1401 Ochsner Blvd. Suite A
Covington, Louisiana 70433

Ear & Balance Disorders


Symptoms of Inner Ear Balance Disorders

The symptoms from inner ear balance disorders can vary a good bit and can range from mildly annoying to totally incapacitating.  The most characteristic symptom is vertigo.  Vertigo is the hallucination of motion.  Most typically, vertigo is a hallucination of spinning motion (whether you feel the room is spinning or that you are spinning is irrelevant).  However, feelings of other types of motion are also common.  Among these, after moving your head, you can feel like things continue to move in the direction after you have stopped or feel like your eyes are slightly behind where they should be requiring a second or two to catch up.  You can feel like you are swaying as if on a boat, rocking back and forth, being pushed or pulled in one direction, falling or dropping.  See these references for a summary of some common causes of inner ear balance disorders.

DDX Fluctuating Vestibular Disease
DDX Fixed Vestibular Deficits

Benign paroxysmal positional vertigo (BPPV) 

This is the most common vestibular disorder, and it occurs when loose calcium carbonate debris (crystals) have broken off of the otoconial membrane and enters a semicircular canal thereby creating the sensation of motion. Patients with BPPV may experience brief periods of vertigo, usually under a minute, which occur with change in position.  BPPV may be diagnosed with the Dix-Hallpike test or, in complex cases, on the Epley Omniax Chair.  It can be effectively treated with one of a variety of repositioning maneuvers.  The Ear and Balance Institute has one of the largest clinical experiences in the diagnosis and treatment of BPPV in the world.

Epley Omniax Video

Superior Semicircular Canal Dehiscence (SCDS) 

This is a medical condition of the inner ear, leading to varying degrees of hearing and balance symptoms in those affected.  The symptoms are caused by a thinning or complete absence of the part of the temporal bone overlying the superior semicircular canal of the vestibular system. It often becomes symptomatic after physical trauma to the head or a severe pressure-altering event.  The Ear and Balance Institute has one of, if not the largest, experience in the diagnosis and treatment of SSCD in the world.

Many patients will have SCDS symptoms but may either have a dehiscence somewhere other than the superior canal or may not have a dehiscence at all.  There are other treatments available to these patients as well.

Deficiency of the SSC
Superior Semicircular Canal Dehiscence A New Cause of Vertigo – 1999.
SSCD: Pathophysiology and Diagnosis

Dizziness and Balance Disorders

These are characterized by impairment in spatial perception and stability. Because the term dizziness is imprecise, it can refer to vertigo, lightheadedness, disequilibrium or a non-specific feeling, such as a floating sensation.  Patients with balance disorders can have causes that include non-vestibular processes and often have multiple system processes contributing to their balance disorder.  Consequently, these patients require a fairly extensive evaluation and may require consultation with some of our trusted colleagues in Neurology, Neurosurgery, Internal Medicine, Orthopedics, Physical Medicine, etc.  Treatment often requires a multi-pronged approach.

DDX Fluctuating Vestibular Disease
DDX Fixed Vestibular Deficits

Perilymph Fistula

This is a tear or defect in one or both of the small, thin membranes between the middle and inner ears. These membranes, the oval window and the round window, separate the middle ear from the fluid-filled inner ear. Treatment typically includes medical and non-medical measures, and in some cases, may require surgery.

 DDX Fluctuating Vestibular Disease

Meniere’s syndrome 

This is the constellation of symptoms that includes fluctuating hearing loss, tinnitus, fullness sensation in the ear and vertigo spells lasting at least 20 minutes, but typically 2-3 hours in duration.  There are a multitude of causes for Meniere’s syndrome, and the first step to control Meniere’s syndrome is an extensive evaluation for a specific cause.  After a specific cause has been identified, treatment is greatly facilitated and success immensely enhanced.  In cases where an exhaustive search has identified no cause, the patient is said to have Meniere’s disease.  However, it has been our experience that most patients have never had an exhaustive investigation into the cause of their Meniere’s syndrome.  Consequently, approximately 9 out of 10 patients that come to The Ear and Balance Institute with the diagnosis of Meniere’s disease leave with a different diagnosis.

Editorial – Meniere’s “Don’t blame the patient”
Sac Vein Decompression for Intractable Meniere’s Disease – Two-Year Treatment Results

Migraine Associated Vertigo (MAV) 

This is where a patient with migraines has associated vertigo.  It may be a part of the migraine complex or may be a separate vestibular disorder.  The treatment is geared toward control of the migraine process and any associated inner ear problems.  A neurology consult is recommended for all of these cases.

