Having a feeling of dizziness or being off balance is unsettling. Did you know a central control room in your body affects your balance, movement, and coordination? This control room is called the vestibular system, and it’s fascinating.

Imagine the feeling of being on a swing, and as you swing up, you drop your head back on the down stroke. That feeling you get is similar to vertigo. It soon disappeared after you got off, but people with a vestibular disturbance live with that feeling every day. Let’s have a look at this important part of the inner ear.

What Is The Vestibular System?What Is The Function Of The Vestibular System?What Is The Mechanism Of The Vestibular System?When Does The Vestibular System Start Developing?How Do You Know The Vestibular System Is Functioning?What Are Common Signs Of Vestibular System Disorders?What Can Cause Vestibular Balance Disorders?Conclusion

What Is The Vestibular System?

What Is The Function Of The Vestibular System?

What Is The Mechanism Of The Vestibular System?

When Does The Vestibular System Start Developing?

How Do You Know The Vestibular System Is Functioning?

What Are Common Signs Of Vestibular System Disorders?

What Can Cause Vestibular Balance Disorders?

Conclusion

Thevestibular systemis comprised of physical structures and neural pathways. These structures contribute to our sense of equilibrium and proprioception. The vestibular system functions include head movement in any direction, body orientation and acceleration, posture, and change in eye movement.

The reflexes of the vestibular system are referred to as vestibulospinal and vestibulo-ocular reflex. The vestibular system is centrally located in the inner ear and is connected to the brain through neural pathways. The brain responds to input from the peripheral vestibular system and makes these reflexes possible.

It is believed that the vestibular system plays a role in human consciousness. Any vestibular system dysfunction can disrupt learning, navigating spatial memory, and cognitive behavior.

The physical part of the vestibular system is made up of the following.

Themain functionof the vestibular system is to detect the movement and position of the head in space. This allows for proper eye movement, equilibrium, and body posture.

Inside the saccule and utricle is the neuroepithelium. This is the macula, providing neural feedback regarding vertical motion from the saccule and horizontal motion from the utricle.

The macula has an otolithic membrane embedded with small calcium carbonate crystals. These crystals are known as otoliths and help the hair cells respond to signals. The three semicircular ducts sense whenever the head rotates or picks up angular acceleration.

The semicircular ducts are dilated close to the opening of the utricle. The dilation is known as the ampulla. The ampulla contains a new row epithelial structure known as the crista ampullaris or the sensory organ of rotation.

The vestibular ocular reflex is an efferent signal. This allows the eyes to remain fixed on an object while the head is tilting or moving. This coordinated movement between both eyes involves the para pontine reticular formation. There are outputs to various extraocular eye muscles, abundance - and ocular motor nerves.

So how exactly does the vestibular system work? Whatmechanicsare in place when the body is in motion, and how does it simultaneously keep the head stable and the eyes fixed on a specific object?

This intricate system accelerates the endolymph within the various vestibular structures and apparatus. The endolymph is accelerated when the head moves in various directions. This acceleration stimulates the hair cell stereocilia. As soon as the head stops moving, the hair cells return to their original position.

This instant repositioning allows them to react to any changes in the acceleration of the endolymph. Due to the acceleration and depending on its direction, the inertial drag of the endolymph will either push or pull the stereocilia to or from the fixed kinocilium.

Any movement towards the kinocilium opens the cation channel, and movements away from the kinocilium close the cation channel. There is a polarization or depolarization that takes place. Depolarization opens up the calcium channels.

When a calcium channel is opened,  neurotransmitters are released across the synaptic cleft. This nerve transmission leads into the vestibular ganglion. Inside the vestibular ganglion, these nerve signals have to pass through 20,000 bipolar neurons And exit along the vestibular nerve.

The cochlear and vestibular nerves enter the brain stem at the pontomedullary junction. The vestibular nucleus complex processes most vestibular signals. Other signals are sent from the vestibular nucleus to the cortex, cerebellum, or thalamus. From here, many postural or ocular muscles are adjusted through various signals.

Along with the vestibular system, the hippocampus is crucial n functions of navigation, orientation, and spatial memory.

From there, the otic pits develop and form the otic vesicles, and the upper part of the otic vesicle becomes the vestibular apparatus. Through the lengthening of the optic vesicle, a division between the ventral circular portion and dorsal utricular portion starts to form.

Later in development, the ventral circular portion becomes the cochlear duct and adult saccule. The dorsal utricle portion becomes the utricle and semicircular canals. At 19 weeks of gestation, the ossification of the system begins. The vestibular system reaches adult size at 25 weeks of gestation.

The following are the most common tests that can be performed on various patients –

If the patient’s eyes deviate to the side opposite of the head movement, it indicates the brainstem being intact. If the brain stem is not intact, the eyes will follow the rotation of the head.

Caloric testing-  This test uses temperature fluctuations to diagnose potential damage to acoustic nerves. Cold air or water is delivered into the ear in small amounts to trigger nystagmus. This is the involuntary movement of the eyes away from the affected ear and slowly turning back. After the cold water and air is deposited, warm water is used, but now the eyes will turn toward the affected ear and then slowly back to the front.

