Why are ears important for balance?

Our ability to hear begins when sound waves reach the outer ear and travel down the ear canal to the eardrum, causing it to vibrate. The vibrations are passed to three tiny bones in the middle ear, known as the ossicles, which amplify and transmit them to the cochlea in your inner ear. This is where the real magic of hearing begins!

The cochlea is a spiral-shaped, fluid-filled structure that’s responsible for your hearing. When the vibrations reach the inner ear, the cochlea converts them into electrical energy, which is passed up the auditory pathways in the brain. The brain then translates them into sound, allowing us to identify voices, music, and the world around us.

The vestibular (balance) system consists of three semicircular canals filled with fluid and two otolith organs (the saccule and utricle). Like the cochlea, the canals are lined with hair cells, but instead of responding to sound waves, these tiny hairs react to your movements.

As you move your head, the fluid bends the tiny hair cells, which trigger an electrical impulse that travels along your vestibulocochlear nerve to your brain. Your brain uses this information to help you stay upright, keep your vision steady, and prevent you from falling over. This happens all the time, without you ever having to think about it!

Although your hearing and balance are controlled by different structures, they share the same neural pathways and work together to help your brain understand what’s happening around you. This means changes in one can sometimes affect the other, which is why you often feel dizzy when you have a blocked ear.

An inner ear problem can affect your hearing, balance, or both.

If you have hearing loss, you may:

• Have difficulty following conversations, especially in noisy places
• Ask people to speak more slowly and loudly
• Need to turn up the volume of the television or radio
• Find yourself withdrawing from social gatherings
• Notice ringing in your ears, known as tinnitus

If your vestibular (balance) system isn’t working as well as it should, you may:

• Feel dizzy or lightheaded
• Experience spinning sensations (vertigo)
• Have trouble understanding what people are saying
• Have unpleasant sensations in your ear, like pain, ringing or pressure
• Struggle with your coordination
• Feel worse when you move your head or change position
• Experience nausea, fatigue or difficulty concentrating

• Benign paroxysmal positional vertigo (BPPV): A vestibular (balance) disorder that happens when small fragments of your inner ear (otoconia) get trapped in your semicircular canal. This can make you feel like you’re moving when you aren’t.
• Hearing loss: Very common with many causes and types, including age-related hearing loss (presbycusis), noise-induced hearing loss (NIHL) and sudden sensorineural hearing loss (SSNHL).
• Inner ear infection (otitis interna): Any condition that causes inflammation in your inner ear. The most common types are labyrinthitis and vestibular neuritis. Infections can cause severe hearing loss and prolonged dizziness.
• Ménière’s disease: A chronic (long-lasting) inner ear condition that causes problems with both hearing and balance.
• Tinnitus: Ringing in your ears that’s often related to hearing loss.

Other conditions that can cause inner ear problems include:

• Earwax blockage
• Hyperacusis
• Autoimmune inner ear disease
• Otosclerosis

The symptoms don’t always mean you have hearing loss or a vestibular condition. But if you’re experiencing poor balance and changes to your hearing that are affecting your confidence, safety or quality of life, it’s a good idea to see an audiologist who will assess your hearing and refer you to a vestibular specialist if needed.