What is the vestibular apparatus and where is it located - how it works and disorders, exercises for training

The vestibular apparatus is an organ of balance. Together with the visual and motor receptor systems (a receptor is an anatomical formation that converts perceived irritation into nerve impulses), it plays a leading role in a person’s orientation in space. The vestibular apparatus perceives information about acceleration or deceleration that occurs during any type of movement, as well as when the position of the head changes in space. The sense of gravity is also analyzed here, which is why the vestibular apparatus is also called the organ of gravity. Under resting conditions, the receptors of the vestibular apparatus are not excited. Irritation of the receptors occurs when the head is tilted or moved. In this case, reflex muscle contractions occur, helping to straighten the body and maintain balance.

General information

Vestibulopathy is a disorder of the normal functioning of the vestibular apparatus , in which characteristic symptoms appear.
The ICD-10 code for vestibulopathy is H81 (Vestibular function disorders). The normal orientation of a person in space and his balance in a vertical position is ensured by the vestibular apparatus. Disturbances in its work lead to a person experiencing confusion, dizziness , and the inability to remain in a standing position. This condition is also called labyrinthopathy. It can develop due to various reasons and diseases, developing at any age in every person. Sometimes vestibulopathy is a congenital pathology.

It may manifest itself as a separate syndrome or as a sign of neuropsychiatric disorders. In the second case, it is more difficult to treat this disease. How this pathology manifests itself, and what treatment methods are advisable to practice, will be discussed in this article.

Treatment in Moscow

The best treatment for vestibular disorders is considered to be exercises for dizziness or vestibular rehabilitation. Vestibular rehabilitation is carried out in many special centers, including the rehabilitation center of the Yusupov Hospital. Therapeutic gymnastics is carried out by an instructor, classes are developed individually for each patient. A preliminary examination by a neurologist will help determine the cause of dizziness, and the doctor will prescribe effective drug treatment. A neurologist will tell you what examination to undergo and how to cure vestibular vertigo during your consultation.

Pathogenesis

Vestibular insufficiency can occur at any age. Sometimes this is a congenital pathology. The pathological process is localized in the inner ear. The vestibular apparatus, which is a complex receptor of the vestibular analyzer, consists of three arches. They are located at an angle of 90 degrees to each other. They contain liquid, which is distributed through the channels depending on the position of the human body, gravity, the force of attraction, as well as the influence of a number of other factors. The brain receives impulses that determine the movements of different parts of the body. Vestibular insufficiency develops when the functioning of the vestibular apparatus is impaired.

Vestibulopathy can develop with a variety of pathogenetic variants of damage to the peripheral or central part of the vestibular analyzer, which performs three important functions - maintaining balance, spatial orientation, and image stabilization.

Sources

• Wu X., Liu M., Zhuang HW., Chen KT., Yang ZY., Xiong GX. [Cochleo-vestibular lesions and prognosis in patients with profound sudden sensorineural hearing loss: a comparative analysis]. // Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi - 2021 - Vol55 - N5 - p.472-478; PMID:32842361
• Rawlins KW., Zhan KY., Mattingly JK., Feldman AZ., Adunka OF. Fibrous dysplasia mimicking a pediatric endolymphatic sac tumor. // Int J Pediatr Otorhinolaryngol - 2021 - Vol129 - NNULL - p.109785; PMID:31770666
• Rajeshwari B., Shanmugam S., Sadiya N., Mitra G., Chendilnathan B. “Endolymphatic sac tumor”: A case report with review of literature. // Indian J Pathol Microbiol - 2021 - Vol62 - N4 - p.608-610; PMID:31611452
• Eguchi S., Hirose G., Miaki M. Vestibular symptoms in acute hemispheric strokes. // J Neurol - 2021 - Vol266 - N8 - p.1852-1858; PMID:31037419
• Lee JY., Kim CH., Park JS., Kim MB. Peripheral Vestibulopathy Presenting as Acute Vertigo and Spontaneous Nystagmus with Negative Video Head Impulse Test. // Otolaryngol Head Neck Surg - 2021 - Vol160 - N5 - p.894-901; PMID:30665325
• Strupp M., Mandalà M., López-Escámez JA. Peripheral vestibular disorders: an update. // Curr Opin Neurol - 2021 - Vol32 - N1 - p.165-173; PMID:30562267
• Wang HW., Guo Y., Zhou J., Zhou HF. . // Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi - 2021 - Vol32 - N2 - p.99-102; PMID:29757553
• Sonoda S., Yoshimura M., Abe C., Morita H., Ueno H., Motojima Y., Saito R., Maruyama T., Hashimoto H., Tanaka Y., Ueta Y. Effects of hypergravity on the gene expression of the hypothalamic feeding-related neuropeptides in mice via vestibular inputs. // Peptides - 2021 - Vol105 - NNULL - p.14-20; PMID:29751050
• Park JS., Kim CH., Kim MB. Comparison of Video Head Impulse Test in the Posterior Semicircular Canal Plane and Cervical Vestibular Evoked Myogenic Potential in Patients With Vestibular Neuroitis. // Otol Neurotol - 2021 - Vol39 - N4 - p.e263-e268; PMID:29494469
• Tamás LT., Lundberg YW., Büki B. Vergence increases the gain of the human angular vestibulo-ocular reflex during peripheral hyposensitivity identified by cold thermal irrigation. // J Vestib Res - 2021 - Vol27 - N5-6 - p.265-270; PMID:29400687