Videonystagnometry– One of the more common tests using a three-part vestibular function approach. These include caloric testing, ocular motor, and positional testing. Further, VHIT - video head impulse testing – and rotation tests can be added to the diagnostics to monitor head rotation at different angles and eye movement as a response. These tests check the integrity of the reflexes.

There are a few common symptoms of vestibular dysfunction, and it can manifest in the following manners –

Although some of these symptoms can be related to other diseases or conditions, if there are no significant results in blood tests, the diagnostic modalities should positively point to a vestibular disorder.

The link between cognition and the vestibular system is still mysterious. There seems to be a link between a vestibular disturbance and diminishing learning abilities, spatial navigation, object recognition, and memory capacity.

In the physiopathological study of vertigo, there are two types: central vertigo and peripheral vertigo. The more common of the two is peripheral vertigo. The most common causalities are –

Meniere’s Disease-

Viral neuritis causes peripheral vertigo as a result of an inflamed vestibular nerve. The other cause can be a viral infection in the inner ear, causing the vestibular nerve to be affected. The presenting symptoms are loss of balance and hearing simultaneously.

These distressing symptoms can last from a few days to several weeks. Because it is usually a viral infection, antibiotics are not readily prescribed, and treatments are symptomatic. These treatments include anti-inflammatory and pain medication, anti-vertigo medication, and sometimes a walking aid such as a crutch or a cane.

A walking aide is usually suggested for older patients due to the risk of falling and injury.

BPVV – Benign Paroxyxmal Positional Vertigo–

The most common and short-lived peripheral vertigo presentation is the BPVV lasting a few seconds to minutes. It is believed it is due to otoconia being displaced inside the posterior semicircular canal.

It creates a feeling of swaying, dizziness, and movement for a few seconds or minutes. The most successful treatment for BPPV is the Epley maneuver which an ENT Specialist or a Chiropractor can perform. The Dix-Hallpike test can be used to diagnose BPPV.

Aspirin Toxicity or Salicylate Poisoning -

Aspirin poisoningis ototoxic and can be a life-threatening condition. One of the results of aspirin poisoning is hearing damage, but fortunately, it is reversible. Symptoms of aspirin poisoning are disorientation, nausea, vomiting, metabolic acidosis, and tinnitus.

Treatment is with sodium bicarbonate and dextrose.

Avestibular balance disordercan affect anyone at any time and have numerous causes. Because the inner ear is so delicate and nerve-rich, it presents rapidly. The following causes are the most common –

Common Symptoms Of Vestibular Balance Disorders

The most common symptoms of vestibular balance disorders present as follows –

How Is Vestibular Balance Disorder Diagnosed?

If going to your regular GP does not result in a favorable diagnosis, they may refer you to a specialist called an ENT or Ear, Nose, and Throat specialist. These physicians specifically diagnose and treat related conditions.

The following tests or examinations can be expected from the ENT –

How Is Vestibular Balance Disorder Treated?

Depending on the diagnosis of the cause, the ENT specialist will prescribe the treatment best suited to the patient but can include the following –

Lifestyle changes– Many times, a lifestyle change such as quitting smoking and alcohol or a dietary change like cutting out sugar is all that is needed to promote healing.

Epley Maneuver– Used effectively to reposition the calcium particles in the semicircular canals.

Treatment for the underlying root cause– Antibiotics for bacterial infections or antifungal medications may be prescribed alongside anti-inflammatory and pain medications.

Surgical intervention –Used only when all other treatment methods have failed.

Rehabilitation –After surgery, you may need to undergo rehabilitation for a period. Vestibular rehabilitation is fairly specialized, and the therapists will help you with the following areas  -

The vestibular system is critical to the body in terms of balance and mobility. A vestibular disturbance or disorder can be devastating and create permanent changes in daily functions.

If you experience sudden onset vertigo, it’s a good idea to have it looked at to determine the root cause and get early treatment.

Resources

https://www.ncbi.nlm.nih.gov/books/NBK557380/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916785/

https://en.wikipedia.org/wiki/Vestibular_system

https://www.britannica.com/science/ear/The-physiology-of-balance-vestibular-function

https://www.webmd.com/brain/vestibular-disorders-facts

https://www.ncbi.nlm.nih.gov/books/NBK499879/

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Reference this article:Practical Psychology. (2022, August).Vestibular System (Function, Location, and Balance).Retrieved from https://practicalpie.com/vestibular-system/.Practical Psychology. (2022, August). Vestibular System (Function, Location, and Balance). Retrieved from https://practicalpie.com/vestibular-system/.Copy

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Practical Psychology. (2022, August).Vestibular System (Function, Location, and Balance).Retrieved from https://practicalpie.com/vestibular-system/.Practical Psychology. (2022, August). Vestibular System (Function, Location, and Balance). Retrieved from https://practicalpie.com/vestibular-system/.Copy

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