Viruses can damage the inner ear, usually by causing swelling or direct infection of the nerve leading to the ear. Some viruses are especially attracted to nervous tissue, and these are the ones most likely to lead to this kind of damage. There are many of these. Enteroviruses—viruses that inhabit the bowels and are passed out through feces—are particularly common causes.
Enteroviruses easily contaminate the environment in bathrooms and in food that is touched by unwashed hands. They often have mild symptoms, like a cold, but some (like polio, for example) can infect the spinal cord, or cause meningitis, an inflammation of the lining of the brain. Rashes and heart inflammation can also rarely occur. Most people with viral inner ear infection will notice some other symptoms of a virus, like a runny nose or cough, before the vertigo begins. Herpesviruses can also damage the ear. This can start as painful blisters on one ear or on one side of the face and can damage hearing as well as balance function.
Bacterial infections, often beginning behind the eardrum and then spreading to the inner ear, can destroy function in the ear. Usually there is pain in the ear, and if there is a hole in the eardrum, drainage is noticed from the ear.
A severe blow to the side of the head can fracture the skull bones including the ones surrounding the ear. Even seemingly small blows to the ear can tear the delicate inner ear membranes and cause sudden losses of function.
In older people, a blood clot can cut off blood flow to the ear resulting in permanent damage. This is more common in people with diabetes, autoimmune diseases, blood clotting disorders or vascular disease.