The Link Between Tinnitus and Dizziness: Finding Balance Amidst the Ringing

Tinnitus and Dizziness: A Common Worry

For many, the onset of tinnitus can be alarming; a persistent ringing or buzzing in the ears that seems to have no discernible source can be both distressing and distracting. Add episodes of dizziness, and the concern is compounded. Patients often ask, "Why both? Could they be related, or do they have separate causes?"

Dizziness can manifest in a variety of forms, with each type impacting individuals in distinct ways. Some may experience an intense sensation of room-spinning dizziness, often referred to as vertigo. This type of dizziness creates the illusion of a spinning environment, which can be quite disorienting and even incapacitating. Others may report feelings of unsteadiness, akin to being on a moving platform, leading to difficulties in maintaining balance while standing or walking. 

Additionally, there are those who describe a sense of lightheadedness or feeling as if they might faint. Finally, a common complaint is a vague sense of being off balance, as if one's internal equilibrium has been disrupted. Each variation of dizziness necessitates a nuanced understanding and approach in terms of management and treatment, underscoring the importance of accurately identifying the specific type of dizziness a person is experiencing.

Anxiety About Your Symptoms

First off, if you’re feeling anxious about having the combination of tinnitus and dizziness, you are in good company. There are a number of patients who worry about what could be causing their symptoms and look to the internet for answers. In the next sections, we’ll go through a few conditions that can cause both tinnitus and dizziness. Please know that there are many conditions that can cause tinnitus and dizziness, either short- or long-term. Some of these are rare conditions. It can take a full work-up from one or more providers to get to the bottom of it. One thing to keep in mind: in nearly every case there are treatment or management strategies to help you feel better. 

Phew - ok, deep breath and let’s get to a little background.

The Intricacies of the Inner Ear: Hearing and Balance

The inner ear, a complex and intricately designed part of our auditory and balance systems, plays a pivotal role in how we hear and maintain balance. When you think about the ear, you might just be thinking about hearing. However, this small but mighty organ is divided into two main sections: the cochlea, responsible for converting sound waves into nerve signals for the brain to interpret as sound, and the vestibular system, which is critical for balance.

Many are aware of the connection between hearing loss and tinnitus, where damage to the inner ear can cause the perception of noise or ringing. However, you might not think about how the inner ear relates to balance. The vestibular system consists of semicircular canals and otolithic organs that detect rotational movements and changes in head position, respectively. This information is then sent to the brain to help maintain our balance and spatial orientation. Here’s a quick 2-minute video that illustrates how it works:

Ok, so now the connection between tinnitus and dizziness.

Conditions affecting the inner ear can result in multiple symptoms, not limited to hearing loss or tinnitus. Vertigo, dizziness, and balance issues can also originate from disruption within this sensitive system. It's crucial to understand that patients may not experience all these symptoms simultaneously; however, the interconnected nature of the hearing and balance functions within the inner ear means that even minor changes to the inner ear environment can cause changes to balance and also hearing or ringing in the ear. For many, stress is a big trigger for tinnitus. And what’s more stressful than sudden, room-spinning dizziness or disequilibrium? Additionally, some conditions affect structures in both the hearing and balance portions of the ear, resulting in the onset of both tinnitus and dizziness at the same time.

The Conditions That Can Cause It

Tinnitus and dizziness, when experienced together, can be attributed to various conditions. Next, we’ll go through some known conditions that can cause both symptoms.

Meniere's Disease: The Ebb and Flow of Your World

Meniere's Disease is an inner ear disorder that manifests through a trio of symptoms: episodes of vertigo, where individuals feel as if they are spinning; roaring tinnitus, a perceived loud noise in the absence of external sound; and fluctuating hearing loss, where hearing ability can vary from day to day. This condition, also called endolymphatic hydrops, arises from an accumulation of excess fluid within part of the cochlea in the inner ear. 

This fluid buildup disrupts the normal hearing and balance signals between the ear and the brain, leading to the characteristic symptoms of Meniere's Disease. Methods that reduce symptoms focus on restoring the ‘natural balance’ of fluids inside the inner ear. For example, management of Meniere's typically involves reducing fluid buildup (through with sodium restriction), and in some cases, medication to reduce symptoms.

