The Balance System
Balance depends on information from three key sources: the visual, vestibular, and proprioceptive systems.
Vision provides our brains with visual information regarding the world around us, and if movement is occurring.
The vestibular system detects our orientation to gravity and movement, helping us navigate the world around us.
The proprioceptive system controls information about our muscles, joints, and body - it tells our brain where our body is in space.
Our brains integrate information from these three systems to ensure our equilibrium and balance. The vast majority of information is detected, and processed by, the vestibular system. Hence, the study of vestibular disorders encompasses many conditions that affect balance.
We are usually not even aware of the information detected by our senses, and processed by our brains to maintain our equilibrium. However, when a problem affects our balance, we are assaulted by a multitude of highly-distressing symptoms.
Symptoms of Vestibular Disorders
VERTIGO can be understood as the illusion of motion. A person may experience spinning, tumbling, rocking, swaying, falling through space, swimming, floating, and other comparable sensations.
DIZZINESS is defined as a feeling of disorientation without sensations of movement. Examples of dizziness include feeling lightheaded, "off", tipsy, and discombobulated.
Vertigo and dizziness may occur without provocation, or be triggered by specific stimuli, like head position, neck movements, visual environments, sounds, straining, and motion.
POSTURAL SYMPTOMS occur when one is upright and moving around. These include unsteadiness (which is commonly described as feeling off balance, unable to walk a straight line, or walking as though drunk), and directional pulsion (feeling as though being pushed or pulled in a particular direction).
OSCILLOPSIA means seeing the visual environment bouncing around, which occurs when a person suffers from NYSTAGMUS (a to-and-fro jerking movement of the eyes).
ATAXIA is a lack of coordination, resulting from problems affecting the cerebellum, or the proprioceptive system.
Many vestibular disorders are accompanied by other symptoms, depending on which part of the inner ear or brain is affected. For example, the cochlea is closely associated with the vestibular apparatus in the inner ear; some disorders like Meniere's disease, is characterized by vertigo, and ear symptoms. In another instance, neurons that convey vestibular information pass through the brainstem, which also controls many important neurological functions; a vestibular disorder in the brainstem can be accompanied by impairment of these neurological functions (e.g., paralysis, slurred speech).
Some symptoms are not directly related to the vestibular system but characterize the disorders they are arise from. For example, light and sound sensitivity occur in people with vestibular migraine. Brain fog and fatigue also occur in people with migraine. Speech and gait difficulties may occur in those with cerebellar ataxia.
Diagnosing Vestibular Disorders
There are a huge number of conditions that can manifest with vestibular disorders. A detailed, thorough history and examination are essential to identify the problem(s) affecting the vestibular system. Vital clues in a person's history can often help pinpoint the diagnosis.
Tests like MRIs, CTs, audiograms, VNGs, and certain laboratory investigations can be undertaken to help refine the diagnoses.
Treatment of Vestibular Disorders
There is no "one-size-fits all" approach to treating vestibular disorders. The right treatment all depends on the diagnosis. Getting the right diagnosis leads to the right treatment plan, which will ultimately help you heal and return to a normal life. Of course, the right treatment will also depend on our patients' preferences and lifestyle.
Treatments for vestibular disorders can be categorized into nutraceuticals (e.g., vitamins, herbal supplements), medications, exercise, vestibular rehabilitation therapy, behavioral modification, psychological support, and neuromodulation.
We believe in a comprehensive, science-based, holistic approach that incorporates all these elements, with our patients' wellbeing as its focus.