From the Guidelines
Increased ear pressure can indeed cause nystagmus, as it affects the vestibular system in the inner ear, leading to involuntary eye movements. This is evident in conditions like Ménière's disease, where excessive fluid in the inner ear is believed to cause symptoms including vertigo, tinnitus, and hearing loss, as described in the clinical practice guideline for Ménière's disease 1. The vestibular system, which includes the inner ear and vestibular pathways in the brain, plays a crucial role in balance, coordination, and posture maintenance, and disruptions to this system can result in nystagmus and other balance-related issues.
Key points to consider:
- The vestibular system is responsible for balance and spatial orientation, and pressure changes in the inner ear can disrupt its function, leading to nystagmus and other symptoms.
- Conditions like Ménière's disease, which is characterized by excessive fluid in the inner ear, can cause nystagmus, vertigo, and hearing loss, as outlined in the guideline 1.
- Diagnostic tests such as video- or electronystagmogram can evaluate vestibular function and help identify underlying causes of nystagmus, although they may carry risks like vertigo and nausea 1.
- Managing the underlying cause of pressure changes, such as using decongestants for congestion or following proper equalization techniques during diving, can help prevent episodes of nystagmus and other symptoms.
In clinical practice, it is essential to consider the potential impact of increased ear pressure on the vestibular system and to investigate underlying causes of nystagmus, as persistent symptoms could indicate a condition requiring treatment, as suggested by the guideline 1.
From the Research
Increased Ear Pressure and Nystagmus
- Increased ear pressure can cause nystagmus (involuntary eye movement) in certain individuals, particularly those with vestibular disorders or anatomical abnormalities such as superior canal dehiscence syndrome 2, 3.
- Studies have shown that changes in middle ear pressure can induce vertigo, oscillopsia, and/or disequilibrium, as well as evoke vertical-torsional eye movements in patients with sound- and/or pressure-induced vertigo 2, 4.
- In patients with cochleovestibular diseases, reduction of chamber pressure has been observed to reduce pathological spontaneous nystagmus, suggesting a transmission of middle ear pressure to the labyrinth 4.
- The direction of evoked eye movements can be explained by excitation or inhibition of the superior semicircular canal in the affected ear, and computed tomographic scans can identify dehiscence of bone overlying the affected superior semicircular canal 2, 3.
- Surgical plugging of the affected canal may be beneficial in patients with disabling symptoms, and pharmacological treatment options are available for vestibular disorders and nystagmus, including antiemetics, anti-inflammatory medications, and aminopyridines 2, 5.
- Animal studies have also demonstrated that increased middle ear pressure can elicit nystagmus in hydropic ears, with significantly lower pressure needed to elicit nystagmus compared to normal control ears 6.