This information is intended as a general introduction to vestibular disorders. As each person is affected differently by balance and dizziness problems, speak with your health care professional for individual advice.

The vestibular (balance) system refers to the links between the inner ear, brain and eyes that help keep you balanced. Vestibular disorders happen when disease, injury or aging damages any part of this delicate and complex system. The causes of vestibular disorders are many and varied as is each patient's journey towards treatment and expected recovery.

Vestibular disorders include:

Acoustic neuroma
A rare benign (not cancerous) tumour of the vestibular nerve. It usually grows slowly. The most common first symptom is hearing loss on one side. As the tumour gets bigger, it can cause hearing loss and tinnitus (ringing in the ears) as well as dizziness and balance problems. Treatment options are observation, surgical removal or radiation.

Age-related dizziness and imbalance
Age-related dizziness and imbalance is one of the most common problems of older people. It has many causes that often overlap. It is often a complex condition and varies greatly from person to person. It can be a sign of something serious, and it can be dangerous if it makes you fall. Much can be done to treat and manage age-related dizziness and imbalance.

Autoimmune inner ear disease (AIED)
AIED happens when the immune system mistakenly attacks tissues in the inner ear. This often causes sensorineural hearing loss. AIED also causes balance problems for about 1 in 2 people who have it. In most cases of AIED, only the ears are affected. This is known as primary AIED.

Benign paroxysmal positional vertigo (BPPV)
BPPV is one of the most common causes of vertigo (spinning sensation). The hallmark symptom is vertigo that lasts less than 60 seconds and is brought on by a change in head position. It is most common in middle-aged and older people. Most people can be treated effectively with head manoeuvres.

Bilateral vestibulopathy
Bilateral vestibulopathy is damage to the balance parts of both inner ears. Hallmark symptoms are imbalance, unsteady gait and "jumpy vision with head movement. Imbalance is worse when walking on uneven ground or in the dark. Avoiding things that make the damage or symptoms worse is important. Vestibular rehabilitation is a helpful treatment strategy.

CANVAS syndrome
CANVAS stands for cerebellar ataxia with neuropathy and vestibular areflexia syndrome. It is a rare inherited multi-system ataxia (lack of muscle control or coordination of voluntary movements) affecting cerebellar and sensory function.

Cervicogenic dizziness
Cervicogenic dizziness is related to a neck problem. Common symptoms include episodes of dizziness, lightheadedness and unsteadiness. Neck movement often triggers symptoms. Diagnosis is made after all other causes of dizziness have been ruled out. Treating the neck problem sometimes makes dizziness symptoms better. Treatment includes physiotherapy and vestibular rehabilitation.

Cholesteatoma
A cholesteatoma is skin in the wrong place in the middle ear. It is not a cancerous growth. Cholesteatoma is rare and slow growing. If not treated, it can destroy parts of the inner ear needed for hearing and balance. Surgery is usually needed to remove most cholesteatomas.

Concussion
All concussions are traumatic brain injuries. You do not need to hit your head to have a concussion. Concussion temporarily changes how the brain works. Common symptoms include headaches, dizziness, nausea and difficulty concentrating. The brain needs rest to recover from a concussion. Assessment and treatment need to be individualized. Fortunately, most people recover quickly.

Enlarged vestibular aqueduct
Some people are born with an abnormal connection between their brain and ear – a so-called "enlarged vestibular aqueduct.” Enlarged vestibular aqueduct may lead to fluctuating hearing loss as well as dizziness.

Labyrinthine infarction
Acute prolonged vertigo and loss of hearing due to blockage of a blood vessel in the inner ear may be a sign of an impending stroke. Vertigo and hearing loss may appear together, or be separated by as much as a month. This is a medical emergency. Seek immediate help - call 911 or visit the nearest hospital emergency department.

Labyrinthitis
Labyrinthitis is an inflammation of the inner ear. It causes a sudden, severe attack of vertigo (spinning sensation), usually with nausea, vomiting and some hearing loss. The acute phase usually lasts 2 or 3 days. Medication may be needed to treat the symptoms. Vestibular rehabilitation may help if dizziness and imbalance linger. In rare cases, hearing loss is permanent.

Mal de débarquement syndrome (MdDS)
"Mal de débarquement" means "sickness of disembarking." It is usually triggered by a long trip at sea. The main symptoms are constant feelings of movement. Symptoms often get better when people with MdDS are in a moving vehicle. MdDS can last for weeks, months or even years.

Ménière's disease
Ménière’s disease is a chronic, progressive disorder of the inner ear. The hallmark symptom is sudden attacks of vertigo (spinning sensation), usually lasting several hours. Other symptoms hearing loss, ringing in the ears (tinnitus) and a feeling of pressure in the affected ear. It is most common in 30- to 60-year-olds. Ménière’s disease does not go away and gets worse over time. There is no cure Ménière’s disease, but the symptoms can be managed.

Motion and cyber sickness
Motion sickness is nausea or discomfort caused by being in a moving vehicle. Cyber sickness is nausea or discomfort caused by using virtual reality (VR). Usually the symptoms go away within hours after the motion or use of VR stops. You can do things to prevent or relieve the symptoms of motion sickness. Cyber sickness is best treated by stopping use of VR if you start to feel symptoms.