Classification

Depending on the nature of its origin, vestibulopathy is divided into several types:

• Vertebrogenic – develops against the background of pathologies of the cervical spine. It can be observed with osteochondrosis , osteoporosis , intervertebral hernia , etc. This form is the most common. This condition is characterized by prolonged dizziness and a feeling of head instability. When trying to focus your gaze on moving objects, discomfort occurs. Spontaneous attacks of eye rotation may occur when a person tries to turn his head sharply. They last no longer than 30 seconds.
• Peripheral - develops as a consequence of the inflammatory process in the nerve ganglia in the inner ear. Most often this occurs due to allergies or infections. With such a lesion, in addition to vestibular disorders, the patient may experience tinnitus and causeless fear. Prolonged dizziness and bouts of eye rolling are noted.
• Central - develops if disturbances occur in the function and structure of the vestibular nuclei of the medulla oblongata and cortex.
• Post-traumatic – develops after traumatic brain injury if hemorrhage occurs in the labyrinth of the inner ear. As a result, tissue damage is noted. The eardrums may also be damaged, and the ganglia of the brain may be shaken and damaged. In this case, both dizziness and other characteristic signs are noted - spontaneous eye movements, nausea, vomiting. In addition, a patient with such a lesion has an unstable gait - it is difficult for him to stand on his feet.

Cochleovestibular syndrome is also distinguished . In this condition, auditory and vestibular function is impaired. Cochleovestibular disorders are accompanied by tinnitus, hearing loss, dizziness, and imbalance.

How to treat vestibular vertigo

Dizziness is a common complaint among patients about feeling unwell. Women and the elderly most often suffer from dizziness. Depending on the cause of dizziness, the doctor prescribes treatment. Treating dizziness is a difficult task for a doctor. He refers the patient for examination to determine whether dizziness is caused by diseases. The patient is prescribed symptomatic treatment, which helps to remove symptoms - nausea, vomiting, and stop attacks of dizziness. Vestibular suppressors are used to stop attacks. To prevent attacks from developing, your doctor may prescribe anticholinergic drugs. Such drugs are prescribed with caution to elderly people due to side effects - hallucinations, amnesia, they can cause urinary retention and psychosis in an elderly patient. Some types of antihistamines and benzodiazepines are also prescribed to enhance the inhibitory response of GABA to the patient’s vestibular system.

Causes of vestibular apparatus disorders

The causes of dysfunction of the vestibular apparatus can be very different. Basically, vestibulopathy is provoked by the following factors:

