Dizziness and Hearing Disorders
Dizziness, hearing disorders and associated terms are often used in a general way covering a
large number of categories of disease. In the following we explain about the conditions in a general way. However,
in diagnosis and treatment, one must be much more specific in
order to narrow down to a smaller potential subset of disorders. For more information, go to
our research and teaching website.
For our clinic, visit the index to this site -- Chicago Dizziness and Hearing.
What is dizziness?
Dizziness is used to describe many different feelings, but for the most part, it refers to an impairment
in spatial perception and stability, including feeling unsteady on your feet or the surrounding
moving around you. Lightheadedness and impending faint is another sensation associated with dizziness.
Dizziness may be a fleeting sensation or a prolonged and intense symptom of a wide range of
health problems. Dizziness, left untreated, can affect a person's everyday activities, ability to
work and quality of life.
Vertigo describes spinning or illusions of movement such as
tilting, floating, or impulsion. Dizziness often occurs along with other symptoms such as hearing
loss, pressure or fullness in the head, tinnitus, nausea and anxiety.
What is imbalance?
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Imbalance refers to unsteadiness leading to increased risk of fall.
Imbalance commonly accompanies dizziness, but can also be independent.
Drop attacks, a very serious problem, are sudden spontaneous falls while
standing or walking, with complete recovery in seconds or minutes. There is usually no
recognized loss of consciousness and the event is remembered. It is a symptom, not a
diagnosis, and it can have diverse causes.
What is a hearing disorder?
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Hearing disorder is a full or partial decrease in the ability to
detect or understand sounds. Clinically there are three "pure" types of hearing loss:
sensorineural, conductive, and central. A fourth type, denoted "mixed", is simply
a combination of sensorineural and conductive.
Causes of dizziness
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Proportion of dizziness attributed to various categories of dizziness varies considerably.
Roughly 50% of all dizziness is caused by inner ear disturbances, about 5% by medical and
neurological problems each, about 15% by psychological disturbances, and the remainder of
the diagnosis (about 25%) is essentially unknown.
Causes of imbalance
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Related to ear, it is the most common type of dizziness in general counting for about 50% of all dizziness.
BPPV (about 50% of which are inner ear related),
Menieres disease (about 18% of inner ear related dizziness),
vestibular neuritis and labyrinthitis (about 14% of inner ear related),
perilymph fistula (rare),
bilateral vestibular loss(rare),
acoustic neuroma (rare)
as well as many other rare disorders belong to this category. Technology has advanced recently in otologic dizziness (i.e. VHIT).
- Central or neurologic causes
This type is brain related, counting for 5% of dizziness in general but heavily represented in the CDH otoneurology practice.
Stroke, migraine and disturbances of circulation to the brain (50% of
neurologic dizziness), Seizure (5% of neurologic dizziness),
MS and other disorders of the white matter (5% of neurologic dizziness),
cerebellar degeneration, Chiari malformation, and other disorders of the cerebellum,
and Mal de Debarquement syndrome (rare) belong to this category.
- Other medical causes
Low blood pressure including syncope, and orthostatic hypotension, cardiac arrythmia
and medication side effect count for 5% of all dizziness.
- Psychological causes
Anxiety and panic disorder, malingering, phobia and somatization syndrome counts
for 15% of all dizziness.
- Unknown causes or diagnoses
About 25% of causes of dizziness is unknown. Although diagnoses have attempted anyway,
they are often too vague to be meaningful, In our opinion, diagnoses such as
multisensory disequilibrium of the elderly, post-traumatic dizziness,
and psychogenic dizziness including PPPD are usually just names for situations rather than causes.
In dizzy patients, most imbalance is caused by inner ear disturbances. When dizziness is not
present, most imbalance is central. In older patients, multisensory disturbances are the most common.
In younger patients, central problems (such as migraine) are more common.
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- Sensory disturbances
It is seen in the loss of position sense, vestibular sense, visual sensation, or a
combination of all three. B12 deficiency (common), peripheral neuropathy (common),
bilateral vestibular loss (rare) and dysequilibrium of blind persons belong to this category.
- Central brain disturbances
includes the same causes of central dizziness listed above, plus
migraine (common), multiple small strokes(common), cerebellar degeneration (moderately common),
chiari malformation (moderately common), and other disorders of the cerebellum
(moderately common), parkinsonism and related disorders of the basal ganglia (moderately
common), hydrocephalus or CSF leak (rare), Mal de Debarquement syndrome (rare),
MS and other disorders of the white matter (rare), remote effect of cancer (rare),
oculopalatal myoclonus (rare) and orthostatic tremor (extremely rare).
- Peripheral causes
Weakness caused by muscle disease, or spinal cord problem, e.g., spinal cord compression (uncommon)
Causes of hearing disorder
The great majority of hearing disturbances are sensorineural,
either associated with aging or noise exposure.
- Conductive type
The cause is mechanical. It includes ear wax, ear drum perforation, middle ear infection or fluid and
inner ear bone (ossicle) disturbance (e.g.otosclerosis).
- Sensorineural type
Attributing to hair cells or nerve, this type of hearing loss is seen in
presybyacusis (an age related hearing loss), noise trauma, acoustic neuroma (rare),
radiation (rare), congenital (rare), and infection due to syphilis (very rare).
- Central type
The cause is in the brain, e.g., brainstem and auditory cortex.
- Psychological type
- Other type
Mechanisms for some hearing disorders are unclear. Sudden hearing loss belongs to this category.
- Hain TC, Herdman SJ. Dizziness in the Elderly. (Ed Sage JI, Mark MH)
Practical Neurology of the Elderly.
Marcel Dekker Pub, New York, NY 1996.
- Hain TC. Approach to the Vertigo Patient In J. Biller (ed). Practical Neurology 2nd edition, Lippincott-Raven, Philadelphia, (2008), as well as several later editions.
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