Secondary endolymphatic hydrops

Secondary endolymphatic hydrops is a build-up of fluid in the inner ear that develops after an identifiable insult, such as a head injury, ear surgery or an inner-ear infection. It can cause episodes of vertigo, fluctuating hearing, tinnitus and ear fullness, much like Ménière’s disease. Diagnosis and medical management are led by an ear, nose and throat specialist (ENT), who will also look at the underlying cause. Research specific to this condition is limited, so physiotherapy plays a supportive role — mainly helping with ongoing imbalance and checking for other treatable causes of dizziness. At McKelvie Physiotherapy in Pickering, we work closely with local ENT specialists so your rehab fits alongside your medical care.

What is secondary endolymphatic hydrops?

The inner ear contains a fluid called endolymph, which plays a key role in both hearing and balance. Endolymphatic hydrops means there is a build-up of this fluid, which can disrupt the inner ear’s hearing and balance organs.

When hydrops develops after an identifiable injury or illness affecting the inner ear, it is called secondary endolymphatic hydrops. This sets it apart from Ménière’s disease, which is also associated with hydrops but has no clear underlying cause.

Secondary hydrops can cause symptoms very similar to Ménière’s disease, including episodes of vertigo and fluctuating hearing. It is less well studied than Ménière’s, and much of what is known comes from case series and reviews rather than large clinical trials (Ferster et al., 2017; Venkatasamy & Péporté, 2025).

What causes secondary endolymphatic hydrops?

Published reviews describe a range of possible causes, which are thought to share a common pathway of disrupting the inner ear’s fluid balance (Venkatasamy & Péporté, 2025). They include:

• head injury or other trauma to the ear
• ear surgery, such as stapes surgery for otosclerosis or cochlear implantation
• inner-ear infection or inflammation, such as labyrinthitis
• other inner-ear conditions, such as otosclerosis
• less commonly, tumours near the inner ear or other conditions affecting the inner ear and surrounding structures

Symptoms don’t always start straight away — in some people, hydrops develops well after the original injury or illness.

What are the symptoms of secondary endolymphatic hydrops?

• Episodes of spinning vertigo
• Hearing loss in the affected ear that may come and go
• Tinnitus (ringing, roaring or buzzing) in the affected ear
• A feeling of fullness or pressure in the ear
• Nausea during episodes
• Imbalance or unsteadiness between episodes, for some people

How is secondary endolymphatic hydrops treated?

Your ENT diagnoses secondary hydrops and leads its medical management. This usually involves a careful history, a hearing test and, in some cases, specialised imaging. Where possible, treatment addresses the underlying cause. Symptoms are often managed with approaches similar to those used for Ménière’s disease, but evidence specific to secondary hydrops is limited, so your ENT will tailor the plan to you.

Audiology and your ENT look after changes in your hearing.

A vestibular physiotherapist has a supportive role. We don’t use vestibular rehab to manage acute vertigo episodes. But many people are left with ongoing imbalance or unsteadiness between episodes, and that’s where tailored rehab can help. Because secondary hydrops often follows a head injury or an inner-ear infection, there may also be other treatable sources of dizziness — such as BPPV or reduced balance function on one side — that we can assess and treat.

1. 01

   Assess

   A detailed history of the original injury or illness, plus a balance and eye-movement assessment with infrared video goggles, to look for other treatable causes such as BPPV.

2. 02

   Coordinate

   Clear advice on when to see your doctor or ENT, so your rehab fits alongside the medical management of your hydrops.

3. 03

   Rebuild

   A tailored program of gaze-stability, balance and walking exercises to help with ongoing unsteadiness between episodes.

Why choose McKelvie Physiotherapy for secondary endolymphatic hydrops?

• Vestibular specialists — our lead physiotherapist holds the Advanced Vestibular Physical Therapist (AVPT) certification.
• Advanced diagnostic technology — we use infrared video goggles (video-oculography) to record eye movements the naked eye can’t see, so your diagnosis is based on evidence, not guesswork.
• We work closely with local ENT specialists — so your rehab fits alongside your medical care.
• A thorough assessment — including checks for other treatable causes of dizziness, such as BPPV.
• One-on-one care in private rooms — your session is just you and your physiotherapist.
• Care that comes to you — in person in Pickering, at home across the GTA, or virtually anywhere in Ontario.
• Direct billing to many major insurers — and no referral needed.