Vestibular Neuritis 

This is a viral infection of the balance nerve that essentially kills part of the balance nerve.  It produces a single sudden onset of severe vertigo that typically prompts a visit to the emergency room and sometimes a brief hospital stay.  The vertigo will last anywhere from days to weeks before it slowly resolves.  There may be some lingering imbalance, and, in a large number of these cases, they may have subsequent BPPV.  However, the patients almost never have a second bout of vertigo as severe as the first episode.

Anatomic Considerations in Vestibular Neuritis
Anatomic Differences in the Lateral Vestibular


This is inflammation of the inner ear.  This can be the result of a bacterial, viral or fungal infection, or it can be the result of an autoimmune process.  Most commonly, this occurs in patients who have a severe acute infection of the middle ear/mastoid or in patients who have longstanding chronic otitis media or mastoiditis.  The mainstay of treatment is control of the infection of the middle ear and mastoid.

Hearing loss

This exists when there is diminished sensitivity to the sounds normally heard. The severity of a hearing loss is categorized according to the increase in volume above the usual level necessary before the listener can detect it. It is caused by many factors, including genetics, aging, exposure to noise, illness, middle and/or inner ear pathologies, medications and physical trauma. Another aspect of hearing loss involves the perceived clarity of a sound rather than its amplitude, which is known as speech perception.

Sudden Sensorineural Hearing Loss (Sudden Deafness)

This is a syndrome where the patient has a sudden (defined by less than 3 days onset, but usually it’s immediate) loss of inner ear hearing in one ear.  This is an otologic emergency since prompt treatment may result in return of hearing.  An initial evaluation is done in order to exclude other causes and prompt treatment with either systemic steroids or intratympanic steroid perfusion is usually prescribed.

Transtympanic Steroids for Treatment of Sudden Hearing Loss


This is an abnormal growth of bone near the middle ear. It can result in hearing loss and/or tinnitus.  This can be treated with hearing aids, surgery or with observation.

Is Stapedectomy Ever Ethical -Faulty Premise
Early Post Laser Stapedotomy Hearing Thresholds


This is a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. Although these are not strictly speaking tumors or cancers, they can still cause significant problems because of their erosive and expansile properties resulting in the destruction of the ossicles as well as their possible spread through the base of the skull into the brain. They are also often infected and result in chronically draining ears.


This is the perception of sound within the human ear (ringing of the ears) when no actual sound is present. “Ringing” is only one of many perceived sounds.   Tinnitus is not a disease, but a symptom that can result from a wide range of underlying causes. Tinnitus is usually a subjective phenomenon, such that it cannot be objectively measured.  However, there are some patients who exhibit objective tinnitus (tinnitus that can be heard by others).


Encephalocele (commonly associated with a CSF Leak)

This is a where a portion of the brain has protruded through the temporal bone into the middle ear or mastoid.  This is often (but not always) associated with a leak of cerebrospinal fluid into the middle ear or mastoid.  There are several approaches in the medical and surgical treatment of this problem.


Patients may experience variable degrees of hearing loss and loss of vestibular function when exposed to medications that are toxic to the inner ear.  The determination of ototoxicity is more difficult than most initially suspect.  The determination of ototoxicity requires an appropriate history and extensive objective testing, as well as exclusion of associated pathologies.  Treatment is geared toward eliminating suppressant medications, treating concomitant vestibular disorders, limiting future ototoxic medications and rehabilitation strategies.

Acoustic Neuroma 

This is a benign tumor that develops on the nerve that connects the ear to the brain. The tumor usually grows slowly. As it grows, it presses against the hearing and balance nerves. At first, you may have no symptoms or mild symptoms. They can include loss of hearing on one side, ringing in the affected ear, and less commonly dizziness/balance problems.

Vestibular Schwannonma: Evidence-based Treatment

Elevated Intracranial Pressure

Increased pressure inside the skull (increased intracranial pressure) can cause a variety of symptoms including headaches, dizziness/vertigo, hearing loss, and tinnitus. At the Ear and Balance Institute, we have a non-invasive means to screen for elevated intracranial pressure. In addition to these symptoms, the pressure may be the cause of other inner ear problems such as encephalocele and perilymph fistula. Treatment usually involves dietary changes and medication but may require surgical intervention in rare cases.

What Our Patients Are Saying

When I leave here after a visit, I always do so knowing I have answers to my questions, and I’m confident in what I learned. There is a plan that works for me!

