Ask the doctors: Managing vertigo from inner ear fluid buildup

Dear Doctors: I recently experienced severe vertigo due to fluid in my inner ear from a sinus infection. It affected not only my balance, but also my blood pressure and anxiety. Are there any precautions to take to avoid a recurrence of inner ear problems?

Dear Reader: A buildup of fluid in either the middle or inner ear can cause the dizzy, spinning feeling of vertigo. This can range from merely uncomfortable to severe enough to affect balance. The stress of these episodes can increase anxiety and even affect blood pressure.

When excess fluid builds up in the middle ear, it is known as otitis media with effusion, or OME. It is most common in young children, but it can also occur in adults. The most common cause of OME is a viral pathogen that has led to a sore throat, cold or upper respiratory infection. Allergies can also cause inflammation that leads to a buildup of fluid.

An accumulation of fluid in the inner ear is a somewhat rare disorder known as Meniere’s disease. It is estimated to affect about 615,000 adults in the United States, with 45,000 new cases diagnosed each year. The disorder typically affects just one ear. In addition to vertigo, symptoms can include tinnitus, which is the presence of a ringing, buzzing or whooshing sound that has no external source. People with Meniere’s disease also often report a feeling of fullness or congestion inside of the ear. The disorder can develop at any age, but it is seen more often in adults between 40 and 60 years old.

Unlike OME, which often clears up on its own, Meniere’s is a chronic disorder. That means it is persistent and can require ongoing management. It often takes the form of recurrent episodes in which symptoms manifest, are present for a period of time and then go away. Episodes can be as brief as a few moments, or they can last all day. Over time, people with Meniere’s often experience an increasing degree of hearing loss in the affected ear.

The symptoms of Meniere’s disease are caused by a buildup of fluid within a delicate region of the inner ear known as the labyrinth. It consists of the cochlea, which is the snail-shaped hair-lined organ central to our ability to hear, and organs of balance. These include structures known as the semicircular canals and otolithic organs. The cause of the disorder is not understood. One theory focuses on the constriction of blood vessels serving the inner ear. Viral infection, autoimmune disease and allergy may also play a role. The condition runs in families, so a genetic link is suspected.

Diagnosis is via a medical history, the presence of specific symptoms and repeated episodes of vertigo. Unfortunately, there is no known way to prevent this disorder, and there is no cure at this time. Treatment focuses on managing symptoms with medication, cognitive therapy and behavioral and dietary changes. Because the symptoms of Meniere’s disease can be caused by a middle ear infection, it would be wise to see an otolaryngologist for a definitive diagnosis. If this proves to be Meniere’s, they can help you with long-term management of the disorder.

Send your questions to askthedoctors@mednet.ucla.edu.