Conditions affecting the inner ear and
Endolymphatic sac surgery:
Controversial procedure for the treatment
of Ménière’s disease

By Joe Walter Kutz Jn
Conditions affecting the inner ear and balance

Conditions affecting the inner ear and balance


Damage to the labyrinth (or related areas) cause a sense of rotation (vertigo), balance problems, and/or dizziness.  

The labyrinth in the inner ear consists of several structures that play a big role in our ability to sense motion (up, down, left, right, and rotation). There are several conditions that can affect these structures, including the following, but are not limited to: 

·       Benign paroxysmal positional vertigo (BPPV):

o   It is a condition caused by abnormal stimulation of the nerve’s endings in the semicircular canals due to loose crystals floating in the area. 

·       Vestibular neuritis:

o   This is a condition that is caused by a viral infection of the vestibular nerve that connects the balance system of the ear with the brain. 

·       Labyrinthitis:

o   Bacterial or viral infection of the hearing and balance structures in the inner ear.  

·       Meniere’s disease:

o   It is a condition that causes hearing loss, vertigo (spinning sensation) and tinnitus (noise in the ears) by causing abnormal pressure fluctuations in the inner ear. 

·       Structural abnormalities:

o   Inner ear fluid leak from the balance structures.

o   Abnormal bone formation.

o   Many others. 

·       Severe, chronic middle ear infection:

o   Longstanding middle ear infection can cause destruction of the balance system. 

·       Masses or lesions affecting the balance nerves or structures:

o   One example is a vestibular neuroma. 

·       Vestibular migraines:

o   Vestibular symptoms (spinning and imbalance) can be caused by episodes similar to migraine headaches.

o   Interesting enough, it does not have to be associated with a headache.

·       Functional dizziness / Phobic postural vertigo:

o   Often caused by a previous abnormality.

o   Maladjustment to compensate for a balance problem.

·       Abnormalities of the brain:

o   There are many causes that may be due problems in the brain.

o   Concussion or head injury is one example. 


For problems of dizziness, imbalance or vertigo, you will need very specific examinations and possibly tests.  We then discuss your case with a team of specialists (if given your consent) to establish a diagnosis and deciding on a management plan.



BPPV – Benign Paroxysmal Positional Vertigo

What is BPPV?

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo.

Vertigo is the sensation that you’re spinning or that the inside of your head is spinning.

BPPV causes brief episodes of dizziness (usually lasting less than a minute).  It is usually triggered by changes in your head’s position.  

Other symptoms you may experience, are loss of balance or unsteadiness and nausea and vomiting.

What causes BPPV?

It occurs when some of the calcium carbonate crystals in a certain part of the balance system (utricle) dislodges and moves to one of the semi-circular canals, where they are not supposed to be.  It causes overstimulation when your head moves in the direction of that particular semi-circular canal.

How is BPPV treated?

Although BPPV can be bothersome, it’s rarely serious.  There is a treatment protocol that we follow, which is very successful in most cases.  This usually starts with positional therapy that is chosen according to the affected area.  The degree of success determines the treatment that follows.