The inner ear consists of two delicate systems responsible for hearing and balance. Because of their anatomic contiguity, disease processes tend to affect both systems simultaneously. For this reason, patients with disorders of the inner ear have both hearing as well as balance symptoms – hearing loss, tinnitus and giddiness. Inner ear symptoms tend to be permanent because most diseases cause irreversible damage to the inner ear structures. The delicate cells of the cochlear and vestibular systems, once destroyed, show little potential for repair and regeneration. Presbyacusis and noise induced hearing loss, which are associated with age related degeneration and noise induced damage respectively, cause permanent hearing loss for which there is little scope for recovery.