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Hearing and Balance Disorders

Balance

Dizziness is a symptom not a disease. It may be defined as a sensation of unsteadiness, imbalance, or disorientation in relation to an individual's surroundings. The symptom of dizziness vary widely from person to person and be caused by many difference diseases or conditions. It can be a mild unsteadiness to a severe spinning sensation known as vertigo. It is not unusual for it to be difficult for the patient to describe their symptom of dizziness to the physician. In addition, because the symptom of dizziness vary so widely from patient to patient and may be caused by many different diseases, the physician commonly requires testing to be able to provide the patient with some knowledge about the cause of their dizziness. Dizziness may or may not be accompanied by a hearing impairment

The ear: a hearing and balance system

The ear is divided into three parts: outer ear, middle ear, and inner ear.

The external ear structures (the pinna and ear canal) gather sound and direct it toward the eardrum. The middle ear chamber consists of an eardrum and three small ear bones (the ossicles). These structures transmit sound vibrations to the inner ear.

The inner ear chamber is encapsulated in bone and filled with fluid. It is divided into two connected parts: the hearing portion (the cochlea) and the balance portion (the vestibule and three semicircular canals). This fluid in the inner ear bathes the delicate nerve endings of the hearing and the balance mechanism.

Sound waves transmitted from the outer and middle ear are transmitted into fluid waves in the cochlea. These fluid waves stimulate the hearing nerve endings which generate an electrical impulse. These impulses are transmitted to the brain for interpretation as sound.

Movement of the head and body can create fluid waves in the vestibular labyrinth. These fluid waves stimulate balance nerve endings, resulting in electrical impulses to the brain, where they are interpreted as motion.

Maintenance of balance

The human balance system is made up of four parts, the eye, inner ear, muscles and central nervous system. The brain acts as a central computer receiving information in the form of nerve impulses (messages) from its three input terminals: the eyes, the inner ear, and the muscles and joints of the body. There is a constant stream of impulses arriving at the brain from these input terminals. All three systems work independently and yet work together to keep the body in balance.

The eyes receive visual clues from light receptors that give the brain information as to the position of the body relative to its surroundings. The receptors in the muscles and joints are called proprioceptors. The most important ones are in the head and neck (head position relative to the rest of the body) and the ankles and joints (body sway relative to the ground).

The inner ear balance mechanism has two main parts: the vestibule and three semicircular canals. Together they are called the vestibular labyrinth and are filled with fluid. When the head moves, fluid within the labyrinth moves and stimulates nerve endings that send impulses along the balance nerve to the brain. Those impulses are sent to the brain in complimentary amounts from both the right and left inner ear. Nerve impulses may be started by the semicircular canals when turning suddenly, or the impulses may come from the vestibule, which responds to changes of position, such as lying down, turning over or getting out of bed.

When the inner ear is not functioning correctly the brain receives nerve impulses that are no longer complimentary, causing it to perceive this information as distorted or off balance. The brain sends messages to the eyes, causing them to move back and forth. This is called nystagmus.

Remember to think of the brain as a computer with three input terminals feeding it constant up-to-date information from the eye, inner ear and muscles and joints (proprioceptors). The brain itself is divided into several different parts. The most primitive area is known as the brainstem, and it is here that processing of the input from the three sensory terminals occurs. The brainstem is affected by two other parts of the brain, the cerebral cortex and the cerebellum.

The cerebral cortex is where past information and memories are stored. The cerebellum provides automatic (involuntary) information from activities, which have been repeated often.

The brainstem receives all these nerve impulses: sensory from the eyes, inner ear, muscles and joints; regulatory from the cerebellum; and voluntary from the cerebral cortex. The information is then processed and fed back to the muscles of the body to help maintain a sense of balance.

Because the cortex, cerebellum and brainstem can eventually become used to (habituate to) abnormal or unequal impulses from the inner ear, balance exercise may be helpful. Exercise often helps the brain to habituate the dizziness problem so that is does not respond in an abnormal way and does not result in the individual feeling dizzy. An example of habituation is seen with the ice skaters who twirl around, stop suddenly, and do not apparently have any balance disturbance.

Experiencing dizziness or balance issues?

If you experience balance issues, contact your medical physician. They may order balance testing with an audiologist to determine if your balance issues are related to the ear. Make sure to include any symtpoms of hearing loss or tinnitus that coinside with your symptoms.