A wide range of ear and hearing disorders can cause balance problems combined with tinnitus and hyperacusis. Ménière’s disease is an ear disorder that causes sudden attacks of vertigo, hearing loss, tinnitus, hyperacusis and aural fullness. Attacks usually last for 2-3 hours and the individual may feel vertigo, unsteadiness, nausea, and a sudden drop of hearing. Tinnitus is reported during attacks, but it may also persist outside the attacks.
Tinnitus and hyperacusis can accompany vertigo after head trauma. Vertigo, tinnitus, and hypersensitivity to sound (either in the form of hyperacusis or noise sensitivity) are reported to be some of the symptoms experienced in Vogt-Koyanagi-Harada syndrome.
Some patients may complain that hearing certain sounds induces nystagmus or vertigo. This could be an indication of superior semicircular canal dehiscence leading to the Tullio phenomenon. This is different from the experience of hyperacusis, however, hyperacusis and tinnitus can also be present. Studies that suggest sometimes pulsatile tinnitus and tinnitus that is induced by head rotation can be related to superior semicircular canal dehiscence when the patient also complains of sound- and pressure-induced vertigo. In addition, over sensitivity to bone conducted sounds also known as bone conduction hyperacusis has been reported in patients with semi-circular canal dehiscence. This could be treatable with operations called RW reinforcement. Autophony, hearing of one’s own footsteps and hearing movements of eyes have also been reported in patients with semi-circular canal dehiscence.
Our Director, Dr Hashir Aazh said: 
“A rare but important cause of balance problems among patients with tinnitus is acoustic neuroma. An acoustic neuroma can cause hearing loss, vertigo, and in some individuals tinnitus. Tinnitus in such cases may be caused by any combination of: tumour-induced pressure on the auditory nerve; damage to the auditory nerve; reduced blood supply to the cochlea; changes in the transmission of regulatory information sent to the ear from the brain; changes in the brain that are secondary to the hearing loss caused by the acoustic neuroma. Sometimes, people with acoustic neuroma perceive tinnitus even without any identifiable hearing loss. Many people with acoustic neuroma have no hearing loss or tinnitus. In over 10% of people who were diagnosed with acoustic neuroma, the acoustic neuroma was discovered unintentionally (usually during a brain scan, such as MRI) during evaluation for an unrelated medical condition, and the patient did not have any tinnitus, vertigo or hearing loss.”
Recent research conducted at the Mayo Clinic in Minnesota, USA, by Dr Maria Peris-Celda and colleagues showed that in 51% of patients who were diagnosed with acoustic neuroma, hearing loss was the most common symptom that led to diagnosis, followed by dizziness in 17%, and tinnitus in 11%. Another study showed that only 6% of those with acoustic neuroma had tinnitus. For people with tinnitus combined with hearing loss in one ear only, an MRI scan is often used to determine whether or not an acoustic neuroma is present.
Joanna Barker, Specialist Audiologist at Hashir International Institute, adds:
“When balance problems are present patient needs to see a multi-disciplinary team. If the patient already has seen ENT and the balance problem cannot be resolved, they may benefit from balance consultation or vestibular rehabilitation. Balance consultation and Vestibular Rehabilitation programme at Hashir International Institute can be delivered independently from tinnitus and/or sound intolerance treatment or it can be offered in combination with CBT for tinnitus and/or sound intolerance depending on patient’s symptoms and priorities.”
From September 2024, Hashir International Institute will offer specialist balance services in face-to-face sessions at our Guildford clinic as well as via online sessions.
For further information, please contact:
Hashir International Institute, 167-169 Great Portland Street, 5th Floor, London, W1W 5PF
Hashir International Institute, 54 Quarry Street, Guildford. GU1 3UA
admin@hashirtinnitusclinic.com
About Hashir International Institute:
Hashir International is an independent research institute and treatment centre dedicated to improving the diagnostic process and rehabilitation programs for patients experiencing misophonia, tinnitus and hyperacusis. They offer specialist training courses, ethical review of research proposals, research design, research sponsorship, and supervising MSc and PhD students.
