Secondary Endolymphatic Hydrops

Secondary Endolymphatic Hydrops, SEH, is a vestibular system disorder caused by endolymphatic response to an underlying condition (1). In a normal ear, the fluid in your ear is maintained at a homeostatic level to help your balance, hearing, and spatial orientation. If you have Secondary Endolymphatic Hydrops, it is likely to be due to an underlying condition. These conditions include, but are not limited to, surgeries that affect the inner ear, inner ear infections, allergies, and head trauma (1, 2). The attacks are spaced weeks to months apart, and over time can destroy your balance and hearing organ slowly. These symptoms manifest in a few different ways depending on the individual. Regardless of your symptoms, we need to treat the symptoms and the root of the problem simultaneously to preserve your vestibular system and restore homeostasis in your body.

The fluid in your ear, endolymph, contains sodium, potassium, and a fluid-like substance. This fluid maintains the correct pressure in your vestibular organ (the inner ear) and helps your balance and hearing function. Too much sodium causes the pressure in your endolymph to increase significantly, leading to an overall pressure change in your inner ear. This pressure fluctuation causes your dizziness and imbalance symptoms. This can be treated by limiting your sodium intake, or limiting other dietary factors that may increase symptoms. Remember, it is not the act of moving your head that causes the fluid to fluctuate; it is other factors like diet, fluid intake, and sodium intake that cause pressure and fluid fluctuations in your inner ear.

Symptoms & Diagnosis

A flareup of Secondary Endolymphatic Hydrops is secondary to another injury or dysfunction, and presents differently between each individual. Symptoms that I frequently hear are:

  • Episodic vertigo and the sensation of spinning
  • Tinnitus
  • Chronic or acute imbalance
  • Aural fullness
  • Temporary or sustained hearing loss

These symptoms tend to last for 8-36 hours. It may cause you nausea and force you to stay in bed during the duration of the episode. Over years of attacks, your hearing can slowly be lost, so it is important to treat it properly once you receive a diagnosis.

To diagnose Secondary Endolymphatic Hydrops, your physical therapist, or other healthcare provider, will need a thorough history of your symptoms, patterns, and observations. The patterns of your symptoms provide a clear diagnosis because there are usually triggers that affect the flare ups.

Triggers of Secondary Endolymphatic Hydrops usually include:

  • Salt or sugar
  • Alcohol
  • Coffee/caffeine
  • MSG
  • Nuts and nut butter

Knowing your triggers, the source of your symptoms, is important to treating SEH through conservative measures.
Another tool your healthcare team can use are a series of diagnostic tests. Electrocochleography, or EcoG, is a test for the vestibulocochlear nerve function, and if it is positive, supports the diagnosis of SEH. Audiometry can also support an SEH diagnosis; this is a hearing test to see if you have unilateral hearing loss. Lastly, new research has shown that an MRI with contrast shows definitively if you have either SEH or Ménière’s Disease, however it cannot differentiate between the two. Because a thorough history and clinical diagnosis is typically very accurate, diagnostic testing is not incredibly common or always necessary (1). Once you receive a diagnosis, it’s important to begin treating both your symptoms, and the root of the symptoms, in order to preserve your vestibular system and decrease your symptoms.


Treating Secondary Endolymphatic Hydrops is very important in order to preserve your vestibular system and prevent future SEH episodes. This can be done through numerous conservative avenues. The first way to treat SEH is through dietary restrictions, the hydroptic diet (1). One of the biggest triggers, and the first thing we typically advise to limit, is sodium. Sodium shows up in our diets more than we think. It is more than just salting our meals, it is in sports drinks, dehydrated foods, ketchup, and sparkling water, just to name a few. Be wary of the presence of salt in your diet, and try your best to limit your intake significantly as too much can cause a large fluid fluctuation and induce an episode. Another common trigger is caffeine (1). Caffeine is the start to your day for many people — whether it is in tea or coffee, most people drink it daily. Caffeine can cause increased symptoms of tinnitus and is a diuretic, which causes fluid loss through urination, therefore disrupting our homeostasis. Following the diet recommended for those with Vestibular Migraines is incredibly effective as a treatment for Secondary Endolymphatic Hydrops.

Another, slightly less conservative option is prescribing a diuretic. Prescribing a diuretic is different from drinking caffeinated drinks, which are technically diuretics. A diuretic works to maintain fluid homeostasis in your body, specifically in your inner ear. This will help you excrete a sustained amount of water throughout the day, so it is important that you increase the amount of water you drink throughout the day in order to avoid dehydration. Some diuretics may cause you to excrete too much potassium, so be sure to discuss with your physician the kind of diuretic you are prescribed to see if you need to take a potassium supplement.

Treatment for Secondary Endolymphatic Hydrops is a process, and finding what helps your symptoms will be different from another person with a similar diagnosis. It is important that you maintain your quality of life by making this a part of your new routine and treating your symptoms effectively for you. Treating your symptoms doesn’t have to feel like it has taken control of your whole life; start small, and work your way into bigger changes if and when they’re necessary.

Physical Therapy

A physical therapist is one of the most qualified providers to help you treat your vestibular dysfunction, specifically Secondary Endolymphatic Hydrops, conservatively. Both your acute and chronic symptoms can be effectively managed with your physical therapist. First, getting a hold of your SEH symptoms by adhering to a hydroptic diet is something your vestibular PT will be able to assist you with. Then, your PT can help prescribe you exercises to improve your balance, decrease dizziness, and discuss any anxiety you may have surrounding your new diagnosis. I have found that those diagnosed with Secondary Endolymphatic Hydrops can be very fearful about their symptoms and sometimes end up secluding themselves from others and their normal activities. Instead of secluding yourself, work with a physical therapist and your healthcare team to get back to your favorite activities, and to continue living your life.

(1) VEDA. (2020, August 07). Secondary Endolymphatic Hydrops (SEH). Retrieved September 01, 2020, from https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/secondary-endolymphatic-hydrops-seh/

(2) BC Balance and Dizziness. (n.d.). Secondary Endolymphatic Hydrops. Retrieved September 01, 2020, from https://balanceanddizziness.org/disorders/vestibular-disorders/secondary-endolymphatic-hydrops/

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