Tim Norby
March 10, 2023

He saved my hearing after I was struck by lightning in 1997. Excellent physician and great bedside manner.

Brooke Horner
March 9, 2023

Life changing, they gave me my life back.

January 30, 2023

I have nothing but wonderful things to say about Dr.G and staff. I have been coming for 10 years now and they have always taken excellent care of me and seen to my every need. I was in a desperate way when I first found them, after seeing so many doctors who never could diagnose me. So very grateful that he was able to help me. Just the most professional group of people and the most caring I've ever come across. Love them all.

August 25, 2022

artsy facility. nice staff. Dr.Gianoli is amazing

Rebecca Thomason
August 15, 2022

Amazing experience with Dr. Gianoli and his staff. They have been helpful and supportive at every step. Our son couldn't walk without assistance and after surgery, he can walk on his own again!

Nicole Fleniken
August 1, 2022

This is actually a Doctor that tell you what’s wrong with you.

Talisha Bailey
December 29, 2021

Traveling from Michigan to Louisiana after 2 years of various doctor visits was definitely worth it! My inner ear issue was finally discovered after thorough testing. A treatment plan was set up and I'm on my way to recovery. For 2 years I lived with dizziness that was unexplainable and undiagnosed - even after several visits to my local ENT and a handful of visits to the emergency room.

Kathleen Dillon
December 15, 2021

I have been searching for answers for two years and spent tens of thousands of dollars trying to figure out why I have all of these symptoms. Dr. Gianoli and his staff have spent so much time with me, testing, talking, and trying to find the root cause and we finally have a plan. I am in tears knowing that someone believes me and actually can SEE what I am feeling.

November 16, 2021

I am very satisfied with Dr. Gianoli's professionalism. I would recommend him to anybody who has ear problems without hesitation. He is a good hearted man that truly cares about his patients.

Randy Moe
November 2, 2021

The obvious concern for the patient is overwhelming. Everything thoroughly examined and explained. Dr Gianoli ended my 3 year search for what was going on. All other health care systems gave up or said It was in my head, they are right, it was in my ears. Dr Gianoli and his ENTIRE staff worked diligently and nonstop for all the tests. He went thru results, concerns, and solutions. I was truly at my wits end and didn't know what I would do next. Don't delay like I did, listening to others... Go see the center.

August 11, 2021

Worth the trip from Michigan. Very kind, caring and compassionate. Listen to me and my symptoms. I have been struggling in the dark for 20 years and 11 months.

Patrick Barney
January 13, 2021

After 25 years of seeing 50+ Physicians/specialist connected to 3 hospital systems I’ve had my first success in diagnosing and curing my balance issues, one issue cured and one to go. I have come to appreciate what Dr Gianoli and his staff can do for people like myself who struggle with inner ear issues, an answer to prayer.

Miguel V
November 20, 2020

Wish he could Take insurance I wanted to do my surgery but With him not taking insurance Im out of luck I will continue suffering from Non Stop Dizziness due Superior Semi Circular Dehiscence 😞

Tyrah Deller
December 9, 2019

I am so very very grateful for Dr. Gianoli’s medical knowledge and care! My life has been greatly improved with his treatment and will continue to get better!! Dealing with vestibular challenges are so very difficult, Dr. Gianoli is the doctor I had been wishing for. So grateful he studies and is an expert in the specialty he does, it has changed my life. We happily travelled from Michigan to his office, very worth it!! He is a kind man and an excellent doctor. Just so very grateful. Thank you.

Rebecca Stewart
December 2, 2019

The staff is professional and kind. Testing is explained. Everyone takes their time, which is nice. Dr. Gianoli is very professional, takes his time when with you and explains everything thoroughly. Much different then other practitioners I've seen. They care about my health.

Carol Perez
November 20, 2019

Dr. Gianoli is one of a kind! 10 stars!! He truly cares about his patients, he takes the time to listen to you, and explains all results thoroughly. He has performed tests that other doctors had not done, nor even offered as an option. Instead of throwing an inaccurate diagnosis at you just to get you out the door as fast as possible so he/she can get to his next patient; Dr. Gianoli and the amazing staff, takes the time to invest in your care, getting you healthy again. (edited to add this after going through treatment) Finding Dr. Gianoli has been life changing. Before seeing him I was having to use a walker to walk, could not drive, could not look up, fell quality of life was non-existent. Now I am back to functioning like normal! Dr. Gianoli gave me my life back and my entire family and I are forever grateful for his awe-inspiring knowledge and dedication.