Otosclerosis
Otosclerosis affects the bones of the middle ear that conduct sound. It is one of the most common causes of conductive hearing loss in young adults. The progression of otosclerosis varies from person to person. How quickly, or to what extent, hearing will be affected in unpredictable. If otosclerosis goes into the inner ear, people may be troubled by ringing in the ears (tinnitus), dizziness and balance problems. Hearing aids are usually the first treatment of choice for otosclerosis.

Pediatric vestibular disorders
Most problems with unsteadiness and dizziness in children are temporary and easy to treat. Dizziness and imbalance problems may be hard to spot in children. Younger children may not have the words to describe what they are feeling. Check in with your child's doctor if you notice a regular pattern of dizziness or imbalance. May children with vestibular disorders face developmental and learning challenges.

Perilymph fistula
Perilymph fistula is an abnormal connection between the air-filled middle ear and the fluid-filled inner. It most commonly occurs after trauma to the head or ear.

Persistent postural-perceptual dizziness (PPPD)
PPPD is a common cause of long-lasting dizziness. The brain over-reacts to normal signals from the eyes, inner ear, and muscles and joints. Anxiety often develops about things that trigger dizziness. It is not a psychiatric disorders. PPPD can overlap with other vestibular disorders. It is usually treatable, especially if diagnosed early.

Ramsay Hunt syndrome
Ramsay Hunt Syndrome is a shingles outbreak affecting a nerve in the face near one ear. It is a rare disorder, most common in older people. The main signs of RHS are a painful red rash with fluid-filled blisters near one ear and facial paralysis on the affected side. Vertigo (spinning sensation), tinnitus (ringing in the ears), ear pain and hearing loss are frequent symptoms. Early diagnosis makes full recovery more likely. Vaccination for shingles can help prevent Ramsay Hunt Syndrome.

Secondary endolymphatic hydrops
Secondary endolymphatic hydrops is a condition that develops as a result of traumatic and inflammatory processes affecting the endolymphatic fluid in the inner ear. It is associated with spells of vertigo (spinning sensation) and hearing loss that comes and goes.

Semicircular canal dehiscence
Semicircular canal dehiscence is a rare condition caused by a hole in one of the bony canals in the inner ear. Semicircular canal dehiscence can cause both hearing and balance symptoms. People with Semicircular canal dehiscence often hear internal sounds - their own voice, heartbeat, joints cracking or even their eyeballs moving. Surgery is suggested for people whose symptoms are severe.

Vestibular migraine
A migraine is a severe headache. Of over 300 types of migraine, dizziness is a symptom of two: migraine with brainstem aura and vestibular migraine. See a doctor who specialized in headaches for an accurate diagnosis. Lifestyle changes may help prevent or lessen the occurrence of migraine. Medication may help prevent migraine.

Vestibular neuritis
Vestibular neuritis causes a sudden, severe attack of dizziness, usually with nausea and vomiting. Vestibular neuritis does not come and go; it is a single, major event. The acute phase usually lasts two or three days. Balance problems and unsteadiness may persist for several weeks or months. Hearing loss is not a symptom of vestibular neuritis. Proper treatment and rehabilitation are important to recovery.

Vestibular paroxysmia
Vestibular paroxysmia is a rare syndrome caused by vascular compression of the vestibular nerve. It is characterized by brief attacks of dizziness lasting from seconds to a few minutes, with or without ear symptoms.

Vestibular toxicity
Vestibular toxicity is damage to the balance system from some drugs and chemicals. Damage may be temporary or permanent. In many cases, using equally effective non-toxic alternative can prevent damage. Early diagnosis may prevent permanent damage. Fortunately, vestibular toxicity is rare. Unborn babes, the very young and older people are particularly at risk.

Visually induced dizziness
Visually induced dizziness is a group of symptoms caused by a problem with the balance system. It is brought on by looking at complex patterns or movement. The symptoms can be distressing and upsetting. Treatment includes controlled exposure to things that trigger dizziness. Treatment takes time and persistence. It is important to keep active - doing nothing is not the road to recovery.

More resources

The following can offer more help and support for affected individuals and their families.

Online

Note: Websites that deal with a specific disorder can be found on the page about that disorder.

Dizziness-and-Balance.com
Information about dizziness and balance problems caused by inner ear disorders, neurological disorders and other conditions. Maintained by Dr. Timothy C. Hain of the Chicago Dizziness and Hearing clinic.

Dizziness and Equilibrium
Clear explanations and diagrams to help in understanding vestibular and balance disorders, diagnostic tests, and vestibular rehabilitation. Includes a glossary of common vestibular terms. Part of the American Institute of Balance (AIB) website.

Medical News Today
Provides news from evidence-based, peer-reviewed studies, along with accurate, unbiased and informative content from governments, medical societies, royal colleges, professional associations, patients' groups, and pharmaceutical and biotech companies, among others.  Browse or search “Ear Nose and Throat” category for information about the inner ear and vestibular disorders.

Medline Plus
Consumer health information from the US National Library of Medicine. Includes current health news, general health information by disease or body system, a medical encyclopaedia and dictionary, anatomical diagrams and videos of surgical procedures.

Merck Manual
Explains disorders, symptoms, diagnosis, prevention, treatment and prognosis in everyday language.

Vestibular Disorders Association
Commonly known as VEDA, the Vestibular Disorders Association's mandate is to help people find balance.