Conditions affecting the ear can be divided into 3 categories:

  1. Those that affect the sensations of Hearing and Balance
  2. Infections and related problems
  3. Other (tumors, trauma, itching, bleeding, etc.)


Benign Positional Vertigo (BPV) - "Ear Crystals"

Benign positional vertigo (BPV) is a relatively common condition which is characterized by episodes of severe spinning (vertigo) associated with turning the head. The episodes are usually brief.

Inside the 3 semi-circular canals (see diagram) there are the nerve endings of balance. Calcium crystals floating in the inner ear fluid stimulate the nerve of balance and stimulate dizziness.

The treatment for this type of dizziness is a physical maneuver which can easily be done in the office.

Dizziness and Imbalance

Dizziness ranges from a minor annoyance to a debilitating problem. There are many factors involved in creating the sense of balance and equilibrium. There is a nerve of balance in each ear, in the inner ear (see diagram). The sense of balance is also affected by vision, special sensory nerves in the muscles and joints, blood pressure and circulation, and some hormones in the blood. Dizziness can be a medication side effect. All of these factors are processed in the brain to provide your sense of balance.

The balance system in the ear is called the vestibular system and it consists of the semicircular canals which have the nerve endings of the nerve of balance. The nerve itself originates in specific areas of the brain known as the vestibular nuclei.

The evaluation of dizziness can be a frustrating problem requiring numerous tests. In some cases the pattern of symptoms suggests a specific cause and this provides a starting point for the evaluation. In other cases we have to go through a process of elimination. In some instances the heart, blood vessels, and brain may also need evaluation by the appropriate specialists. In most cases we are able to help.

Meniere's Disease

Meniere's Disease (MD) is characterized by hearing loss, ringing in the ear, and episodes of severe dizziness often with nausea and vomiting. It is caused by an imbalance of fluid pressure in the inner ear. This triggers both the nerve of hearing and the nerve of balance leading to the typical symptoms.

Treatment of MD is directed primarily at controlling the episodes of dizziness which can be debilitating. MD is a chronic condition which is managed like other chronic conditions such as asthma or arthritis. There are medications or treatments taken on a regular maintenance basis and there are other medications or treatments for acute flare ups.

The progression of MD is very variable. People can have one episode every few years or frequent episodes several times a week or month. If over time, medications are no longer controlling symptoms, there are surgical options.

Middle Ear Infections (Otitis Media)

Middle ear infections are the most common type of ear infection, particularly in children. Bacterial or viral infection sometimes in association with allergy leads to an accumulation of fluid in the middle ear space behind the ear drum (see ear diagram). Normally this fluid would drain through the Eustachian Tube into the nose but with an infection the drainage tube may be blocked. The fluid in the middle ear absorbs the sound vibrations leading to a hearing loss. Hearing loss in young infants can slow down or distort their speech development.

Treatment includes antibiotics to treat the infection and in some cases allergy treatment to reduce Eustachian Tube swelling and help with drainage.

In some cases the bacteria can be eliminated but the fluid remains causing a persistent hearing loss. In these cases the fluid is drained by placing a ventilation tube (or pressure equalization tube, PE tube) through the ear drum with a brief surgical procedure. While this is more common in children, the problem can occur at any age.

In some situations the acute infection may resolve, but continue to recur despite medical therapy. This indicates a chronic problem with the natural Eustachian Tube drainage. Placement of a ventilation tube creates an alternative pathway and helps control the infections. (Patient Information on Surgical Procedures -Tympanostomy Tubes)-link

Outer Ear Infections - Otitis Externa

Infections of the Outer Ear (or Ear Canal), have different causes including retained water in the ear canal and trauma or excessive manipulation of the ear canal These causes can increase the humidity of the ear canal, create damage to the ear canal skin, and disrupt the protective function of ear wax creating a favorable environment for bacteria and/or fungus to thrive. That is why it is a common condition among swimmers.

Treatment includes prescription ear drops. In some cases the ear canal to be cleaned in the office for the drops to be effective. Precautions must be taken to keep water out of the ears.

In some cases these infections are recurrent or chronic and require other treatments and medications.

Sudden Hearing Loss

A person can have sudden hearing loss for many reasons. Wax can accumulate slowly leaving only a small opening for sound to pass through. If that hole is plugged by water or shifting wax, the patient experiences a 'sudden hearing loss'. If pressure builds up in the middle ear because of Eustachian tube dysfunction or infected fluid that can also cause a 'sudden hearing loss'. Noise trauma from a concert can cause a 'sudden hearing loss', usually temporary.

The medical diagnosis of 'SUDDEN HEARING LOSS' is a hearing loss due to inflammation of the nerve of hearing (viral infection is the most accepted theory). This is an emergency requiring immediate treatment in order to maximize the chance of regaining hearing. This condition can only be evaluated by an ear, nose, and throat specialist.

Ringing in the Ear (Tinnitus)

Tinnitus is the condition of ringing or other noises in the ears. It is a common condition estimated to affect 45 million Americans in one form or another. The noises range from infrequent and inconsequential to continuous and disruptive during the day and night. The sound can be in one or both ears, pulsating or steady, fluctuating or constant. It may also be associated with dizziness.

There are many different reasons why people have tinnitus. Most patients with tinnitus have some underlying hearing loss. Yet there are patients with severe tinnitus who have normal hearing! Medical science has not unraveled the specific causes of tinnitus.

What we do know about tinnitus:

  1. Certain foods and medications make it worse
  2. There are coping strategies that help
  3. There are treatments which have helped some people but have not been statistically demonstrated in a research study and are not FDA approved
  4. Sensory retraining may be helpful to some patients.

Viral Labyrinthitis (Vestibular Neuronitis)

This condition is caused by a viral infection of the nerve of balance in the inner ear. There is a nerve of balance in each ear. This is called the vestibular system. The vestibular system is based on symmetry; the input from each nerve of balance has to be coordinated with the other. When one nerve has a viral inflammation it begins to send signals to the brain out of sync with the other ear. These signals tell the brain you are moving when you are not actually moving, resulting in the sensation of spinning known as vertigo.

Viral labyrinthitis has a typical pattern of continual (not episodic) dizziness. The dizziness can be controlled with medications until the virus has passed through the system. In some cases residual symptoms may require further treatment. In other cases, the nerve of hearing may also be involved.