Hearing Aids and Vertigo Introduction
If you are experiencing both hearing loss and vertigo, you are not alone. While most people associate the ears with hearing, they also encompass major organs of the vestibular system, which is responsible for balance and equilibrium. Thus, there are many conditions that can affect both the hearing and balance organs of the inner ear.
How Does The Vestibular System Work?
Our sensations of balance and equilibrium are maintained by three systems: the vestibular organs of the inner ear (semicircular canals, utricle, saccule), sense of touch/tactile awareness, and our visual pathways from the eyes to the brain. The lateral, superior, and posterior semicircular canals are responsible for detecting head movement.
Each of the three canals can detect a position the head can turn (up and down, side to side, tilting on a diagonal). The canals are filled with a fluid called endolymph, and the movement of the head, in turn, sends the fluid to the ampulla in a specific pattern which activates nerve cells and sends a signal to the brain to confirm what is being interpreted by the somatosensory/tactile and visual systems. The utricle and saccule are the other organs in the vestibular labyrinth.
The utricle is responsible for forward and backward movements, while the saccule is responsible for upward and downward movements. Known as the otolith organs, they contain tiny crystals called otoconia. When these crystals shift, signals are sent to the brain to maintain balance. The utricle and saccule are also responsible for the sensation of gravitational force.
If this all sounds quite technical and complex, think about a time when you have felt car sick. Your three systems need to be working in tandem and sending compatible signals to the brain. Your eyes are telling you that you are in a moving car as you see the scenery go past, and your utricle will sense the forward motion and the changes in speed as you accelerate or decelerate. Your sense of touch will cue the brain that you are seated in a chair, and you’ll feel the rumble of the car on the pavement and the slight motions that are associated with driving: changing speed, changing lanes, maybe the wind in your hair with the windows down.
When Are You Likely To Experience Carsickness?
When one or more of these systems gives an incompatible signal. Have you ever tried to read in the car or even just looked at your phone for too long and felt ill? That’s the visual system not matching up. Ever sat on a train where you’re rear-facing (or perhaps you were raised in a time when hatchback vehicles had rear-facing seats in the trunk that are no longer legal) and felt nauseous? The car is moving forward, but your utricle is telling you you’re moving backward. Some people have trouble in the new electric vehicles because the ride is so smooth that they don’t have the tactile sense of accelerating and decelerating, particularly if they are not drivers.
There are a lot of examples of experiencing discomfort or unpleasant symptoms related to your vestibular system being out of balance, but vertigo is a very specific condition and sensation.
What Are The Symptoms of Vertigo?
So, what is vertigo, specifically? Sometimes “vertigo” it is used as a synonym for “dizziness”, but they are not actually the same. Dizziness has a few different subcategories, of which vertigo is just one. Vertigo refers to the feeling that you are spinning, or that the environment around you is spinning while you remain still.
Those of a legal drinking age may have experienced “the spins” after overindulging- this is a (thankfully) temporary example of vertigo. Vertigo is a very specific sensation that is able to be attributed to the inner ear through a series of tests performed by an audiologist and can be caused by several different underlying conditions. It is distinctly different from feeling lightheaded or as if you are about to faint (presyncope), disequilibrium or loss of balance without any spinning sensation, or just a general wooziness.
What Are Side Effects Of Vertigo?
Vertigo can last anywhere from seconds to hours, and may occur in isolation or co-occur with other symptoms such as:
- Headaches (including migraines)
- Hearing loss in one or both ears
These side effects will vary depending on the underlying cause of the vertigo and the
characteristics of the individual. The severity of the vertigo and these side effects can vary considerably, as well.
What Causes Vertigo?
Benign paroxysmal positional vertigo
One of the most common causes of vertigo, particularly in older adults, is known as BPPV. This occurs when otoconia from the utricle and saccule are dislodged into the semicircular canals, which causes the brain to receive inaccurate signals regarding head movement.
BPPV is characterized by a sudden onset of severe vertigo in response to head movement, like rolling over in bed or looking up to reach a dish in a cabinet. The good news is that BPPV is both easily diagnosed and easily treated by an audiologist, who will perform a series of maneuvers to confirm it is BPPV and then attempt to shift those otoconia crystals back into their intended place. The bad news is that the recurrence of BPPV is quite high. Fortunately, once you’ve been diagnosed, it is often less alarming and scary, and you know how to treat it.
Meniere’s disease is characterized by fluctuating hearing loss that is often more severe in the low frequencies, tinnitus, and episodic vertigo. Many patients also report a feeling of fullness in the ear. It is believed to be caused by an excess of fluid and pressure in the inner ear and is typically a unilateral condition. It comes in the form of “attacks,” which can last a few hours or up to a full day. There is no known cure for Meniere’s disease. Still, the individual symptoms can be managed, and many healthcare professionals recommend certain lifestyle and dietary changes to lessen the severity of the attacks, such as limiting caffeine and sodium intake.
Vestibular neuritis or labyrinthitis
These conditions are usually caused by a viral infection and result in inflammation of the vestibular organs, which can lead to vertigo. While not inherently dangerous, the symptoms can be quite severe, and this is an example of when the vertigo is intense and accompanied by nausea and vomiting.
The onset is usually sudden, and it can take days or weeks to resolve. One distinguishing factor between the two is that labyrinthitis is likely accompanied by hearing loss due to inflammation of the entire inner ear space. At the same time, vestibular neuritis is restricted to the balance organs. Medical advice should be sought in these cases to rule out other conditions with similar symptoms (such as stroke) and due to the likelihood of fatigue and dehydration.
