Understanding the Vestibular System and Its Disorders
Each day, our bodies engage in a series of functions we don’t really consciously think much about. For example, our hearts beat on their own, we breathe without making any effort, and we keep our balance without trying. That last bodily function is a product of the vestibular system. What is this and why is it important?
The vestibular system manages our posture, keeps our head and eyes in place when our bodies move, and allows us to maintain our balance. Disorders of the vestibular system may cause alterations to a person’s psychological or cognitive wellbeing as well.
Like the many fine details of our lives, God has created an intricate system that manages our stability. For most of us, we only experience the sensation of being thrown off kilter when spinning in a circle or riding a roller coaster. But, for those who suffer from sensory issues of the vestibular system, the ride is not so smooth. As you read, think if you will of a rocking boat with waves crashing over like in Matthew 8:23-29. This is the story where Jesus was a sleep as the disciples panicked as they watched the storm grow. That panic and uncertainty is a glimpse at what it might feel like for a person with vestibular issues!
In this article, we will talk in great detail about the vestibular system, including how it works and the ways we use it, as well as potential treatments to calm the storms of your senses.
What Is the Vestibular System?
The vestibular system is within our inner ear. This part of the ear also includes the cochlea. While the cochlea allows us to hear, the vestibular system manages our balance. We can also keep our posture and maintain head stability when our bodies move thanks to the vestibular center.
Our head stability comes from two parts of the vestibular system, the otoliths and the semicircular canals. Here’s an explanation of both these components.
Otoliths go by such names as statoliths, otoconiums, and statoconiums. They’re located in our inner ear’s saccule, or a sensory cell bed, as well as the utricle. These two components comprise our otolith organs.
Without otolith organs, we’d have no sense of gravity or linear acceleration.
We’re not the only ones to have otoliths. Birds, mammals, reptiles, amphibians, and fish possess these inner ear parts as well. That said, the location of the utricle and saccule differs from one animal type to another due to the size and shape of their head.
Semicircular canals, sometimes also called semicircular ducts, include three tubes. One tube is called the posterior semicircular canal, the other a superior semicircular canal, and the third a horizontal semicircular canal. These tubes start at the inner ear and are connected.
The posterior semicircular canal has a sagittal or antero-posterior axis. When our heads move, this semicircular canal picks up on the movement. Of all the three semicircular canals, the posterior is longest.
The superior semicircular canal detects rotations of our head, such as left and right. The most common example of the superior semicircular canal in action is when you nod your head.
Finally, there’s the horizontal semicircular canal. This may also be referred to as an external semicircular canal or the lateral semicircular canal. It may be the shortest canal, but it’s quite a crucial one. The horizontal semicircular canal has fluid within it that moves depending on how your head does.
Each canal is sort of parallel to one another, so that there’s a counterpart on the opposite side. So, let’s say you did nod your head. This would activate your superior semicircular canal. The semicircular canal opposite that would temporarily stop until it was needed. Then your superior semicircular canal would stop for the moment when the other canal is active.
This is known as a push-pull system. Without this type of movement system, we’d lose our rotational direction options.
The vestibulo-ocular reflex or VOR also comprises our vestibular system, although it’s not related to our posture. Instead, it’s a type of eye movement that’s reflexive. In other words, if our heads move, the retinal images we see get stabilized by the VOR.
How? Our eyes move in the opposite direction our heads do, keeping the image front and center in our field of vision. VOR disorders may cause reading difficulties and other vision issues.
How Do We Use the Vestibular System?
As we alluded to at the beginning of this article, you don’t actively use the vestibular system. It’s something that naturally happens for many of us every day. The only exception is if you have a vestibular system disorder, of which we’ll talk about more in the next section.
Thus, you don’t have to do anything to activate your vestibular system. As you live and go about your day-to-day life, the vestibular system works behind the scenes. Here’s what you can do because of the vestibular system.
Our balance is dictated by sensorimotor control systems. The vestibular system is one of these, but not the only one. The others in the sensorimotor control system are our proprioception and vision systems.