• Cervical osteochondrosis - due to displacement of discs and vertebrae, the functioning of the vertebral artery is disrupted, which impairs blood supply. In addition, with osteochondrosis, the nerves are pinched, which also leads to dysfunction of the vestibular apparatus. Also, problems with the vestibular apparatus can be observed with intervertebral hernia, osteoporosis, etc.
• Pathologies of the inner ear - this may be a violation of lymph flow in the middle ear, inflammatory processes, otitis media, etc.
• Labyrinthitis is an inflammatory disease that provokes the development of periodic dizziness.
• Meniere's disease - during the development of the disease, pathological changes in the inner ear are noted.
• Infarction of the labyrinth – leads to impairment of hearing and function of the vestibular apparatus.
• Vestibular neuronitis is a consequence of herpetic damage to nerve fibers. If a person is diagnosed with vestibular neuronitis, it should be taken into account that signs of the disease appear periodically - during exacerbation. As a rule, this happens in spring and autumn. Also, vestibular neuritis can develop as a consequence of acute respiratory infections, influenza , etc.
• Migraine - with this disease, the symptoms are similar to vestibulopathy, but the hearing does not change.
• Diseases of the central nervous system - can cause pathological processes in the membranous labyrinth.
• Traumatic damage to the thin bone membranes of the labyrinth , in which the eardrum ruptures or hemorrhage in the middle ear - this can happen with severe coughing, straining, diving.
• Vertebrobasilar insufficiency - manifests itself mainly in older people, causing damage to the vestibular analyzers. With this pathology, the blood vessels, cerebellum and brain stems are affected. The duration of such an attack is several minutes, during which the person loses balance and orientation in space, he develops weakness, and his limbs go numb.
• Intoxication of the body due to taking certain medications.
• Neurotic disorders.
• Neuromas are tumors that form and grow from nerve cells.
• Occupational diseases – working in conditions of constant vibration or noise.

THE IMPORTANCE OF THE VESTIBULAR APPARATUS AND METHODS OF TRAINING IT

№20, 02.07.2019

Pedagogical Sciences

Miftakhov Almaz Faridovich

Tolibova Mokhinur Fayzullo Kizi

Key words: VESTIBULAR APPARATUS; MOVEMENT COORDINATION; healthy lifestyle; TRAINING; EQUILIBRIUM; VESTIBULAR; COORDINATION; HEALTHY LIFESTYLE; EXERCISE; BALANCE.

Abstract: This article reveals the importance of such a human organ as the vestibular apparatus.
Its training is needed not only by those who plan large overloads and flights into space. It is the vestibular apparatus that provides us with an exceptional evolutionary feature - upright posture. The study describes the structure of the vestibular apparatus, its impact on a person’s well-being and orientation in space, its significance both in everyday life and for athletes and astronauts. We also describe the main ways to strengthen the vestibular system for better health. The structure of the vestibular apparatus
The mechanism of operation of the vestibular apparatus is very complex; it is a small organ in the inner ear that provides us with a sense of balance. This mechanism monitors changes in the position of the head and body, sending signals to the brain - “up”, “down”, tilt.” It is he who is responsible for coordinating processes such as running, walking, jumping. Many animals, for example cats, have a vestibular apparatus that is more developed than that of humans. For example, in turtles it is less developed. However, our vestibular apparatus is significantly different: it is thinner than all others, since it synchronizes the simultaneous work of hundreds of muscles and ligaments to ensure balanced movement of the body on two points of support [1]. The peripheral section of the vestibular analyzer is a part of the inner ear, consisting of semicircular canals located in three mutually perpendicular planes, and statocyst organs - two sacs - oval (uterus) and round, located closer to the cochlea. One end of each semicircular canal expands, this expansion is called an ampulla. The ampoules of the semicircular canals contain a crescent-shaped bone ridge. Directly adjacent to the scallop is a membranous labyrinth and an accumulation of two rows of cells: supporting and sensitive, having at the upper end 10-15 long hairs, glued together by a gelatinous substance into a brush (flap). The oval and round statocyst sacs of the vestibule are lined on the inside with flat epithelium, with the exception of some areas (spots). The spots consist of columnar epithelium, where supporting and sensitive hair cells are located. Supporting cells form many fibers, which include calcareous pebbles - otoliths adjacent to the hair cells. The sacs and semicircular canals are filled with endolymph. The hair cells of the crests of the semicircular canals and the spots of the statocyst sacs are connected with the fibers of bipolar neurons located in the Scarpa vestibular node, located deep in the internal auditory canal [2].

The mechanism of operation of the vestibular apparatus is that with various movements of the head, the endolymph and otoliths move, which irritates the hair cells of the semicircular canals and statocyst sacs. Centripetal impulses arise there, which are transmitted along the vestibular nerve to the medulla oblongata, and then to the cerebellum, midbrain, diencephalon and temporal lobes of the cerebral hemispheres. The semicircular canals, in turn, are irritated at the beginning and end of rotational movements of the head. Statocyst sacs, in turn, perceive the beginning and end of uniform rectilinear movement, linear acceleration and deceleration, changes in gravity and centrifugal force, shaking, rolling - they mainly regulate posture.