Most people who suffer from vestibular migraines have experienced motion sensitivity (such as carsickness) since childhood. This condition encompasses the traditional migraine symptoms (head pain, sensitivity to light, nausea) in addition to vertigo, imbalance, and/or unsteadiness. This is a tricky diagnosis because often, the vestibular symptoms can occur separately from the traditional migraine symptoms and can also co-occur with Meniere’s disease and/or BPPV.
How Is Vertigo Diagnosed?
If you are experiencing vertigo, you can make an appointment with an audiologist for an evaluation. Because BPPV is quite a common cause of vertigo, the audiologist will likely begin with some maneuvers to determine whether this is the cause. Then, there is a series of tests involving tracking eye movements in response to temperature changes in the ears, performed with either hot and cold water or air.
Some centers will incorporate additional vestibular tests, such as the vestibular evoked myogenic potential (VEMP) or rotary chair tests, depending on the reported symptoms of the patient and their facility’s capabilities.
Hearing Aids And Vertigo
Can Hearing Aids Cause Vertigo?
No. Stimulation to the inner ear in the form of amplification by hearing aids cannot cause vertigo. If someone is suffering from both hearing loss and vertigo, such as in the case of Meniere’s disease, it is advisable to treat both symptoms.
Sometimes when patients are new to hearing aids and adjusting to amplification, they can feel quite overwhelmed by the input they have been missing. This could lead to fatigue or a sense of being disoriented or overstimulated, but not vertigo or dizziness. If you are experiencing vertigo or dizziness, you should consult a medical professional.
That said, once you have adjusted to hearing aids, they can actually be beneficial for vestibular symptoms as they will help you to localize sound and have a generally better awareness of your surroundings. Hearing aids, in this way, could also assist with balance issues. In fact, certain hearing aids on the market today (such as the Starkey Genesis AI) have built-in fall detection, which may be beneficial for patients who are concerned about fall risk as a result of vestibular symptoms in addition to their hearing loss.
How is Vertigo Treated?
Sometimes vertigo will resolve on its own or is easily treated, such as in the case of BPPV. Other times vertigo is more of a chronic condition that requires further treatment. The following are some common treatment options for vertigo, depending on the underlying cause.
- Vestibular rehabilitation
Certain physical therapists are trained specifically in vestibular rehabilitation, which involves strengthening the vestibular system to be able to communicate more effectively in tandem with the visual and somatosensory systems.
In some instances, medication can be prescribed to suppress the vertigo. This is not a long-term solution, as it is more of a temporary treatment of a symptom rather than an underlying cause. Often these medications make the individual extremely drowsy, so they essentially sleep through the remainder of the vertigo attack, which obviously isn’t advisable as a repeated remedy.
- Changes in diet
Many professionals believe that significantly reducing sodium intake can alleviate symptoms of vertigo, as a lot of salt in the diet can cause water retention and a buildup of fluid in the body. Other recommendations include limiting caffeine and alcohol, getting enough sleep, and regular exercise.
In rare cases, a surgery called labyrinthectomy might be recommended for the treatment of vertigo if it is co-occurring with complete hearing loss. This involves the removal of the entire vestibular labyrinth which would destroy hearing ability on that side in addition to the balance organs. This is a last-resort procedure and involves considerable vestibular rehabilitation post-operatively to re-train the brain to solely rely on the vestibular system from the opposite ear.
What Can I Do If I’m Experiencing Vertigo?
Remember the three systems that contribute to your sense of balance and equilibrium, and try to provide your brain with extra visual and/or somatosensory input. Place your feet firmly on the ground and try to focus your eyes on one unmoving spot. This will provide two separate cues to the brain that you are, in fact, not moving, and hopefully, vertigo will subside. Suppose the episodes continue to occur or vertigo lasts longer than a few seconds or minutes. In that case, it is a good idea to contact a professional to have an evaluation to determine the underlying cause.
The description of your specific symptoms can help the provider to determine whether what you are experiencing is related to the vestibular system (vertigo), cardiovascular system (presyncope), neurological system (disequilibrium), or an otherwise psychiatric or metabolic issue (wooziness or giddiness).
In a non-emergency situation, consulting an audiologist for a vestibular evaluation is a good place to start. The audiologist will perform a case history to inquire about your vestibular symptoms and also your hearing abilities and may recommend a hearing test. In instances where hearing loss and vestibular symptoms co-occur, treatment of the hearing loss with hearing aids or a cochlear implant is almost always recommended.
Hearing Aids and Vertigo Takeaway
Vertigo is a very specific sensation of spinning that can be experienced for seconds or hours, in isolation or in repeated episodes, with or without additional symptoms. If you are concerned about vertigo or are experiencing symptoms consistent with any of the conditions described above, you should contact a medical professional.
If you are experiencing hearing loss in addition to vertigo, know that hearing aids will help to alleviate some of the frustration associated with hearing loss and will not contribute to or worsen your vertigo, which can be treated separately.
Erin Edwards received her Doctor of Audiology degree from Towson University in 2015 and her Ph.D. in Education and Leadership from Pacific University in 2022. She has worked with patients of all ages in a variety of settings and has a specific interest in cochlear implants, the relationship of hearing loss and dementia, and interdisciplinary healthcare.