The spatial orientation and equilibrium granted to us by our vestibular system keep us upright when we’re standing. Proprioception relates to our ability to perceive our body, and our vision system manages our sight.
Some situations might make us feel unbalanced, such as spinning around or riding a scary roller coaster at an amusement park. Alcohol consumption can also impair balance. Otherwise, in our day to day lives, we should feel secure and stable when we stand, sit, or walk.
As we get older, our balance may begin to turn unsteady. The same is true of taking some medications, developing diseases, or sustaining a particularly serious injury.
You should stand tall and proud every day just as God made you, but that can sometimes be easier said than done. Our lifestyles don’t exactly promote the best posture, after all.
Three types of posture issues are very common in modern society. These are kyphosis, anterior pelvic tilt, and over-pronated feet. Let’s talk more about all three.
Kyphosis or a hunchback, as the name implies, is often caused by long-term hunched sitting. Office workers know the feeling all too well of being crunched over their desks in an uncomfortable chair. This can cause the upper back to curve.
Having a hunchback can lead to back and neck pain if left untreated. By doing exercises and stretches like seated rows, face pulls, and doorway stretches, it’s possible to reverse moderate cases of kyphosis.
Anterior pelvic tilt doesn’t affect the back, but rather, the hips. You tilt them forward, often without even realising it, and tighten the hip flexors. Your lower back may begin to hurt, and your hamstrings and hips are probably not as strong as they could be.
If you have anterior pelvic tilt, you likely developed it from spending too long in a seated position. You need to get up and stretch your body after an hour or so. Exercises can also help this posture issue.
With over-pronated feet, your feet turn too far outwards. This can affect your knee rotation as well as your calf muscles and feet arches. Orthotics treat over-pronated feet effectively. So can exercises.
Think of how much movement your head does on an average day. If you drive to work, you turn your head when in the car to make sure you can safely turn or pass. In school, you have to turn to fellow classmates at times, especially if you’re working on a group project together.
If every time your head moved, you felt pain or instability, daily life would be pretty hard. Through our vestibular system, we can move our heads without effort.
With the posterior and anterior semicircular canals, our frontal and sagittal planes let us nod and make other free head movements. The horizontal semicircular canal manages head movements around the neck, or our vertical axis.
Disorders That Can Affect the Vestibular System
The above ways of using the vestibular system are not something everyone can do, like we said. Those with a vestibular system disorder may have problems with posture, balance, vision, and more. According to Vestibular.org, vestibular dysfunction is quite common, affecting 69 million people in the United States who are 40 or older. That’s 35 percent of the adult population in the country.
Which disorders can cause your vestibular system to malfunction? They include perilymph fistula, secondary endolymphatic hydrops, Meniere’s disease, labyrinthitis and vestibular neuritis, and benign paroxysmal positional vertigo or BPPV.
The ear’s round and oval windows are torn when you have perilymph fistula. These windows are membranes that keep the inner ear’s perilymphatic fluid from the middle ear. With perilymph fistula, that fluid reaches the middle ear, where it should not be.
Now, when the air pressure changes around you–such as riding in a train or an airplane–and your ears pop, the inner ear is impacted. This could cause issues with your hearing and/or balance.
Another symptom is increased headaches. These occur because your brain’s cerebrospinal fluid moves to the ear. Cerebrospinal fluid is close to perilymphatic fluid in terms of sodium content, so it can be use used interchangeably. This takes away the cerebrospinal fluid from the brain though, which makes your head hurt.
Secondary Endolymphatic Hydrops
You could have secondary endolymphatic hydrops, an inner ear disorder. The endolymph is a part of your inner ear that has electrolyte fluids like chloride, potassium, and sodium. The pressure also remains consistent here.
Endolymphatic fluids cover the inner ear’s sensory cells so they can work as they should. Thus, with secondary endolymphatic hydrops, this fluid is either lessened or completely depleted. The endolymph’s volume can change, which causes symptoms like a feeling of imbalance, wooziness, hearing loss, ear ringing, and a full feeling in your ears.
