A conversation with

Robert Stokroos & Raymond van de Berg

In the column 'A conversation with...', experts from Maastricht UMC+ discuss one of the questions submitted for the Dutch National Research Agenda. This time Professor of Otolaryngology, Robert Stokroos, and Raymond van de Berg, a specialist in vestibular disorders, discuss the following question:

Is there a relationship between tinnitus and vestibular disorders?

"This seems an easy question to answer, simply because the organs of both balance and hearing are located in the same area. They are packed together in a 'box', so to speak. That box is known as the inner ear. Both organs consist of connected tubes, through which a fluid flows that passes through both the vestibular organ and the hearing organ. The two organs are therefore literally connected to each other, although they are different senses that observe different sensations. One registers different types of soundwaves, and the other detects acceleration in movement and the body's position in relation to gravity. The drawback is that if anything happens to one organ, there can also be a problem with the other.

Robert StokroosRobert StokroosTinnitus is also known as ringing in the ears. Patients who suffer from it hear a constant ringing, whistling or buzzing sound inside their head. It is estimated that a million people in the Netherlands suffer from ringing in the ears to some extent. A mild form can be caused by spending a night at the disco where the music is too loud, for example. This form often only lasts temporarily and the buzzing disappears after a few days. However, there are 60,000 patients in the Netherlands with a serious form of tinnitus and who suffer constantly from noise that doesn't actually exist, a so-called 'phantom sound'. Interestingly, the cause of the disorder is to be found not only in the hearing organ, but also in the brain.

A drawing of the inner earA drawing of the inner earAn example of a disorder that can cause tinnitus is Ménière's disease, which damages the inner ear and causes incorrect signals to be sent to the brain. Because hearing has been damaged, the brain creates the missing sound itself, even if there is no sound to be heard. Ménière's disease can also cause dizziness and even a complete loss of balance. What causes Ménière's disease is unclear, however, and it can appear suddenly. The syndrome can cause a build-up of fluid in the inner ear, which can, for example, lead to the tubes tearing because of the increased pressure. And, as already mentioned, the fluid flows through both the hearing and the balance organ.

Problems with the senses in the inner ear can also be caused by disorders other than Ménière's disease. A tumour, medicines, meningitis or a genetic disposition can all be the cause of problems with balance and hearing. There is also evidence that a person's state of mind, such as stress, can contribute to disrupting his or her balance, which reinforces the hypothesis that the brain plays a crucial role in the process.

Raymond van de BergRaymond van de BergHowever, the primary problem is often a disorder in one of the two senses. For example, a patient might first attend the ear, nose and throat specialist complaining of tinnitus, only for it to be found that they are also experiencing dizziness. Naturally, it can also work the other way around. In Maastricht, therefore, special care programmes have been set up around the principal complaint; in other words there is a tinnitus care programme, but also a balance care programme, so that patients receive optimal care. Because of the strong correlation between balance disorders and tinnitus, it is also possible is to treat both complaints simultaneously. With an artificial implant, both tinnitus and problems with balance can be treated. These implants are still in the research phase, but have already proved successful on a number of occasions. Maastricht UMC+ is investigating whether this innovative method of treatment, which is known as neuromodulation, can also be used for tinnitus or for balance disorders separately."