder form. This pattern of episodic dizziness, particularly when changing positions, is characteristic of Benign Paroxysmal Positional Vertigo (BPPV). However, since your dizziness has recurred and you have undergone various tests that returned normal results, it suggests that there may be other underlying issues at play.

The results from the inner ear temperature test you mentioned indicate a difference in how your ears respond to stimuli, which can suggest an imbalance in the vestibular system. This could point toward vestibular dysfunction, which may not necessarily be BPPV. The fact that you experienced significant dizziness when cold water was introduced to your right ear but only mild dizziness with the left ear suggests that your left vestibular system may be less responsive or functioning suboptimally.

Now, regarding your question about whether this could be Meniere's disease, vestibular neuritis, or another condition:
1. Meniere's Disease: This condition is characterized by episodes of vertigo, tinnitus (ear ringing), hearing loss, and a feeling of fullness in the ear. It typically affects one ear and can lead to fluctuating hearing loss. Your symptoms of dizziness and ear sensations could align with Meniere's, but the absence of hearing loss during your episodes makes this less likely.

2. Vestibular Neuritis: This condition involves inflammation of the vestibular nerve, often following a viral infection. It typically presents with sudden, severe vertigo that can last for days, but it usually does not cause hearing loss. Given that your dizziness has been episodic and not continuous, this may not fully explain your symptoms.

3. Other Conditions: There are several other potential causes of your symptoms, including vestibular migraine, which can cause dizziness and imbalance without the classic headache, or even issues related to the inner ear structure, such as labyrinthitis or autoimmune inner ear disease.

Given that your symptoms have recurred and you have experienced significant dizziness, it would be prudent to follow up with an ear, nose, and throat (ENT) specialist or a neurologist who specializes in vestibular disorders. They may recommend further testing, such as imaging studies (MRI) to rule out structural issues or additional vestibular function tests to assess the balance system more thoroughly.

In the meantime, consider keeping a diary of your symptoms, noting when they occur, their duration, and any associated factors (like changes in position, stress, or dietary factors). This information can be invaluable for your healthcare provider in determining the best course of action.

Lastly, while it can be frustrating to deal with these symptoms, many vestibular disorders can improve with appropriate treatment and management strategies. Physical therapy, particularly vestibular rehabilitation therapy, can also be beneficial in helping to retrain your balance system.

I hope this information helps clarify your situation and provides a pathway for further evaluation and management. Please take care and seek the necessary follow-up with your healthcare provider.

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