What does vestibular mean?
Vestibular means relating to the vestibule, the central chamber of the inner ear, and more broadly to the balance organs of the inner ear and the nerve that connects them to the brain. So the vestibular system is simply your balance system, and vestibular problems are balance problems that start in the inner ear or in the parts of the brain that process its signals. The vestibular nerve runs alongside the hearing nerve, which is why some inner ear conditions affect both balance and hearing.
The inner ear
Each inner ear contains three semicircular canals that detect rotation of the head and two otolith organs that detect tilt and straight-line movement. Fluid and tiny hair cells in these structures convert movement into nerve signals many times a second.
The brain
Signals from both ears travel to the brainstem and cerebellum, where they are combined with what the eyes see and what the joints and muscles report. The brain uses this to keep the eyes fixed on a target while the head moves, to adjust posture, and to give a sense of where you are in space. Because the system integrates three sources, the brain can compensate when one is faulty, which is the principle behind vestibular rehabilitation.
What is vestibular sensation?
Vestibular sensation is your sense of head movement, acceleration and gravity, often described as the sense of balance. It works mostly without you noticing. You become aware of it when it is strongly stimulated, such as the sinking feeling as a lift stops or the spinning that continues after a fairground ride, or when it goes wrong. Along the vestibular pathway, signals travel from the inner ear through the vestibular nerve to the brainstem and cerebellum, which trigger fast reflexes that keep your eyes steady and adjust the muscles that hold you upright.
Vestibular system problems
Displaced crystals in a canal cause BPPV, brief spinning on turning over or looking up; see what BPPV is. Infection of the nerve or inner ear causes days of severe vertigo followed by weeks of imbalance, as in vestibular neuritis. Migraine can disrupt processing and cause episodic dizziness. Head injury, ageing, some medications and Meniere's disease also affect it. The symptoms are vertigo, dizziness, unsteadiness, visual blurring with head movement, nausea, and a sense of the world moving.
Not every dizzy spell comes from the vestibular system. Light-headedness can come from low blood pressure on standing, dehydration, anaemia, low blood sugar, anxiety or medicines. For a fuller guide to dizziness causes, see why do I feel dizzy.
Why it matters for treatment
Dizziness is a symptom with many causes, and treatment depends on which part of the system is involved. Assessment of eye movements, positional testing and balance identifies the source. BPPV is treated with a repositioning manoeuvre; other causes with exercises that use the brain's ability to recalibrate.
When to get urgent help
Call 999 if dizziness comes with face drooping, arm or leg weakness, slurred speech, double vision, a sudden severe headache or difficulty walking, as these can be signs of a stroke. See a GP if dizziness keeps coming back or comes with hearing loss.
At Omnia
Vestibular First at our Chiswick clinic assesses the whole system and treats accordingly, with tai chi available for longer-term balance training. Book a vestibular assessment for vertigo in Chiswick, including treatment, for £50, and explore tai chi in Chiswick, with group classes at £15. Omnia Lifestyle is at 8 to 9 Bedford Corner, The Avenue, Chiswick W4 1LZ, close to Turnham Green station, on bus routes 94, E3 and 272. Limited parking is available on request when booking.
Book a Vestibular First assessment in Chiswick: assessments from £50. Book online or call 020 4515 0000. Read more about vestibular rehabilitation at Omnia.