The ear is divided into three parts: external ear, middle ear, and inner ear. The external ear structures gather sound and direct it toward the eardrum. The middle ear chamber consists of an eardrum and three small ear bones. These structures transmit sound vibrations to the inner ear fluid. The inner ear chamber (labyrinth) is encased in bone and filled with fluid (endolymph and perilymph). This fluid bathes the delicate nerve endings of the hearing and the balance mechanism. Fluid waves in the hearing chamber (cochlea) stimulate the hearing nerve endings which generate an electrical impulse. These impulses are transmitted to the brain for interpretation as sound. Movement of fluid in the balance chambers (vestibule and three semicircular canals) also stimulates nerve endings, resulting in electrical impulses to the brain, where they are interpreted as motion.

The human balance system is made up of four parts. The brain acts as a central computer receiving information in the form of nerve impulses (messages) from its three input terminals: the eyes, the inner ear, and the muscles and joints of the body. There is a constant stream of impulses arriving at the brain from these input terminals. All three systems work independently and yet work together to keep the body in balance. The eyes receive visual clues from light receptors that give the brain information as to the position of the body relative to its surroundings. The receptors in the muscles and joints are called proprioceptors. The most important ones are in the head and neck (head position relative to the rest of the body) and the ankles and joints (body sway relative to the ground). The inner ear balance mechanism has two main parts: the three semicircular canals and the vestibule. Together they are called the vestibular labyrinth and are filled with fluid. When the head moves, fluid within the labyrinth moves and stimulates nerve endings that send impulses along the balance nerve to the brain. Those impulses are sent to the brain in equal amounts from both the right and left inner ear. Nerve impulses may be started by the semicircular canals when turning suddenly, or the impulses may come from the vestibule, which responds to changes of position, such as lying down, turning over or getting out of bed. When one inner ear is not functioning correctly the brain receives nerve impulses that are no longer equal, causing it to perceive this information as distorted or off balance. The brain sends messages to the eyes, causing them to move back and forth, making the surroundings appear to spin. It is this eye movement (called nystagmus) that creates a sensation of things spinning. Remember to think of the brain as a computer with three input terminals feeding it constant up-to-date information from the eye, inner ear and muscles and joints (proprioceptors). The brain itself is divided into several different parts. The most primitive area is known as the brainstem, and it is here that processing of the input from the three sensory terminals occurs. The brainstem is affected by two other parts of the brain, the cerebral cortex and the cerebellum. The cerebral cortex is where past information and memories are stored. The cerebellum, on the other hand, provides automatic (involuntary) information from activities which have been repeated often. The brainstem receives all these nerve impulses: sensory from the eyes, inner ear, muscles and joints; regulatory from the cerebellum; and voluntary from the cerebral cortex. The information is then processed and fed back to the muscles of the body to help maintain a sense of balance. Because the cortex, cerebellum and brainstem can eventually become used to (ignore) abnormal or unequal impulses from the inner ear, exercise may be helpful. Exercise often helps the brain to habituate to (get used to) the dizziness problem so that is does not respond in an abnormal way, does not result in the individual feeling dizzy. An example of habituation is seen with the ice skaters who twirl around, stop suddenly, and do not apparently have any balance disturbance.

Sensations of unsteadiness, imbalance or disorientation in relationship to one’s surroundings may result from disturbances in the inner ear, neck muscles and joints, the eyes, the nervous system connections of these structures, or a combination of any of the above.

Dizziness from inner ear problems is one of the most common types of dizziness, results from disturbances in the blood circulation or fluid pressure in the inner ear chambers, from direct pressure on the balance nerve, or physiologic changes involving the balance nerve. Inflammation or infection of inner ear or balance nerve can also cause dizziness. The inner ear is extremely sensitive. There are two inner ear chambers: One for hearing (cochlea), and one for balance (vestibule and semicircular canals). These chambers contain a fluid which bathes the delicate nerve endings. These nerve endings are stimulated when there is movement of the fluid. Nerve impulses are then transmitted to the brain by the hearing and balance nerves. The nerves pass through a small bony canal (internal auditory canal), accompanied by the facial nerve. Any disturbance in pressure, consistency or circulation of the inner ear fluids may result in acute, chronic, or recurrent dizziness, with or without hearing loss and head noise. Likewise, any disturbance in the blood circulation to this area or infection of the region may result in similar symptoms. Dizziness may also be produced by over-stimulation of the inner ear fluids, such as one encounters when spinning and then stopping suddenly.

