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The vestibular system comprises the peripheral vestibular apparatus, of which there is one in each inner ear, the nerves that relay the information and specific areas of the brain, termed the central vestibular system. There are many conditions that affect the vestibular system, with the three most common being BPPV, vestibular neuritis and vestibular migraine.  A wide range of symptoms can include: spinning vertigo, dizziness, blurring of vision (oscillopsia), imbalance and falls.  Vestibular rehabilitation is a targeted approach to reduce these symptoms and help people to improve their quality of lives.


What is the vestibular system and what does it do?

The vestibular system has two distinct roles: balance and posture; and, stability and clarity of your vision.  Each ear has three semi-circular canals arranged perpendicular to each other which detect rotational head movements, for example looking left/right or up/down.  Additionally, each ear has a central chamber containing two otolith organs that detect vertical and horizontal head movements, for example travelling in a lift or car, as well as head tilt.


Each semi-circular canal and otolith organ have individual receptor areas that detect movement and convert this into a nerve signal that specific areas of the brain then interpret.  Integral to the receptor areas for the otoliths is the presence of otoconia or calcium carbonate crystals.  These crystals make the otoliths gravity sensitive and can be responsible for the most common cause for dizziness – Benign Paroxysmal Positional Vertigo (BPPV). 

Information from the vestibular system as well as information from the muscles and joints (proprioception) and eyes, are processed by the central vestibular system in the brain for the control of posture and balance.  The semi-circular canals also detect head motion and, through the vestibulo-ocular reflex (VOR), maintain stability of gaze (vision) when moving. 


Common conditions

There are many conditions that affect either the peripheral vestibular system or the central vestibular system.  Common peripheral vestibular conditions include: vestibular neuritis, labyrinthitis, Meniere’s disease and BPPV. 


Central vestibular disorders affect the areas of the brain responsible for processing peripheral vestibular information and other connecting areas of the brain.  Common causes include: stroke, head injury, vestibular migraine and multiple sclerosis.


What is the treatment?

There are many treatment resources and sources of advice available online, and often people can fully recover on their own.  However, a large proportion don’t and require more specialist help. This treatment approach is called Vestibular Rehabilitation (VR).

Vestibular rehabilitation is a progressive exercise-based approach that helps to improve balance, posture and visual stability.  It may also include specific treatment manoeuvres when symptoms are triggered only by position changes such as getting in and out of bed or looking up or down as with BPPV.  Therapy works to help patients resume activities and independence in activities that they are unable or struggling to do, including daily household tasks, work, leisure and social activities. 


At VESTIBULAR REHAB PHYSIO we are able to complete a detailed assessment and provide a personalised therapy approach.  If you have dizziness or imbalance then get in touch to arrange an assessment and to find out how we can help. 

Introduction to the vestibular system

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