Unfortunately, there are cases when the vestibular apparatus is highly sensitive, and as a result, in the case of prolonged vestibular influences, so-called motion sickness is observed, associated with a deterioration in well-being and vegetative disorders, the totality of which is called seasickness.

Let us note that the excitability of the human vestibular apparatus manifests itself from the very day of birth, and its functions are trained by rhythmic stimulation (rocking and carrying).[3]
The importance of training the vestibular system
The simplest tip for improving the functioning of the vestibular system is to lead a healthy lifestyle. The good news is that many exercises can be done at home. For example, it is recommended to practice holding various objects on your head, walking along a curb, or walking backwards. Further, if a person successfully copes with these tasks, you can begin systematic training of the vestibular apparatus.

Nowadays, there are many ways to train coordination of movements: you can practice with exercise machines, swings, rocking chairs, and also in an equipped gym.

The following exercises are best done daily for 10-15 minutes to achieve a systematic approach: • Tilt your head down and exhale, lift your head up and inhale. • Turn your head left and right 10-15 times. • Tilt your head to your left shoulder, take the starting position, tilt your head to your right shoulder 10-15 times. • Make circular movements with your head from left to right and from right to left. When lowering your head, exhale, raising your head, inhale[4].

It is important to note that there are the following tips: 1. Exercises should always be performed at a calm pace, sudden movements are not allowed. 2. You should breathe through your nose, and your breathing must be deep. 3. The key to success is consistency in training, breathing control and, if possible, fresh air. If classes are held in a building, it must be well ventilated.

After some time, in order to complicate the tasks, you can begin to perform the exercises with your eyes closed. Coordination for athletes

Most sports, such as martial arts, require a well-developed vestibular system. The following exercises to overcome dizziness differ in complexity from the initial level and are recommended for athletes in the absence of contraindications: • Do several somersaults, stand up and try to cope with dizziness by choosing a certain point in space and concentrating on it. You should not overuse the exercise to the point of nausea. The number of somersaults in the approach should be gradually increased.

• Raise your head up and extend your hand with your index finger, which you need to focus on when circling. Start circling around your axis. This exercise is for a while. After 30 seconds, you should perform the following task: stop and cope with the dizziness. [5]

This sports training will help in achieving stability, making quick movements, and the ability to easily recover from missed blows during wrestling.
Vestibular apparatus and yoga
Yoga classes play a special role in training the vestibular apparatus.
It is believed that a set of stretching exercises, and especially coordination and static balance, has a beneficial effect on the functioning of the vestibular apparatus. Thanks to yoga, harmony of thoughts with the body is achieved, since the psychological state also affects the functioning of the vestibular apparatus. Conclusion
Thus, a strong vestibular apparatus makes a person’s life better. People with a weak vestibular system are contraindicated from traveling on buses, planes, and ships in order to avoid dizziness and motion sickness. No matter how difficult it may be, it is quite possible to combat this problem. To maintain the health of such people, in this article we have presented the main methods of improving a person’s health by performing exercises, from the simplest to the rather complex.

Symptoms of vestibulopathy

The basis of vestibulopathy are four main symptoms:

• systemic dizziness;
• vegetative manifestations - nausea, vomiting, hyperhidrosis , heart rate disturbances, etc.;
• imbalance;
• spontaneous nystagmus .

However, disorders of the vestibular system can manifest themselves differently in different diseases. Therefore, it is important to pay attention to the following manifestations:

• I feel dizzy from time to time, and this symptom occurs quite often.
• Difficulties appear in maintaining balance - it seems that the body “does not obey” while walking or trying to move.
• Vision deteriorates, spots and goosebumps appear in the eyes.
• of migraines increases .
• Hearing deteriorates, tinnitus bothers me.
• Nystagmus is periodically observed - the movement of the eyeballs in one direction.
• Periodic nausea and vomiting.

If a person does not know what vestibular neuritis and how it manifests itself, then he can ignore the symptoms of vestibular neuritis for a long time, believing that these are just signs of overwork.

Exercises for vestibular vertigo

Dizziness often occurs when turning the head or body - this forces patients to try to avoid such movements. Gymnastics for patients with vestibular system disorders includes various types of exercises, including exercises with head and body turns. Exercises can be performed while sitting on a bed, with or without a pillow, sitting on a chair, or standing. The exercises are based on the principle of sensory mismatch between the movements of the eyes, torso and head. Special simulators that work on the principle of biofeedback will help increase the effectiveness of gymnastics. During the training period, you should avoid taking sedatives and alcohol.

