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Timothy
C. Hain, MD 
Content last updated:
December 30, 2007
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| Locations of external, middle and inner ear |
Pressure sensitivity, with respect to the ear, consists of dizziness induced by transient alterations in pressure in the inner ear, middle ear, or external ear.
An example of dizziness induced by inner ear pressure changes might be dizziness associated with the Valsalva maneuver. This is a straining maneuver that increases pressure in the spinal fluid and inner ear perilymph space. Superior canal dehiscence is the main cause of Valsalva induced dizziness.
An example of dizziness induced by middle ear pressure fluctuation is "alternobaric vertigo" -- such as occurs in people who can "clear" one ear, but not the other.
An example of dizziness induced by external ear pressure is dizziness associated with perilymph fistula, when people get dizzy when they stick their finger into their ear.
Vestibulofibrosis causes very strong and reproducible dizziness of this nature -- generally much greater than that which is produced in persons with window fistulae.
Dizziness due to pressure also occurs in the conditions that cause Tullio's phenomenon -- Superior canal dehiscence, perilymph fistula, Meniere's syndrome, post fenestration surgery, and vestibulofibrosis (Nadol, 1974; 1977).
Supplemental material
on the site DVD: Movie of nystagmus
elicited by pressure
Supplemental material on the site DVD: Movie of nystagmus elicited by Valsalva
Pressure sensitivity is a symptom, not a disease, so you diagnose it by simply making the observation that pressure fluctuations makes a person dizzy. It is particularly important to try to determine which ear is the problem. The next step should be to consult with a doctor who knows something about this. Generally this will be an otolaryngologist who specializes in ear problems (an otologist). This doctor will likely do a hearing test, take a careful history, and get a temporal bone CT scan to look for superior canal dehiscence and other ear problems.
Treatment is based on the cause. Generally it is not terribly effective. Fistulae can be patched, Meniere's can be treated medically and surgically. Fenestrations may be closed, although this is done very rarely. Vestibulofibrosis can be treated with approaches that destroy vestibular function, disconnecting the ear from the brain. More practically, you may find it useful to wear "ear plane" plugs, and avoid things that make your ear pop.
| © Copyright May 22, 2008 , Timothy C. Hain, M.D. All rights reserved. Last saved on May 22, 2008 |