Named after Prosper Meniere, a physician from France who researched tinnitus and vertigo, Meniere’s disease is yet another vestibular system disorder.
Meniere’s disease causes endolymphatic polyps, which occur during certain times as a vertigo attack. These attacks can cause worsening symptoms, as can an advanced case of the disease. At the start of the disease, symptoms may include dizziness and various degrees of hearing loss.
The vertigo attacks, by the way, come with their own symptoms. These are an uneasy feeling, sensitivity to sounds, increased tinnitus, and a boost in ear pressure. You may feel lightheaded, woozy, and unbalanced as well. Some patients with Meniere’s disease also report an aura before a vertigo attack.
Labyrinthitis and Vestibular Neuritis
Vestibular neuritis and labyrinthitis are related disorders. When you have an ear infection and the inner ear becomes inflamed, the nerves in the inner ear may be affected as well.
All that swelling makes it difficult for the brain and the ear to maintain a sensory connection. This can leave you with hearing troubles, vision issues, balancing difficulties, dizziness, and vertigo.
Benign Paroxysmal Positional Vertigo
Speaking of vertigo, benign paroxysmal positional vertigo or BPPV is yet another vestibular system disorder. It causes vertigo, or a sensation that you’re spinning even if you’re stationary.
BPPV is associated with the inner ear. Canaliths or calcium carbonate crystals pass from the utricle’s gel to your semicircular canals. If the particles build up, the fluid within the semicircular canals cannot travel freely. The inner ear may then pass along unnecessary signals to your brain.
A feeling like vertigo can also occur if you have vestibular over-responsiveness. With this disorder, if you do a physical activity, the effects of it stay with you for hours at a time. For example, a child riding on a swing at a park in the morning could still be experiencing nausea in the afternoon.
In children, symptoms of vestibular over-responsiveness are frequent motion sickness, fear of their feet leaving the ground, a preference for a sedentary lifestyle, and a lack of interest in playing with other children.
Oppositely, vestibular under-responsiveness calls for more physical motions than most people engage in. The symptoms of this in children are being unable to sit for long periods, acting impulsively when let out to play, running in inappropriate places (such as a classroom), and constant fidgeting.
Treatment for Vestibular System Disorders
If you or someone you know has been diagnosed with a vestibular system disorder, it can be a hard experience. Having difficulties verbalising what you’re going through can make you feel like you’re all alone. You might not look sick, but inside your body, a lot is going on that makes you miserable.
Luckily, many treatments exist for alleviating vestibular system disorder pain and discomfort. Not every disorder we mentioned above is curable, but with the right treatment, many vestibular system disorders can become more manageable.
Here is an overview of treatment options. Much more can said about sensory integration treatment and how it works with the vestibular system, but for now here is the overview.
For initial vestibular disorders, acute ones (ongoing for at least five days), and chronic disorders, medication may lessen and even eliminate symptoms. A doctor will subscribe vestibular suppressants like benzodiazepines, antihistamines, and anticholinergics.
Other effective medications include antibiotics like amoxicillin, antiviral meds such as acyclovir, or steroids like prednisone. These medications are especially adept at reducing middle ear infection symptoms during the acute phase.
Your doctor will likely halt most medications as you move to the chronic phase of your vestibular system disorder. Your brain must go through vestibular compensation to adapt to the disorder. Suppressants taken at this time could interrupt your vestibular compensation.
Talk therapy with a counselor or psychiatrist can help the vestibular disorder patient better understand what’s happening to them. If you have feelings of grief, guilt, or depression–which does sometimes happen–therapy allows you to identify and then rectify those feelings.
What you eat may play a role in the severity of some vestibular disorders, among them migraines, secondary endolymphatic hydrops, and Meniere’s disease. It’s important to cut certain foods and eat more balanced and nutritious meals. Here are some foods and ingredients to omit.