Miguel V
November 16, 2019

Dr Gianoli its Great Doctor and understands his patients very well He is very Good With SSCD (Superior Semi-Circular Canal Dehiscence) he is very professional and the staff are very helpful

November 9, 2019

Dr. Gianoli took me from bed ridden from Vestibular issues to working again! He is personable, professional, experienced and dedicated, in my opinion to helping every person who walks theough the door as are his whole staff! I highly recommend him and Dr. Soilleu !

November 6, 2019

Dr. Gianoli has a unique and exceptional technical capacity at diagnosis and treatment of neuro-otology related conditions. At the same time he has amazing "bedside manner" and ways of working with patients and their families. He is down to earth and makes very complex issues understandable. He is patient and compassionate from the moment you meet him. The doctor and staff at the Ear and Balance Institute in Covington, LA did intensive comprehensive evaluation that shed light on a condition I have been struggling with since a traumatic brain injury 2.5 years ago. They were all kind, compassionate, and professional and spent many hours with me. Other specialists told me my condition was not treatable and that I would need to just live with it, unable to do many simple things I used to be able to do. I am confident that with Dr. Gianoli I will have great improvement in functioning and quality of life.

James Armand
August 28, 2019

Dr. Gianoli and his staff are always prompt, professional and cordial each and every time we have appointments. My wife would not let anyone else touch her ears. Thanks for such an excellent practice.

March 14, 2019

The office staff and medical professionals are all wonderful. The Audiologist is very knowledgeable and properly prepares the patient for testing. Dr. Gianoli provides results of his examination and tests in a very thorough and understandable manner and takes the time to answer any questions and/or concerns. I always feel I am in very capable hands in dealing with my medical issues.

stefan grosser
December 27, 2018

dr. gianoli changed my life quality in a very positive way!! ..after first SCDS surgery method in johns hopkins all the bad symptoms came back! dr. gianoli did in a revision surgery a perfect work! seemed to me like a wonder.. i come from switzerland in europe. nobody else was able to do this great job!!!

Slavia Polandia
November 13, 2018

After 3.5 years of chronic balance, vision and hearing problems and bouncing from one uncaring doctor to another, I traveled to the US to see Dr. Gianoli. I finally have a diagnosis and I know what steps need to be taken in order to get my life back. Dr. Gianoli seems to be far more knowledgeable and experienced than any other ENT I have dealt with. He is also very approachable, has great bed side manners and genuinely cares about his patients. His staff couldn't be more professional and welcoming. No wonder this place has the reputation it has and welcomes many foreign patients.

Starla Smith
September 27, 2018

It has been a pleasure to be evaluated & educated by Dr. Gianoli. His staff is professional & very friendly. We are thankful we were referred to him. I highly recommend him!!

Rod Mickler
September 15, 2018

I’ve had a great experience with Dr. Gianoli and staff, he is very thorough and spends a good deal of time answering your questions and explaining his diagnosis. My PLF was treated and I’m feeling much better. Highly recommend Dr. Gianoli.

Tim Paris
October 21, 2017

Absolutely the best and most caring doctor I've seen since my TBI 8 years ago. He will not settle for Occam's easiest and simplest answer to any balance problem. Dr. Gianoli is determined to find the answer, not simply the most likely answer. Vastly different in the field of medicine. Having a diagnosis based on fact and not theory makes an immeasurable difference to my outlook on life. I am very thankful I found Dr. Gianoli. I now have a future in front of me.

Jordin P
April 9, 2017

Dr Gianoli is very thorough each and every visit. I am now 4 years a patient with him and have been more than pleased with the results I have achieved with Dr Gianoli.

Benjamin Mayer
May 26, 2016

Dr G. Knows how to fix benign positional vertigo!

Esther R
February 4, 2016

We were very pleased with Dr. Gianoli. He was very accessible before our appointment, responding to my questions via email. It will be several weeks before we see if the treatment is effective, but we are very encouraged. Everyone we encountered was very helpful.

Tracy W
November 10, 2015

The amount of time with the doctor and his staff spends is a very big plus for me. I do not rushed. That is hard to find now-a-days.

Mary P
November 7, 2015

I love DR. Gianoli and Kacey and the entire staff. I have been a patient for 11 years. Their kindness and compassion is just as much a part of their treatment as their high level of expertise.

Jessie Blevins
November 4, 2015

I really appreciated the time Dr. Gianoli and his staff spent with me. There was no rush to get to the next patient. Thanks for the care and concern!

