Are you feeling dizzy? Are you losing your balance? Let's talk about the amazing system that controls our body's balance (Vestibular System)

Do you suddenly feel dizzy? Or do you feel like things around you are spinning around you? Do you ever feel like you are suddenly going sideways or losing your balance while walking? We have all experienced this at least once in our lives. For some, this is an occasional occurrence, but for others, it can be a constant, lifelong problem. So today we are going to talk about the main cause of these things, the amazing and complex system that controls our body's balance.

What is the Vestibular System?

Simply put, the vestibular system is the main sensory organ that controls our body's equilibrium, or balance. It's like an automatic 'spirit level' built into our body. It reports to the brain all the information we have about whether we're standing, leaning, moving, and what position we're in.

This system can be divided into two main parts:

• Peripheral vestibular system: This is the main part of the system. It is located in our inner ear . We usually refer to this part as the "vestibular system." This is where we sense information related to our balance.
• Central vestibular system: This is part of our central nervous system, which is the brain and spinal cord. It receives signals from the ears, analyzes them, and instructs the other organs to maintain balance.

How exactly does this system work?

The balance of our body is not something that can be controlled by just one thing. It's like a team sport. There are three main players in this.

1. Vestibular system (part of the ear): Provides information about the position, speed, and direction of head movement.

2. Eyes (vision): Give us information about our environment, where we are, and where things are relative to us.

3. Muscles and joints (Proprioception): Provides a sense of where our limbs are, how we stand on the ground, and how our joints are bent.

Imagine you're walking in a slightly dark room. Since your eyes can't see very well, the vestibular system in your ear and the sensation of your feet hitting the ground are the main things that help you keep your balance. All three pieces of information go to your brain, and the brain combines them all to decide how to keep your body balanced.

There are two very important reflexes that help this process happen automatically.

The relationship between the eyes and balance (Vestibulo-ocular reflex - VOR)

This is a very interesting thing. Imagine you are trying to read a number on a bus on the road. Even if you are walking and your head is moving from side to side, your eyes can still focus on that number. What you see is blurred, not blurred. That is what this `VOR` reflex helps with. When your head moves in one direction, your eyes automatically move in the other direction, keeping what we are looking at steady. Without this, when we walk, the world we see seems to be shaking, like a camera is recording a shaky video.

The relationship between muscles and balance (Vestibulospinal reflex - VS)

This is because our muscles automatically adjust to balance. Imagine you're walking on a gravel road. With each step, your body sways back and forth. But you don't fall easily. That's because, as soon as your head tilts slightly, this system in your ear detects it and immediately sends a signal to your muscles, saying, "Your body is leaning to the right, so don't let it fall and put your weight on your left leg to balance yourself." This happens so fast that we don't even have time to think about it.

Parts of this system and their functions

As we mentioned earlier, the main sensory organs of the vestibular system are located in the inner ear. The cochlea, which helps us hear, is also located in the inner ear. Close to it, in a separate part, are the 5 organs related to balance. These are called the vestibular labyrinth.

Inside these organs there is a fluid called `endolymph` and very fine hair-like sensory cells (`hair cells`). When we move our heads, this fluid also moves. Then the hair cells bend and send signals to the brain through them. These signals are carried to the brain through the `vestibular nerve`.

Let's understand these parts more clearly from the table below.

There's something else special about the otolith organs. They're tiny calcium carbonate crystals called `otoconia.' These are tiny, limestone-like crystals. They're embedded in a jelly-like substance that sits on top of the hair cells. When we move, these crystals move back and forth under the influence of gravity. The hair cells then bend and send signals to the brain. Sometimes these tiny crystals can become dislodged and travel into the semicircular canals, which can cause severe dizziness in some people.

What problems can arise in this system?

There are various medical conditions that can disrupt the functioning of this complex system. Here are a few of them.

• Benign Paroxysmal Positional Vertigo (BPPV): This is the most common cause of vertigo. It occurs when the otoconia, which we mentioned earlier, become dislodged and move into the wrong place. It is felt as a severe dizziness that lasts for a few seconds, especially when rolling over in bed or when moving your head up and down.
• Vestibular Neuritis and Labyrinthitis: These are usually caused by a viral infection that causes inflammation of the vestibular nerve or inner ear. The symptoms can start suddenly and include severe dizziness, nausea, and vomiting that can last for several days. In `Labyrinthitis`, in addition to dizziness, hearing loss can also occur.
• Ménière's disease: This is caused by an increase in the pressure of the fluid (endolymph) in the inner ear. This causes symptoms such as sudden, severe dizziness, ringing in the ears (tinnitus), a feeling of fullness in the ear, and hearing loss.
• Vestibular Migraines: For some people, dizziness may be a more prominent symptom than headache when they develop a migraine.
• Mal de débarquement syndrome (MdDS): This is a strange condition. It is the feeling of being still floating at sea after you have been on a boat or ship and have come ashore.
• Persistent Postural-Perceptual Dizziness (PPPD): In this, there is a persistent feeling of dizziness and loss of balance for no apparent reason.

How do you know there's a problem? Main symptoms

The main symptoms of vestibular system problems are dizziness and vertigo. Although we use these two words interchangeably, there is a slight difference between the two.

In addition to these two symptoms, other things may occur.

• Nausea and vomiting
• Loss of balance and difficulty walking
• Blurred vision
• Ringing in the ears (tinnitus)
• Hearing loss

How does a doctor test this system?

If you have these symptoms, you should definitely see a doctor. The doctor will ask you about your symptoms and examine you. If necessary, they may refer you for these tests.

• Vestibular testing: This is a combination of several tests. These mainly look at how well your eyes and balance system, called the `VOR`, work together.
• Blood tests: To check for things like infections.
• Imaging tests: You may be asked to have a CT or MRI scan to see if there are any structural problems in the brain or ear.

What are the treatments for this?

Treatment depends on your condition. Often, a combination of treatments is used.

• Vestibular Rehabilitation Therapy (VRT): This is a very important treatment. It involves "training" your brain. It involves special exercises that teach the brain to adapt to and ignore incorrect signals from the balance system. In conditions like `BPPV`, a physiotherapist can help you perform `repositioning maneuvers` to put the displaced balls back in place.
• Medications: If there is an infection, the doctor may prescribe antibiotics, as well as medications to control nausea and dizziness.
• Lifestyle changes: You may be advised to stay away from certain things that increase dizziness (e.g., excessive salt, caffeine, stress).
• Surgery: Surgery is not necessary in most cases. However, in very severe cases where no other treatment is effective, surgery may be necessary to repair the structures of the inner ear.

What can we do to keep this system healthy?

To be honest, it's difficult for us to prevent many problems that arise in the vestibular system. But the best and most important thing we can do is to see a doctor as soon as we notice any symptoms and seek advice.

Don't dismiss dizziness as a simple thing. Sometimes it can be a sign of a serious condition, such as a stroke. Therefore, if you experience dizziness along with symptoms such as difficulty speaking, drooping on one side of your face, or numbness in an arm or leg, go to the emergency room (ETU) of a hospital immediately.