Vestibular disorders: When your ears throw you off-balance

Some people don’t need to go on a merry-go-round to feel as though the world is spinning around them, and they don’t need to climb up a tower to get dizzy... just standing up leaves them feeling off-balance. These people suffer from vestibular disorders.

There are several types of vestibular disorders, and they cause a variety of symptoms ranging from vertigo, dizziness, the illusion of movement, loss of balance, and even hearing and concentration problems.

Which organs are responsible for balance?

If you can walk, jump or ride a bike without falling, it’s thanks to a complex set of reactions that involve several different systems in your body. In order for you to keep your balance, your body is constantly sending sensory information to your brain from your eyes, touch and ears. The brain interprets this information and sends commands to the body (mainly the muscles and joints) in order for it to correct its position and keep its balance. All this happens constantly and at lightning speed, anytime you move.

The ear plays an important role in our equilibrium, and it has nothing to do with sound. It’s important to know that our ears are made up of three parts: the outer ear (the pinna), which is the segment that we see outside the head; then the middle segment, which is found just inside the head (where the eardrum is); and lastly the inner ear, which is deeper inside the skull. The latter is the segment that is involved in our sense of balance.

The inner ear is composed of various structures (receptors, canals and cavities, the latter two filled with fluid) that make up the vestibular apparatus. When you move, the fluid inside the vestibular apparatus gets displaced inside the ear canals and cavities. The receptors react to this by sending information to your brain about the position of your body in its environment (e.g. to tell it whether it is standing, leaning over or lying down), or the direction of your movements (e.g. moving backwards, forwards, up or down).

Losing your bearings

Most balance disorders are the result of an inner ear problem. When something goes wrong in the inner ear, the signals transmitted to the brain can be wrong or contradictory, leading to symptoms such as dizziness, the illusion of movement, or a loss of balance. Vision problems can also affect your sense of balance, as can a weakening of the muscles or a muscle injury.

There are dozens of disorders that can affect your balance. Here are some of the most common.

Ménière's disease:

In this disease, one of the liquids in the inner ear (endolymphatic fluid) accumulates in an area of the inner ear, causing symptoms such as loss of balance, dizziness, headaches and hearing problems. These symptoms come on as attacks with a frequency that varies from one person to another. Ménière's disease usually develops in adulthood (after age 40 in most cases). It is not yet known what causes the accumulation of fluid, and as yet there is no cure for the condition.

Benign paroxysmal positional vertigo (positional vertigo):

This is the most common vestibular disorder. It causes a spinning sensation brought about by rotational changes in the position of the head. In persons under the age of 50, this type of vertigo is usually a result of head trauma (e.g. concussion), which causes a calcium deposit in an inner ear canal. In older individuals, it is common for no exact cause to be found. In those cases, the problem is thought to be age-related. To solve the problem, the physician may try cranial and upper-body manipulations to try to dislodge the calcium deposits from the canal where they have accumulated.

Labyrinthitis and vestibular neuritis 

These disorders are caused by an inner ear infection. Because of the infection, various inner ear structures become inflamed, which affects the transmission of information to the brain. As a result, the brain receives the wrong information, producing symptoms such as dizziness, loss of balance, vertigo and hearing problems. These infections are usually caused by a virus. The virus may only affect the inner ear and cause no other symptoms, or it may attack the whole body. For example, the flu virus can cause labyrinthitis or vestibular neuritis in addition to the usual flu symptoms.

With this type of problem, symptoms appear suddenly and usually disappear over a period of several weeks. Some people may experience permanent symptoms (e.g. dizziness) if part of the inner ear was damaged by the virus.

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