Does Vestibular Rehab Help Ringing in the Ears?

What Causes Ringing in the Ears?

Ringing in the ears is referred to as "tinnitus" and is usually assessed by an ENT doctor and an audiologist

Ringing or buzzing in the ears is referred to as “tinnitus” and is usually assessed by an Ear, Nose, Throat doctor and an Audiologist.  Tinnitus is typically a symptom of a related problem with hearing nerves, different parts of the ear, or the part of the brain that interprets information.  According to the Tinnitus Association of Canada, “150,000 Canadians experience a degree of tinnitus that significantly affects their quality of life”.

The Canadian Academy of Audiology reports that the exact mechanism underlying tinnitus is not known, but that some of the causes can include:

• Outer ear disorders such as excessive ear wax, a hair touching the eardrum or a perforated eardrum
• Middle ear disorders such as an ear infection
• Inner ear disorders like damage due to noise exposure, hearing loss related to aging, or Meniere's Disease

How Does Vestibular Rehabilitation Differ from Tinnitus Treatment?

It is important to understand that Vestibular Rehabilitation DOES NOT address tinnitus.  If you have dizziness, unsteadiness and sensitivity to motion in addition to your hearing-related issues, then Vestibular Rehabilitation can be helpful with those symptoms, but you should not expect your tinnitus to change.  

Having said that, research is finding that some peoples’ tinnitus has an element of mechanical contribution to it that can come from the jaw-joint (TMJ) or neck.  If you seem to be able to alter your tinnitus with certain head, neck or jaw movements, posture, or trigger points, then it’s possible that therapy focused on these areas may help reduce tinnitus.  This is referred to as ‘somatically related tinnitus’ and research is showing positive outcomes with treatments such as TENS, therapeutic exercise, manual therapy, biofeedback/stress reduction and education. 

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5 Symptoms of Vestibular Disorders

Changes to Parts of the Inner Ear and Brain Controlling Balance Can Cause a Vestibular Disorder

Problems with balance and spatial orientation can include difficulty walking straight or turning a corner

According to the Vestibular Disorders Association if the vestibular system gets damaged or altered, a vestibular disorder can result. The vestibular system includes the parts of the inner ear and brain that control eye movements, perception of head movement and balance. Therefore, problems in any of these areas or pathways can create dizziness, unsteadiness or visual issues.

Besides dizziness or vertigo, five of the most common symptoms of a vestibular disorder are:

1. Imbalance or falling
2. A rocking sensation
3. A sense of exaggerated or "after-motion" when you move
4. Nausea or vomiting
5. Visually provoked dizziness (see below), or blurry/'jumpy' vision during head movement

Problems with balance and spatial orientation can include a tendency to touch or hold onto something when standing, difficulty maintaining straight posture, clumsiness or stumbling, and difficulty walking straight or turning a corner.

With visually provoked dizziness, there can be sensitivity to light or certain types of computer monitors, poor depth perception, trouble reading or watching TV, and discomfort in busy visual environments like crowds, traffic, or stores.

Some people with an inner ear disorder can experience these as well as other symptoms, and an inner ear disorder can even be present without any obvious symptoms at all. It is important to seek professional help and get a vestibular assessment if you are experiencing any of the issues noted above.

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Taking Good Balance for Granted

It's Not Until Dizziness Becomes a Problem That We Notice How Important Our Balance Is To Us

According to the Vestibular Disorders Association (VEDA), the body maintains balance with sensory information from three main systems:

• Vision
• Proprioception (touch sensors in the feet, trunk, and spine)
• Vestibular system (inner ear)

The Brain Integrates Sensory Information to Help Us Keep Our Balance

These three systems send information to the brain, and in response, the brain figures out where you are in space and sends information to the eyes for steady vision, and to the muscles for balance. When your balance system is working properly, you feel normal when you are standing or moving around:

• you can keep your balance when you're doing different activities
• you can see everything clearly when you move around
• you don't give a second thought to whether or not you should move your head

But when the balance system isn't working, even small activities like walking on uneven ground or walking down the stairs can be challenging and even cause an accident.

When the balance system isn't working, walking down the stairs can be challenging

Conflicting Information to the Brain Causes Disorientation

If the brain is getting conflicting sensory information from the vestibular system, the eyes, muscles or joints, it is difficult to process it. The goal of vestibular rehabilitation is to correct problems in the inner ear, or create a treatment program for you that will help the brain re-establish the coordination between your inner ears, eyes, muscles and joints. 

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Why Am I Dizzy?

Spinning, Dizziness or Falling Can Mean the Complex System That Looks After Our Balance Isn't Working Properly

Dizziness can be caused by the balance organs of the inner not working properly

Our bodies have a complex system to look after our balance that includes the inner ear, brain, vision, muscles and joints. If any part of this system isn't functioning, the result can be a feeling of spinning, dizziness or falling. Many adults feel dizzy, and there can be many possible reasons, but one of the more common culprits is that the balance organs of the inner aren't working properly, or that some parts of the central nervous system that process information about balance aren't working properly.

The word 'dizziness' means different things to different people. People using that word may be trying to describe vertigo (spinning), feeling faint or light-headed, disequilibrium (loss of balance) or unsteadiness, falling, nausea, a sense of exaggerated motion or just feeling "off". The better you are able to describe what you mean by 'dizziness', the easier it is for your medical provider to try to diagnose what is going on.

Vertigo Usually Indicates a Problem with the Function of the Inner Ear

According to the Vestibular Disorders Association (VEDA), if you have vertigo (a sense of spinning or whirling), especially when you tilt or move your head around, that is likely a sign of a problem with the function of your inner ear. On the other hand, dizziness can mean that there is a different type of vestibular problem or other issues such as vision, metabolism, neurological, psychological or cardiovascular. Since there are so many different types of dizziness and possible disorders that dizziness can be a result of, it is sometimes challenging for medical professionals to diagnose, and difficult and frustrating for patients until help is found.

Many things can be the cause of dizziness, from ear infections or trauma to an ear, to Meniere's Disease, to medications, to age-related degeneration, to central processing issues such as a stroke, to migraine-associated vertigo, to cardiovascular problems, to the neck, among other causes.

Assessment is Crucial in Finding the Cause of Dizziness and Vertigo

The assessment stage of vestibular treatment is crucial in trying to find the cause of dizziness and vertigo. At LifeMark Dizziness & Balance Program, we take a thorough medical history first and screen for neurological problems. Our vestibular assessment includes vestibular-ocular reflex testing, or testing of the integration between the inner ear and the eye muscle to see if you can focus clearly while your head is in motion. It also includes many tests using an infrared camera in blackout goggles to check for nystagmus, which is an involuntary eye movement associated with vestibular problems. We also evaluate your sensitivity to specific movements and positions, your balance, and the possibility that other areas are contributing to your symptoms like your feet or neck.

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