Vestibular System Disorders


The vestibular system provides vital sensory information for the control of balance and posture. Vestibular end organs on each side sense linear and angular acceleration in three‐dimensional space: the saccule and the utricle (linear motion), and the anterior, posterior and lateral semicircular canals (angular motion) and transduce this information to electrochemical signals. The central nervous system integrates this information from the vestibular system with visual and proprioceptive information to a best possible estimate of the actual movement of the head and body to stabilise gaze during head motion by means of the vestibulo‐ocular reflex (VOR) and to control balance by modulation of muscle tone through the vestibulocollic and vestibulospinal reflexes. Disorders of the vestibular system, either peripheral or central, often give rise to the sensory illusion of rotation, vertigo, disequilibrium or imbalance, common symptoms in clinical practice.

Key Concepts:

  • The role of the vestibular sensory organs is to transduce the forces associated with head acceleration and gravity into a biological signal.

  • The control centres in the brain use this signal to develop a subjective awareness of head position and head movement in relation to the environment and to produce motor reflexes for equilibrium.

  • The two main motor reflexes are the vestibule‐spinal reflex (responsible for the stability of the body) and the vestibule‐ocular reflex (responsible for stabilising gaze in space).

  • Pathological dysfunction in the sensory organs or in the central pathways of the motor reflexes lead to the sensation of vertigo.

  • History together with a careful clinical neuro‐otological examination are the keys for most vestibular disorders and much more important than recordings of eye movements or brain imaging techniques.

  • Benign positional vertigo is the single most common cause of vertigo that can easily be diagnosed clinically and effectively treated by specific deliberation manoeuvres.

  • Vestibular migraine, a since recently much underestimated disorder, should be suspected when frequent attacks of fully reversible vertigo occur with or without headaches and can be treated successfully with classical migraine medication both for the acute attack as well as prophylactic treatment.

Keywords: vestibular system; vertigo; dizziness; postural control; vestibulo‐ocular reflex; vestibule‐spinal reflex

Figure 1.

The outline of the membranous labyrinth of the right ear of a mammal, seen from a little below and slightly behind the interaural line. Note the indentation of the wall of the ampullae at the region of the cristae. The endolymph cavity of the scala media of the cochlea communicates with the cavity of the sacculus by the ductus reuniens. Sacculus and endolymphatic sac in turn communicate with the utriculus, which also receives all the openings of the semicircular canals. The endolymph cavities of the whole labyrinth thus form a continuous closed system of bags and tubes.

Figure 2.

Classification of physiological vertigo and vestibular disorders with their origin at different sites within peripheral or central vestibular structures. Vestibular disorders are not clinical entities but different sensorimotor syndromes arising from unusual stimulation or lesional dysfunction. From Brandt and Daroff .

Figure 3.

(a) Benign paroxysmal positioning vertigo and nystagmus are precipitated by rapid lateral head tilt towards the affected ear or by neck extension. (b) The typical nystagmus (best seen with Frenzel's glasses) beats towards the undermost ear (or upwards), rotating counterclockwise with right ear lesions (bottom left), and clockwise with left ear lesions. (c) The rotatory linear nystagmus reflects ampullofugal stimulation of the posterior semicircular canal with activation of the ipsilateral superior oblique and contralateral inferior rectus eye muscles. From Brandt (1999).



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Further Reading

Baloh RW and Halmagyi GM (1996) Disorders of the Vestibular System. Oxford: Oxford University Press.

Baloh RW and Honrubia V (1990) Clinical Neurophysiology of the Vestibular System. Philadelphia: F.A. Davis Company.

Brandt T (1999) Vertigo: Its Multisensory Syndromes, 2nd edn. London: Springer.

Eggers SDZ and Zee DS (2009) Vertigo and Imbalance: Clinical Neurophysiology of the Vestibular System. Amsterdam: Elsevier.

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Fetter, Michael(Sep 2010) Vestibular System Disorders. In: eLS. John Wiley & Sons Ltd, Chichester. [doi: 10.1002/9780470015902.a0002213.pub2]