Vestibular Migraines: When Your Headache Comes with a Spin

Vestibular migraines represent a unique and often misunderstood type of migraine, diverging markedly from the 'traditional' migraine headache that comes to mind. These are not simply migraines with an added symptom of dizziness; rather, they center around episodes of vertigo or severe dizziness that can persist from minutes to hours, profoundly affecting an individual's ability to function. 

Those suffering from vestibular migraines may find themselves suddenly experiencing a wave of dizziness, and feelings of spinning or tilting can occur. Coupled with these unsettling episodes, there may also be changes in hearing, adding another layer of distress. The heightened stress that often accompanies these episodes can also trigger or worsen tinnitus. 

Migraine journals can be a big help to identify triggers that occur just before an episode. Migraine management may involve reducing or mitigating triggers (e.g., certain foods, stress levels, etc.) or medication.

Acoustic Neuroma: A Tumor's Silent Pressure

An acoustic neuroma, a rare condition, is characterized by a benign (non-cancerous) growth of cells on the vestibulocochlear nerve, which is responsible for both hearing and balance. It is typically slow-growing, which means that the associated symptoms, including changes in balance, unilateral tinnitus, and hearing loss, may develop gradually and subtly over time. This slow progression can make early detection challenging, but it may show up as an asymmetric hearing loss on an audiogram, the presence of new balance concerns, or tinnitus in just one ear. 

As it is slow growing, the most common approach is to monitor it with regular MRIs and audiograms. Patients focus on interventions that address the hearing loss and tinnitus to improve quality of life.

Intracranial Hypotension: A Labyrinth Under Pressure

Another rare condition that can lead to tinnitus and dizziness can occur in the brain. Abnormally low cerebrospinal fluid (CSF) pressure, often due to a CSF leak, is another condition that can trigger tinnitus and, in some cases, dizziness. This condition, known as Intracranial Hypotension, occurs when the fluid that cushions and supports the brain and spinal cord diminishes in volume, reducing the protective buffer it provides. 

Managing Intracranial Hypotension requires identifying and addressing the underlying cause of the CSF leak, coupled with strategies to alleviate the immediate symptoms, to restore equilibrium, and improve the quality of life for those affected. In some cases, it can resolve on its own. Physicians may recommend bed rest and hydration to manage the condition conservatively, while others may require medical procedures.

The Lingering Effects of (Long) Covid

While still relatively new in the research, one German study examined over 1000 patients experiencing ‘long Covid’ symptoms with some experiencing tinnitus and dizziness. Approximately 60% experienced and 30% had tinnitus, with some experiencing both symptoms. There is a lot here that is not completely understood in terms of the pathophysiology behind these symptoms currently, and research is still working to uncover

Others Less Common Culprits

Beyond the causes mentioned above are many others, including head injuries, superior canal dehiscence, viral infections affecting the vestibular system (such as labyrinthitis or vestibular neuritis), and neurological disorders. 

As with any condition involving the auditory and balance systems, identifying the underlying cause is essential for effective management. Approaches may vary from medication to therapy, surgery, lifestyle modifications, or a combination of these strategies.  Regardless of the specific cause, seeking prompt and appropriate treatment is essential for mitigating symptoms and maintaining one's well-being.

Taking Action: Next Steps in Managing Symptoms

If you are experiencing symptoms such as tinnitus, dizziness, or fluctuations in hearing, taking proactive steps towards a diagnosis and treatment is crucial. You might be wondering when it’s time to see a doctor. Anyone experiencing sudden, severe, or recurrent episodes of dizziness (with or without tinnitus) should seek medical evaluation. 

The first and most essential step is to schedule an appointment with an Ear, Nose, and Throat (ENT) specialist. ENT doctors are qualified to diagnose conditions affecting the auditory and balance systems, thanks to their specialized training in both medical and surgical management of these disorders.

During your consultation, the ENT will conduct a thorough physical exam which may also include ordering hearing tests, balance assessments, and imaging studies to uncover the root cause of your symptoms. It's important to approach this appointment with an open mind and be prepared to discuss all your symptoms, no matter how minor they may seem. This comprehensive assessment is vital in developing an effective treatment plan tailored to your specific needs.

Remember, many conditions causing tinnitus and dizziness are treatable, and seeking timely medical attention can significantly improve your quality of life. Whether through medication, therapy, lifestyle adjustments, or surgery, the goal is to manage your symptoms effectively and restore your sense of balance and hearing.