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

They have been great to work with and very helpful.
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Dr G. Is honest and feels like he cares. I been to many that didn't.
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Dr. Gianoli quickly diagnosed balance and inner ear issues, feeling much better within 6 months of treatment.
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Great Doctor and Great experience. I highly recommend him and his staff as they really care about their patients.
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1401 Ochsner Blvd. Suite A
Covington, Louisiana 70433
Phone: 985-809-1111
Fax: 985-809-1119



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