What is Vestibular? Or, Vestibular for Dummies!

By now I hope you’ve read my previous “Dizzy” posts, so you’ve seen the word “vestibular” and read about my experience with vertigo and the onset of my condition. If you’re like me, the word “vestibular” wasn’t in your vocabulary until either you or a loved one had a personal run-in with it (like I did), or my posts have piqued your curiosity and you’ve looked up the term. In this post I hope to provide a simple (very simple! easy!) explanation of the vestibular system and why it is so important to our overall well-being and daily lives. It’s not really that difficult to understand, but it can be kind of tricky.

But First!

But first things first! I need to start with two very important caveats. First, just about everything I know about vestibular disorders, including my own, I learned from VeDA, the Vestibular Disorders Association. You’ll see a link to their website, www.vestibular.org, at the bottom of my homepage. I’m the type to research everything, so when I fell ill, one of the first things I did was to look online for an answer. A simple Google search led me right to VeDA, which was a lifesaver, and continues to provide support, information, and friendship to me. I’ll write more about them over time as my story progresses, but for now, I’ll just say that the information in this post about the vestibular system is more than likely is “borrowed” from the articles available on their website. I’m crediting them now, rather than including endnotes! And thanks to VeDA for the drawing of the inner ear anatomy that graces this post! You’ll find this drawing with their comprehensive article about the Vestibular System by clicking on this link. https://vestibular.org/article/what-is-vestibular/the-human-balance-system/ear-anatomy/ I encourage you to take a look through their site. There is a lot of great information, a broad range of topics, and it is user-friendly.

I should add that I also picked up some bits of knowledge from various other websites, none of which were as helpful or comprehensive as VeDA’s, and much of it was on the clinical level, so it just went above my head. But when you are under duress, looking for answers, all viable sources of information can be useful! And yeah, yeah, my physicians were helpful, too…but they’ll get a post of their own in the future.

Second, nothing I write in this post, or any other post, should be considered medical advice. I am not a doctor, nor do I claim to have any real knowledge of medical or physiological matters. I only know what I know by learning it the hard way, from first hand experience, or from the experiences of others with similar stories. Or from VeDA articles, of course! If you, or someone you know, suffers from dizziness, vertigo, or disorientation, I urge an immediate trip to a physician. But (Important!) go in to the appointment armed with some knowledge you have gleaned from perusing VeDA’s site (“Doc, could it be a vestibular disorder?”). Knowledge is power. So, with that out of the way, what the heck does “vestibular” mean?

The Vestibular System

According to Merriam-Webster, “vestibular” is 1) of, relating to, or functioning as a “vestibule” (in our case, cavities in one’s inner ear); or 2) of, relating to, or affecting the perception of body position of movement. So, the way I interpret this definition, #1 is the physical “space” and #2 is how or what your brain is making of the information fed to it by what is contained in #1! Clear so far? Great!

Now, let’s understand your ear in just a couple sentences. There are 2 components of the ear: 1) Hearing; and 2) Balance. For my purpose I’m going to ignore the Hearing aspect, although hearing loss and related conditions, such as tinnitus (aggravating!) is an important issue for many vestibular patients, including yours truly. The Balance component is made up of complex passageways and chambers (vestibules!), within which are tubes and sacs of fluid. Thus, the “vestibular” system! (Thanks, VeDA!)

Now it gets more complicated, and I’m not going to bore you with complex details. So I’ll just say, VERY SIMPLY, that when your head moves, for example, the vestibular system (remember – sacs of fluid!) in one ear is communicating, along with the other ear, with your brain. Your brain then communicates this head movement to your eyes and your body: your eyes are responsible for maintaining focus and a level gaze (no blurring, please!); and your body is responsible for maintaining stability (no falling, please!). These components – inner ears (vestibular), eyes, and body, work together to maintain your balance and equilibrium when you move. So, when you move your head, for example, everything doesn’t appear to be a blur or off center, and your body doesn’t flop around uncontrollably. It all works great!!

Until one day, suddenly it doesn’t….

A Damaged Vestibular System

Your vestibular system can become compromised due to several causes, from medications, head trauma, disease, or simple aging. In my case, my physicians theorized that a virus attacked and damaged or destroyed the vestibular nerve in my right inner ear. There was nothing I could have done to foresee or prevent this from happening. And although it seemed to happen suddenly, in hindsight the damage was gradual. But that is a story for another time.

So then, you ask, vestibular nerve? What’s that? Well, a part of the vestibulocochlear nerve or auditory vestibular nerve, also known as the eighth cranial nerve, cranial nerve VIII, or simply CN VIII…harumph. Simply (again!) the vestibular nerve is the actual component that communicates messages about head position and motion from your inner ear to your brain. When this is compromised, the other components that contribute to balance, your eyes and body, say, “Whoa! What the…!” and there is general chaos and disorder! Really! Pandemonium!

This results in one or more of the following symptoms: dizziness, feeling off-balance, feeling as if you are floating or as if the world is spinning, blurred vision, disorientation, and falling or stumbling. How fun is this! For me, my lasting, daily symptoms are being off-balance, listing to one side, disorientation, and stumbling. Also, occasionally I have a feeling of floating or being our-of-body. Usually when this happens when I am playing the organ (fun!), but I’ll talk about this another time (am I repeating myself?). Those who know me may notice my head tilts to my right side. Quite a bit, at times. However, my perception is that I am looking straight ahead just fine. This is because the vestibular nerve in my right inner ear is not communicating with my brain! See how something simple that you take for granted, like holding your head straight with your eyes following along, is compromised!

What Can Be Done?

So what can be done if your vestibular system is damaged or compromised? Well, good question. For some people, medications can be helpful, especially in the short term, especially in dealing with dizziness or vertigo, and the accompanying nausea (fun!). Vestibular Therapy by a specially trained physical therapist can be helpful in learning to compensate physically for the signals that the brain is no longer sending to the body. Depending on the diagnosis, there could be other medical answers. However, I only know for sure my own experience, which in the long term, is…nothing, really. The vestibular nerve does not heal or regenerate. Once it is gone, it is gone. So at this time there is nothing that can “cure” me. I know there is constant medical research going on, so someday they may develop an implant or some such that will replace what was lost. But until that day, I carry on and live my best life. (Future Post Alert! Organ Donations!)

In future posts I’ll talk about compensation, which is basically how you can learn to overcome what’s been lost and still live life to its fullest. I’ll also talk about my journey through medical tests, navigating through insurance and social security disability, and most importantly, how I learned to live with my new normal. It’s quite a ride, so I hope you’ll ride along with me!

Coda, Finally!

So, to wrap this up (YAY), I hope that you have stayed with me through this long post, and I hope you found it informative, and perhaps a tad entertaining. This is important information to know in order to understand the everyday difficulties of vestibular patients. Although on the outside we may look fine (head tilt and all!), on the inside is a constant battle to maintain order. But it is okay. Life is meant to be lived, not to dwell on your struggles. So I always choose to remain positive, and try to reflect that in everything I do.

Thanks for reading!

Paul