Surgical and Non-Surgical Treatments for Dizziness in Patients With Hearing Loss

Some people feel dizzy when they stand up too fast or take long rides in the car. But for people with chronic dizziness, everyday actions—including walking and lying down—can only be done with extreme difficulty. If you are one of these sufferers, you may be wondering: do you have to fight confusion and nausea for the rest of your life, or is there a permanent treatment for your dizziness symptoms?

Dizziness: Surgical Treatment

If your dizziness symptoms have persisted without improvement despite medical treatment, you and your doctor may wish to discuss surgery to correct the problem. There are two types of surgeries to correct vestibular disorders such as vertigo and dizziness: corrective and destructive. In corrective surgery, the aim is to correct the dizziness without affecting inner ear function, so the patient will still be able to hear out of the corrected ear.

Destructive surgeries are so named because they destroy the transmission of sensory information from the inner ear to the brain. While this will correct the dizziness, it will also destroy the patient’s ability to hear on the affected side, so it is usually only considered as a last resort. Destructive surgeries are recommended for patients who are experiencing extreme or disabling vertigo due to an inner ear problem, and whose ear is affected only on one side.

Surgical Procedures

There are many different surgical procedures for vestibular disorders. The procedure performed will depend upon several factors, such as the health and age of the patient, the degree of hearing impairment in the affected ear, and the suspected cause of the symptoms.

The most common inner ear procedures for dizziness relief include:

• Endolymphatic shunt. An endolymphatic shunt is considered a corrective surgery, as it alleviates dizziness symptoms without sacrificing hearing in the affected ear. During this procedure, a small tube is placed in the endolymphatic sac, a pouch containing fluid that controls balance in the inner ear. The shunt allows excess fluid to drain, restoring stability in the balance system. This procedure is commonly used to treat vertigo in patients with Ménière’s disease.
• Labyrinthectomy. Translabyrinthine labyrinthectomy is a destructive procedure, resulting in a total loss of hearing in the affected ear. A surgeon makes an incision behind the ear and removes the inner ear balance chamber (labyrinth) as well as a portion of the mastoid bone. When this organ is removed, the brain is unable to process gravity and motion signals from this part of the inner ear, restoring balance. Labyrinthectomy may be performed with or without a vestibular nerve section (a cutting of the vestibular nerve).
• Middle fossa section of the vestibular nerve. A vestibular nerve section is a destructive procedure that involves cutting the vestibular branch of the vestibulo-cochlear nerve in one ear. A neurosurgeon will open the cranial cavity at the middle fossa to locate and section the nerve. The patient will then have to rely on the unaffected ear for hearing and balance information.
• Retrosigmoid section of the vestibular nerve. In a retrosigmoid section, the vestibular branch of the vestibulo-cochlear nerve is cut via an incision in the back of head near the skull.

Risks and Complications of Surgery for Dizziness

Patients may wait several weeks after surgery before they notice a change in their dizziness symptoms. Pain and headaches are also common, but usually subside once the opposite ear is able to stabilize the balance system.

Other complications of vestibular disorder surgery include:

• Hearing loss. Even in surgeries designed to preserve hearing, patients may experience unavoidable hearing loss.
• Tinnitus. Hearing loss may be accompanied by ringing in the ears.
• Facial nerve injury. The facial nerve is located close to the vestibulocochlear nerve, placing it at risk of damage during surgery. However, most surgeons use facial nerve monitors to prevent injuring or cutting the facial nerve, making this complication extremely rare.
• Spinal fluid leak or meningitis. Procedures that rely on opening the brain cavity (such as middle fossa section) increase the risk of spinal fluid leakage. Inflammation of the meninges, or meningitis, is also a potential risk.
• Infections. Infections are a known risk of all surgical procedures, with an increased danger to patients over the age of 70 or who are in ill health.

Dizziness: Nonsurgical Treatment

Many patients will opt for non-surgical control of their dizziness symptoms. The first line of treatment may include medications such as anti-nausea drugs and diuretics to decrease the fluid buildup in the inner ear. If the patient is still experiencing symptoms, a doctor may recommend vestibular rehabilitation.

In vestibular rehabilitation, patients are observed closely and asked to perform simple movements, such as standing on one foot, lying down, and rising from a chair. A balance professional records the patient’s responses, and takes note of which movements provoke dizziness symptoms. After the evaluation, the professional designs a series of movements for the patient to perform on a regular basis, reducing the dizziness response over time.

Are you at your wits’ end from chronic dizzy spells? Call us at 866-517-4415 to discuss your treatment options with one of our hearing care specialists.