Hearing and balance: diagnosis and treatment
Hearing and balance rely on the same organ, deep inside the inner ear. That is why hearing loss, ringing in the ears and dizziness are checked together, with the same basic examination. Sudden hearing loss is the exception: it cannot wait, because treatment only works within a limited time window.
What do we treat?
- Hearing loss and hearing tests: when you miss words in conversation, keep asking people to repeat themselves or keep turning the volume up. The test shows how well you hear and at which frequencies, and whether the problem is in the middle or the inner ear, which completely changes the treatment.
- Tinnitus: a sound you hear that is not really there, usually a buzzing, whistling or a sound like a cicada.It is not a disease but a symptom, and the first job is to rule out causes that need treatment, especially when it affects only one ear.
- Dizziness and vertigo: vertigo, the feeling that the room is spinning, is not the same as dizziness or as feeling unsteady on your feet, and not every episode is labyrinthitis, as people often say. The distinction comes from the questions and the examination, and decides whether the cause is in the ear or elsewhere.
Why are they examined together?
Inside the inner ear there is a system of small cavities called the labyrinth, which houses 2 organs: the cochlea, which turns sound into a nerve signal, and the balance organ (vestibular system), which tells the brain where your head is in space. They share the same fluid and the same nerve. Whatever affects one often affects the other. This is also where the term labyrinthitis comes from, which many people use for any kind of dizziness.
The numbers show it clearly: in sudden hearing loss, dizziness is also present in 30–60% of cases. That is why a patient who comes in for dizziness leaves with a hearing test, and a patient who comes in for ringing in the ears also has their balance checked. These are not extra tests, they are the same diagnosis.
How is the examination done?
The examination starts with your history, which matters more here than anywhere else: how long an episode of dizziness lasts, what triggers it, whether it involves one ear or both, and whether it comes with ringing or a feeling of pressure in the ear. This is followed by otoscopy, a look at the eardrum and the ear canal.
Hearing test and tympanometry
The hearing test (audiogram) shows how well you hear at each frequency and separates conductive hearing loss, which involves the middle ear, from sensorineural hearing loss, which involves the inner ear. Tympanometry shows whether there is fluid behind the eardrum or a problem with the Eustachian tube. Together they answer the first question in every case: where exactly the problem is.
Balance testing
When the main symptom is dizziness, we examine your eye movements, walking and posture, and use specific head maneuvers that trigger the symptom in a controlled way so that the cause becomes visible. The most common type of vertigo is treated with a repositioning maneuver at the same appointment.
Frequently asked questions
Because the balance organ sits right next to the hearing organ and is supplied by the same nerve. A hearing test often reveals the cause of the dizziness.
No. Dizziness can come from the ear, the nervous system, blood pressure or medication. An ENT examination shows whether the ear is responsible and, if not, which specialist you should see next.
No. The hearing test and tympanometry are painless, are done at the practice and take a few minutes.
Often not. Labyrinthitis is an inflammation of the labyrinth and causes vertigo together with hearing loss or ringing in the ears. When hearing is normal, the cause is usually something else, which is why the assessment of dizziness and vertigo starts with a hearing test.
Yes. Sudden sensorineural hearing loss needs a hearing test within 14 days, and steroid treatment ideally starts within the first 2 weeks.
When should you not wait?
Urgent
Sudden hearing loss in one ear
A hearing test within 14 days, and treatment ideally within the first 2 weeks. After that, the chances of recovery drop.
Soon
Ringing in one ear only
Tinnitus in one ear needs to be investigated, unlike tinnitus in both ears, which is more common and usually harmless.
Immediately
Dizziness with neurological signs
Double vision, slurred speech, weakness or numbness on one side of the body, or a severe headache together with the dizziness are not a case for the practice.
Medical review: Dr. Ioannis KotrotsosENT Surgeon and Specialist in Phoniatrics and Pediatric Audiology.
Πηγή: Chandrasekhar SS et al., Clinical Practice Guideline: Sudden Hearing Loss (Update), AAO-HNSF, 2019.
The information on this page is for general information only and does not replace a medical examination. For diagnosis and treatment, please consult a doctor.
