Vertigo is a symptom defined as a false sense of spinning or motion. Tinnitus is the perception of sound, such as ringing, buzzing, or hissing, without an external source. These two distinct symptoms frequently occur together, indicating a shared underlying problem. When experienced simultaneously, they strongly suggest a disorder affecting the sensory structures within the skull.
Shared Anatomical Basis
The frequent co-occurrence of balance and hearing symptoms is due to the close physical arrangement of their sensory organs. Both the cochlea (hearing organ) and the semicircular canals (balance organs) are housed together within the inner ear’s bony labyrinth. This confined structure is filled with a specialized fluid called endolymph.
Damage or inflammation in this shared compartment can easily affect both systems. The cochlea contains hair cells that translate sound vibrations, while the semicircular canals sense head movement and gravity. Any pressure change or disruption of the endolymphatic fluid can disturb the function of both the auditory and vestibular systems. Both sets of sensory signals are transmitted to the brain via the vestibulocochlear nerve (the eighth cranial nerve), meaning a single issue can interrupt the signals for both hearing and balance.
Specific Conditions Causing Both Symptoms
The most common condition causing both severe vertigo and tinnitus is Ménière’s disease, a chronic inner ear disorder often starting between the ages of 40 and 60. It is characterized by a classic triad of symptoms: episodic vertigo, fluctuating hearing loss, and tinnitus, often accompanied by a feeling of fullness in the ear. Vertigo attacks are debilitating, lasting from 20 minutes up to 12 hours, and can cause significant nausea and vomiting.
The symptoms of Ménière’s disease are attributed to endolymphatic hydrops, an increase in the volume of endolymph that disrupts sensory cell function. The tinnitus is often described as a low-frequency roar or hum and may worsen before or during a vertigo attack. While it typically affects only one ear, both ears may become involved in 15 to 30 percent of cases.
Other conditions also link these symptoms. Labyrinthitis involves inflammation of the entire labyrinth, including the cochlea and vestibular system, often due to a viral infection. This can cause sudden, intense vertigo lasting for days, along with hearing loss and tinnitus. Vestibular neuritis primarily affects the balance portion of the nerve, but inflammation can sometimes spread, causing temporary tinnitus.
A less common but serious cause is an acoustic neuroma (Vestibular Schwannoma), a slow-growing, non-cancerous tumor on the eighth cranial nerve. Pressure from the tumor can lead to progressive, unilateral hearing loss, persistent tinnitus, and balance issues that manifest as vertigo. Benign Paroxysmal Positional Vertigo (BPPV), the most common cause of vertigo, has also been associated with a higher incidence of tinnitus.
Seeking Professional Diagnosis
A medical professional, such as an otolaryngologist or neurologist, must evaluate the co-occurrence of vertigo and tinnitus to determine the precise underlying cause. The diagnostic process begins with a detailed patient history, focusing on the duration, frequency, and triggers of the vertigo attacks, and the specific characteristics of the tinnitus. This is followed by a physical and neurological examination, which includes bedside tests to assess balance and involuntary eye movements.
Specific tests are then used to confirm inner ear function. Audiometry, or a hearing test, checks for hearing loss patterns, which can point toward conditions like Ménière’s disease if low-frequency hearing is affected. Videonystagmography (VNG) or Electronystagmography (ENG) tests assess the connection between the inner ear and the eyes by recording eye movements while the head is moved or in response to visual stimuli.
Advanced testing may include Electrocochleography, which measures the electrical responses of the cochlea and auditory nerve, helping to identify fluid pressure changes seen in Ménière’s disease. Imaging studies, such as Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scans, may be ordered to rule out tumors or other structural issues affecting the auditory and vestibular nerves, such as an acoustic neuroma. This systematic approach allows for an accurate diagnosis, which is the necessary first step toward developing a management strategy.