Ear Institute : Ear Institute Programs

Vestibular (Balance) Program

At the UHealth Ear Institute there is state of the art equipment available to diagnose, treat, and assess the vestibular/balance system structures and their function. To better understand these available services, below is a brief description of the balance structures, their function, disorders and assessment.

The vestibular system, which contributes to our balance and our sense of spatial orientation, is the sensory system that provides the dominant input about movement and equilibrioception. Together with the cochlea, a part of the auditory system, it constitutes the labyrinth of the inner ear, situated in the vestibulum in the inner ear (Figure 1). As our movements consist of rotations and translations, the vestibular system comprises two components: the semicircular canal system, which indicates rotational movements; and the otoliths, which indicate linear accelerations. The vestibular system sends signals primarily to the neural structures that control our eye movements, and to the muscles that keep us upright. The projections to the former provide the anatomical basis of the vestibulo-ocular reflex, which is required for clear vision; and the projections to the muscles that control our posture are necessary to keep us upright.

Some otologic diseases that can affect the vestibular system are:

  • Meniere’s disease
  • Vestibular schwannoma/acoustic neuroma
  • Vestibular neuritis
  • Labyrinthitis
  • Superior canal dehiscence syndrome
  • Benign paroxysmal positional vertigo (BPPV)
  • Autoimmune inner ear disease
  • Herpes Zoster oticus
  • Ramsey hunt syndrome
  • Mal of Debarquement

These diseases have the following possible symptoms in common: Dizziness, vertigo, lightheadedness, disequilibrium, tinnitus (ringing and/or noises in the ear), hearing loss, aural fullness.

These diseases can also affect or compromise different structures from the vestibular system. The diagnosis, treatment and prognosis will be determined by the damaged structures within the vestibular system. Therefore, a comprehensive examination and expertise are imperative when diagnosing vestibular problems.

A balance disorder is a disturbance that causes an individual to feel unsteady, giddy, woozy, or have a sensation of movement, spinning, or floating. Balance is the result of a number of body systems working together. Specifically, in order to achieve balance, the eyes (visual system), ears (vestibular system) and the body’s sense of where it is in space (proprioception) need to be intact. Also the brain, which compiles this information, needs to be functioning normally.

Balance is the result of a number of body systems working together. Specifically, in order to achieve balance the eyes (visual system), ears (vestibular system) and the body’s sense of where it is in space (proprioception) ideally need to be intact.

The vestibule is the region of the inner ear where the semicircular canals converge, close to the cochlea (the hearing organ). The vestibular system works with the visual system to keep objects in focus when the head is moving. This is called the vestibulo-ocular reflex (VOR).

Movement of fluid in the semicircular canals signals the brain about the direction and speed of rotation of the head – for example, whether we are nodding our head up and down or looking from right to left. Each semicircular canal has a bulbed end, or enlarged portion, that contains hair cells. Rotation of the head causes a flow of fluid, which in turn causes displacement of the top portion of the hair cells that are embedded in the jelly-like cupula. Two other organs that are part of the vestibular system are the utricle and saccule. These are called the otolithic organs and are responsible for detecting linear acceleration, or movement in a straight line. The hair cells of the otolithic organs are blanketed with a jelly-like layer studded with tiny calcium stones called otoconia. When the head is tilted or the body position is changed with respect to gravity, the displacement of the stones causes the hair cells to bend.

The balance system works with the visual and skeletal systems (the muscles and joints and their sensors) to maintain orientation or balance. For example, visual signals are sent to the brain about the body’s position in relation to its surroundings. These signals are processed by the brain, and compared to information from the vestibular, visual and the skeletal systems.

The equipment and tests available at the UMEI to assess and treat vestibular and balance disorder can be found in our Diagnostic Services: section.