Balance and hearing are connected within the inner ear - why this matters - Healthy Hearing

Walking and moving without falling or feeling dizzy are tasks you can accomplish thanks to your balance system. As with many systems in your body, when it's functioning properly, it's easy to take your balance for granted. 

Our balance system—also known as the vestibular system—is a complicated one. The brain relies primarily on information from three sources:

• the tiny vestibular organs located in the inner ear
• our eyes
• sensations in our legs and feet (formally known as proprioception)

What is the vestibular system, anyway? 

The vestibular system helps us maintain our balance, orient ourselves in space, and navigate our environment, explained Jennifer Stone, PhD, a research professor of otolaryngology–head and neck surgery at the University of Washington, during an October 2021 Hearing Health Foundation (HHF) webinar on the relationship between balance and hearing. 

All of these functions, Stone said, mean that having it work properly is "crucial for our wellbeing." 

It's made up of five organs, each with a different function. "It's the integration of these five organs that's really important for how the vestibular system works," she said. That's what tells the brain "how we are oriented in space and how we are moving."

Balance organs in the inner ear

• The three semicircular canals: These canals are filled with fluid. As you rotate your head, the fluid causes cupula—sail-like structures at the end of the canals—to move, bending hair cells, according to the National Institute on Deafness and Other Communication Disorders (NIDCD). 
• Two otolith organs (utricle and saccule): Inside these organs are tiny stones, known as otoconia, that move in response to gravity. This is how your brain knows whether you are standing up or lying down, for example. 

Balance problems are very common, especially as we age

Feeling dizzy is common, especially as we
get older. 

Whenever there's a delicate process happening within your body, there's potential for it to go awry. 

Statistics vary, but around 15 to 20 percent of American adults experience balance or dizziness problems every year, estimates show. This increases with age: A much-cited study in the Journal of Vestibular Research found that 35 percent of adults (age 40+) in the United States experience balance dysfunction. 

There's a variety of reasons equilibrium issues are more common with age. For instance, some vestibular disorders are more common as we get older, according to Dr. Cameron Budenz, MD, medical director of the Audiology and Cochlear Implant Center at Phelps Hospital, Northwell Health in Sleepy Hollow, New York. 

With age also comes changes to vision or a potential loss of sensation to your legs and feet, she says. Dual sensory impairment—such as vision loss and hearing loss—also places extra stress on the balance system.

Hearing and balance are both part of the inner ear

The inner ear is the same part of the ear where the cochlea—the snail-like organ where soundwaves get converted into electrical impulses and transmitted to the brain—resides. The hearing system and the balance organs share a nerve pathway to the brain, known as the vestibulocochlear nerve.

The connection between the hearing and vestibular system is direct, but there's a division as well, Dr. Budenz notes. "One part is dedicated to hearing, another part to balance." 

This means when something goes wrong in one, it can affect the other. If you are experiencing dizziness and hearing loss or ringing in the ears (tinnitus), it could be something wrong with your inner ear, for example.

"People who have hearing loss are much more likely to have balance disorders than those who do not have hearing loss," Stone said, primarily because of this shared connection.  

Audiology testing can be useful for balance issues

Dr. Budenz shares a helpful analogy for considering the connection between the hearing and balance systems: if you're in a two-bedroom home, and there's a fire, it could affect only one bedroom—but flames may very well cause issues throughout both rooms. 

"There are many disease processes that can affect both simultaneously because of the direct connection between the two," Dr. Budenz says.

That's why if she's evaluating a patient for dizziness and balance issues, she'll also recommend a hearing test, which will provide insight.

Audiologists, who often work with ENT doctors, can also perform balance tests, such as:

Videonystagmography (VNG) test: This test detects involuntary eye movements known as nystagmus, which can be caused by some disorders of the inner ear. 

Auditory brainstem evoked response (ABR): This test can detect problems with the nerves that connect your hearing and balance systems to the brain. 

Conditions that affect both hearing and balance

• Ménière's disease: This disease causes dizziness, tinnitus and hearing loss.
• Acoustic neuroma: These benign, slow-growing tumors grow on the vestibulocochlear nerve, causing hearing loss, tinnitus and vertigo.
• Ototoxic drugs: These are many medications, including antibiotics, chemo drugs and aspirin, that can potentially cause damage to hearing and balance systems.  
• Prolonged noise exposure: You're likely well aware that loud noises are harmful to hearing. Research points to noise exposure damaging cells within the vestibular system, too, Stone said. 
• Aging: As noted above, getting older means more balance problems. And of course, the same is true for hearing. One-third of adults over age 65 have age-related hearing loss.
• Infections: Cytomegalovirus (CMV), Epstein-Barr virus, or meningitis can "also cause a loss of balance and hearing functions," Stone said. 
• Genetic mutations: "The sensory organs in our inner ear, vestibular and auditory, have a common embryonic origin, so a single gene mutation may disrupt development of both sensory systems," Stone said. One example being neurofibromatosis 2, which causes tumors to grow on nerves.

Common balance disorders 

If you have a balance disorder, you may experience a variety of symptoms, including dizziness, vertigo, feeling faint, falling (or feeling as though you will), and confusion.

"If you have a vestibular disorder...the primary thing that you'll experience is a sense that something is horribly wrong," researcher and clinician James Phillips, PhD, said during the HHF webinar. Beyond that, symptoms vary according to the particular cause, of which there are many, according to American Speech-Language-Hearing Association (ASHA), which lists more than twenty. 

Here are some of the most common balance disorders, according to the NIDCD: 

• Benign paroxysmal positional vertigo (BPPV): Sometimes referred to simply as "positional vertigo," benign paroxysmal positional vertigo (BPPV) is a common balance disorder that causes sudden dizziness upon moving. It is one of the most common causes of vertigo.
• Labyrinthitis: This occurs when the inner ear gets infected or inflamed, often due to an upper respiratory infection, according to the NIDCD. 
• Vestibular neuronitis: This occurs due to a virus, and results in the vestibular nerve being inflamed.
• Perilymph fistula: An issue with the membrane separating the inner and middle ears, which allows fluid to move from the inner ear to the middle one, according to the Vestibular Disorders Association (VeDA). It's most commonly caused by head trauma, per VeDA. 
• Mal de Debarquement syndrome (MdDS): When the feeling of movement continues even after you're off a water vessel. 

When to see a doctor 

Feeling dizzy or experiencing vertigo aren't a diagnosis—those are symptoms, Dr. Budenz points out. They're a sign that something is awry. Through tests, a detailed patient history, and other diagnostic tools, health care providers can pinpoint the cause of these symptoms. 

It's fine to start with your primary care doctor, Dr. Budenz says. Depending on the symptoms, they can determine next steps and an appropriate specialist. Lightheadedness might indicate it's appropriate to visit the cardiologist to rule out blood pressure concerns, while headaches might point to migraines being an issue, making a neurologist the next visit, she says. 

If vertigo or balance issues are the main symptoms, an ear, nose, and throat (ENT) doctor is a reasonable starting point.

Treatments vary depending on your condition, Dr. Budenz says. For most balance-related disorders, a treatment is available, although in some cases, the main goal may be to minimize symptoms.