Thomas L
October 16, 2015

Great experiences with everyone, staff and Dr. Gianoli. Everyone was very professional and explained all procedures to me thoroughly.

Stephen H
September 30, 2015

I previously tried seeing several doctors and specialists in DFW for my vestibular neuritis without success. He is a expert in his field, easy to talk to and he has certainly changed my life.

Brenda W
September 25, 2015

Dr Gianoli and his staff have been wonderful to deal with in the diagnosis and treatment of my SCDS. I have had a complete resolution of my debilitating symptoms, and am back to living life without dizziness. Dr Gianoli is a miracle worker, in my opinion! He gave me back my life!

Marion R
March 7, 2015

Overall, this has been the most thorough medical exam I have ever had for my symptoms. Dr. Gianoli and his staff have all been very understanding and compassionate throughout my appointments and testing.

Anneke Manning
December 16, 2014

Came for yearly check-up. As always, it was a pleasure to see Dr Gianoli. After almost 6 years of being a patient here, he has become a friend, as well as my doctor. I have made enormous steps back towards health, and I remain so very thankful to have found Dr Gianoli, who, in my opinion, is the best Neurotologist in the country...and I should know...he was the 37th doctor I went to in search for answers to my vestibular problems.

Jamie M
December 11, 2014

Dr. Gianoli is very thorough in running tests and making a diagnosis. He truly cares about his patients and takes a personal interest in their progress.

Kerry M
November 7, 2014

Dr. Gianoli and his staff were very thorough in their testing and diagnosis, and he spent as much time with my wife and I as necessary to explain their diagnosis, treatment options and to answer any questions we had.

Briviere Wilkinson
October 11, 2014

When no other physician could accurately diagnose the cause of my hearing loss and dizziness, Dr. Gianoli not only diagnosed but performed a minor surgery that has eliminated the debilitating dizzy spells and nausea which accompanied them.

Bret D
September 20, 2014

He has an excellent manner and is very detailed in his explanation of the problem. I felt very comfortable with him, as he is easy to talk to.

Maggie McDowell
August 29, 2014

If you have an inner ear problem, this is the place to go. The Staff and doctor were very helpful and informative during the visit. All procedures were explained in detail. Doctor took time to explain results and most beneficial treatment.

Robin V
August 16, 2014

Very professional I would recommend him to anyone with inner problems. Seems to be very knowledgable in his profession.

Sonia Richardson
July 26, 2014

Dr. Gianoli was instrumental in helping me with my vertigo. I am still under his care but now only have to see him on a yearly basis as I no longer have problems with vertigo. I still have hearing loss but this is a permenent condition for me and that will be for the rest of my life. But I honestly feel that Dr. Gianoli has healed my vertigo condition. The entire staff is very friendly and helpful. They go beyond the call of duty to do everything they can to make you feel comfortable during your visit.

Leslie Babin
June 17, 2014

In 2000, I was diagnosed with Otosclerosis. Dr. Gianoli determined that the left ear was much worse than the right. He operated on my ear that same year. The results were immediate with a marked improvement in hearing. A few years later I began to notice the same gradual degradation in my ability to hear in my right ear with an increased level of tinnitus. I would go to Dr. Gianoli every few of years for testing and evaluation. We both came to the conclusion earlier this year (2014), that it was time I had the procedure done in my right ear. He operated on me on March 13th. Everything went well and my hearing is much improved! A positive side effect is that the level of tinnitus is greatly reduced to the point that I am most often unaware of it. Thanks Dr. G!!

Betty Miles
June 12, 2014

Very thorough, patient, efficient. Wait time at a minimal. Staff and doctor make you feel comfortable.

Very professional and knowledgable. Honest and straight-forward. The treatment, ie surgery, from Dr. Gianoli changed my quality of life.

Campbell F
April 16, 2014

Dr. Gianoli and his staff are fantastic! Appointments are easy to schedule and you are always seen promptly upon arrival. Office visits are thorough and you are never rushed. I currently travel 1+hour to see Dr. Gianoli, however, I would easily travel 10 hours for care and treatment. He has quite literally saved my life by diagnosing and treating my condition. Thanks to Dr. Gianoli I am able to drive, work and have a family.

Marion B
March 31, 2014

Dr. Gianoli's professional manner and medical expertise is exceptional. His treatment of my condition was life changing, I do not know what I would have done without him.


1401 Ochsner Blvd.
Suite A
Covington, LA 70433
Phone: 985-809-1111
Fax: 985-809-1119



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