Any disturbance affecting the function of the inner ear or its central connections may result in dizziness, hearing loss or tinnitus (head noise). These symptoms may occur singly or in combination, depending upon which functions of the inner ear are disturbed. Inner ear dizziness may appear as a whirling or spinning sensation (vertigo), unsteadiness, or giddiness and light-headedness. It may be constant, but is more often intermittent, and is frequently aggravated by head motion or sudden positional changes. Nausea and vomiting may occur. There is no loss of consciousness from inner ear dizziness.

Postural or positional dizziness is a common form of balance disturbance due to loose mineral deposits in the inner ear. It is characterized by sudden, brief episodes of dizziness when moving or changing head position. Commonly it is noticed when lying down, arising or turning over in bed. This type of dizziness is rarely progressive and usually responds to treatment with a properly performed Epley Maneuver, a brief office procedure.

Some individuals develop imbalance as a result of the aging process. In many cases this is due to circulatory changes in the very small blood vessels supplying the inner ear and balance nerve mechanism. Fortunately, these disturbances, although they may persist, rarely become worse. Postural or positional vertigo (see above) is the most common balance disturbance of aging. This may develop in younger individuals as a result of head injuries or circulatory disturbances. Dizziness on change of head position is a distressing symptom, which may be helped by vestibular exercises. Temporary unsteadiness upon arising from bed in the morning is not uncommon in older individuals. At times this feeling of imbalance may persist for an hour or two. Arising from bed slowly usually minimizes the disturbance. Unsteadiness when walking, particularly on stepping up or down, or walking on uneven surfaces, develops in some individuals as they progress in age and may be related to sensory deficits: vision changes such as cataract, proprioceptive problems such as lack of sensation in feet from diabetes, spinal stenosis from joint degeneration... Walking with a small "shopping cart" or walker may help prevent falls. Vision correction is important. Treatment of dizziness due to changes in circulation involves proper hydration, blood pressure control. Sometimes your doctor will suggest aspirin or blood thinners. Sometimes lowering the levels of circulating fat such as cholesterol will help blood flow. Decongestants should be avoided. Also no smoking. Regular exercise approved by your health-care provider is important.

Dizziness due to viral ear infection can present with sudden true vertigo, and sometimes associated with hearing loss and tinnitus. The natural course of the illness causes vertigo with the slightest movement, and this can last for 2-3 days and be associated with nausea, causing the person to be "bed-ridden", Then over the next several weeks the inner ear recovers gradually. Meningitis is a rare cause for this sudden dizziness and is usually associated with fever and neck stiffness with headache. Stroke can sometimes present with sudden dizziness, and other neurological symptoms usually are associated such as slurred speech, extremity weakness. Sudden vertigo and or hearing loss should receive prompt medical attention.

Meniere’s disease is a common cause of repeated attacks of dizziness, and is due to increased pressure of the inner ear fluids, commonly due to delayed food allergy. Fluids in the inner ear chamber are constantly being produced and absorbed by the circulatory system. Any disturbance of this delicate relationship may result in overproduction or under-absorption of the fluid. This leads to an increase in the fluid pressure, called hydrops that may produce dizziness. Fluctuating hearing loss/ear fullness, buzzing, ringing or abnormal ear noises and sometimes noise sensitivity may be associated. Sometimes even loud noise can cause brief dizziness. Meniere’s disease is usually characterized by attacks consisting of vertigo (spinning) that varies in duration from a few minutes to several hours. Hearing loss and head noise, may accompany the attacks. Violent spinning, whirling, and falling associated with nausea and vomiting may uncommonly occur. Sensations of pressure and fullness in the ear or head may be present during the attacks. Attacks of dizziness may recur at irregular intervals and the individual may be free of symptoms for years, only to have them recur again. In between major attacks, the individual may have minor episodes occurring more frequently and consisting of unsteadiness lasting for a few seconds to minutes. Occasionally hearing impairment, head noise, and ear pressure occur without dizziness. This type of Meniere’s disease is called cochlear Meniere's. Episodic dizziness may occur without hearing loss or tinnitus: vestibular Meniere's.

Treatment of Meniere’s Disease Past medical treatment of Meniere’s disease has been poorly accepted. Low salt diet and diuretics to lower inner ear fluid pressure has had little lasting effect and has many side effects such as low blood pressure, and feeling dizzy and faint! Likewise the medications to reduce dizziness have as a major side effect: dizziness Some severe cases surgery has been done to actually remove the inner ear: no more hearing, and worse vertigo for several months! Similar result from using a strong antibiotic to poison the inner ear! And when both ears are involved....only one can be treated with surgery or gentamycin. The Allertol® protocol for delayed food allergies has been found since 2007 to quickly and effectively relieve Meniere's, without need for medications, diets, or surgery. SheaENT is the developer and patent holder for this simple solution.