- Tyramine: If you have frequent migraines or headaches from a vestibular disorder, stop eating foods with tyramine. This amino acid is in nuts, ripened cheeses, figs, citrus fruits, bananas, chocolate, yogurt, smoked meats, chicken liver, and red wine.
- Alcohol: Fluid levels and pressure of the inner ear can both change depending on how much alcohol you drink. Thus, it’s recommended you skip alcohol as much as you can.
- Caffeine: Caffeine will worsen tinnitus, so limit any foods and beverages with caffeine in them.
- Excess salt and sugar: Sodium can lessen your body fluids, so ask your doctor about how much sodium is appropriate for someone with a vestibular system disorder. Sugars can have a similar effect, so limit these.
Vestibular Rehabilitation Therapy
Vestibular rehabilitation therapy or VRT may improve your balance and inner ear symptoms. Under this form of rehab, you do exercises with the guidance of a professional. These exercises may include habituation exercises, which can help lessen self-motion-caused dizziness.
Gaze stabilization exercises and balance training exercises may also be included under a VRT regimen. This rehab will differ for each vestibular disorder patient depending on their type of disorder and which symptoms interrupt their lives most.
It’s also possible for you to continue your VRT from the comfort of your own home. These exercises focus on strengthening your balance and lessening your dizziness.
Canalith Repositioning Maneuvers
The Epley Maneuver or canalith repositioning procedure for BPPV patients encourages you to turn your head to loosen the canaliths so they can get back to the utricle. There, the canaliths may break down or dissolve. If not, they’ll at least stay in place.
You don’t do canalith repositioning movements at home, but rather, with a medical professional’s guidance. The professional will study how your eyes move as your head does. Medications like diazepam may lessen the nausea some patients experience during this treatment. In all, you’ll spend 15 minutes or longer per session undergoing the canalith repositioning procedure.
Vestibular.org notes that 80 percent of patients who undergo this treatment are cured of BPPV.
Sensory Integration Therapy
For some patients with vestibular processing issues, sensory integration therapy will be the answer. This therapy has it’s own fidelity measurements and proper procedures to help children and adults develop their vestibular processsing and go from strength to strength with it.
If the above methods have not helped with your vestibular system disorder symptoms, surgery is the last resort. Here are some procedures you may undergo.
- Ultrasound surgery: The ear’s balance end organs get destroyed through ultrasound surgery. This prevents the brain from getting unnecessary ear signals in the future.
- Cholesteatoma removal: The middle ear skin growth known as a cholesteatoma uses enzymes to wreck bone. This surgery takes out the cholesteatoma to preserve ear bone structure.
- Acoustic neuroma removal: A vestibular schwannoma or acoustic neuroma removal takes out thevestibulo-cochlear nerve tumor. This tumor is benign, but it can be problematic.
- Microvascular compression: The vascular loop, which is a type of blood vessel, may have a buildup of pressure around the vestibulo-cochlear nerve. A microvascular compression surgery lessens that pressure.
- Canal plugging: Canal plugging or partitioning can help with BPPV. The semicircular canal gets diverted or filled with human fibrinogen glue and bone chips so particles can’t get in there anymore.
- Pneumatic equalization tubes: Perilymph fistula patients may receive a pneumatic equalization tube procedure. The surgeon will send a tube through the eardrum from the middle ear to the ear canal. This keeps ear drum air pressure equalized for fewer symptoms.
- Labyrinthectomy: For Meniere’s disease patients, your doctor may recommend a labyrinthectomy. The cochlea and balance end organs get removed during this procedureto stop inaccurate signals from the inner ear to the brain.
“The men were amazed and asked, “What kind of man is this? Even the winds and the waves obey him!”—Matthew 8:27
The vestibular system manages our balance, posture, and head stability. Many people don’t think twice about their vestibular system because it works just fine. However, it can become all you think about is you have a vestibular disorder. Jesus Christ himself controls the winds and the waves, and He can help calm your storms too. Christian Occupational Therapy Support is here to help adults and children better understand their difficulties and overcome their symptoms. Do book a call to talk things through!