Tests and diagnostics

To establish a diagnosis, the patient must see a doctor, who first conducts a detailed survey and examination. Further, if necessary, further studies will be prescribed.

The study of the vestibular apparatus can be carried out using different methods. There are three main tests to check how the vestibular apparatus works: rotational , thermal and mechanical . In addition, you can undergo simple testing to determine the presence of coordination disorders.

With the help of such tests, a study of the functions of the vestibular apparatus for VVC in Moscow (Khimki, etc.) and other cities is carried out.

• Rotation test - to conduct it, a person sits in a chair and tilts his head forward. After this, 10 rotations are carried out over 20 seconds, then the chair suddenly stops. After this, nystagmus develops. Having measured its duration, the procedure is repeated again with rotation in the opposite direction. Normally, nystagmus will last the same amount of time - 20-50 seconds. If the difference between the two results is 25%, then we can talk about balance disorders.
• Mechanical examination - for this purpose, a rubber bulb is used, with the help of which the external auditory canal is filled with oil to displace the air from it. Next, the pear is compressed and unclenched, checking for damage to the bone capsule of the labyrinth.
• Thermal examination - the patient's ear canals are washed with water for 30 seconds.

At this time, nystagmus occurs, and assessing its duration makes it possible to determine the sensitivity of the vestibular apparatus.

Tests are carried out to determine coordination. This could be walking in a straight line with your eyes closed, trying to touch the tip of your nose with your eyes open and closed, etc.

There are other tests to determine whether the vestibular apparatus is weak or strong.

• Nystagmus can be measured using so-called Frenzel glasses . These are special magnifying glasses with bulbs equipped with light bulbs that illuminate the eyes.
• Also for this purpose, the method of electronystagmography - measuring nystagmus using electrodes.
• A neurological examination is also carried out, aimed at determining the condition of the nerve trunks of the eyeball and the muscles of the facial skull.
• MRI allows you to determine the condition of the spine.
• The inner ear and eardrum are also examined.

Other studies may be prescribed. The doctor will tell you during the consultation where to undergo such a study and what the conclusion looks like.

Autonomic reactions

Through a set of nerve structures located in the central parts of the brain stem (medulla oblongata and midbrain, visual thalamus), the cardiovascular system, gastrointestinal tract and other organs are involved in vestibular reactions. With strong and prolonged stress on the vestibular apparatus, autonomic reactions occur in the form of a slowing pulse, decreased blood pressure, dizziness, nausea, vomiting, cold hands and feet, pale face, cold sweat, etc. Similar symptoms are possible with seasickness or going up in a high-speed elevator. This is due to the fact that a person is accustomed to movements in the horizontal plane, but movements up and down or to the sides are unusual for him. Special training (swings, rotation) and the use of medications reduce the excitability of the balance organ and prevent undesirable effects.

Treatment with folk remedies

Some folk remedies can be used as auxiliary methods during the period of treatment and recovery for vestibulopathy.

• Melissa tea . 1 tbsp. l. Dried lemon balm pour 1 cup boiling water. After 10 minutes, drink with honey. It is recommended to drink this tea for dizziness twice a day.
• Infusion of parsley seeds . Finely grind parsley seeds, 1 tsp. pour the raw material into 1 glass of water and leave for 8 hours. Drink 50 ml 4 times a day.
• Infusion of nettle leaves . 1 tbsp. l. Pour dry nettle leaves into a thermos and pour 200 ml of boiling water. After two hours, strain by squeezing out the nettle leaves. Combine the resulting liquid with the same amount of fresh apple juice. Drink throughout the day. Take for two weeks.
• Essential oils . Mix 50 ml of camphor oil with 25 ml of fir oil and 10 ml of juniper. Mix thoroughly and lubricate the lymph nodes on the neck, nose and mouth with the resulting product. Please note that this product should not be applied to open wounds.
• Infusion of mistletoe and Japanese Sophora . The dry raw materials of both plants need to be crushed and mixed with 15 g of each component. Pour 500 ml of boiling water. When the product is infused, drink 100 ml before meals.

Prevention

The following prevention methods should be practiced:

• Limit situations that provoke an attack of vestibulopathy.
• Eat right, avoiding lack of vitamins and minerals. If necessary, take vitamin-mineral complexes periodically.
• Get proper rest, sleep at least 7 hours a day.
• To refuse from bad habits.
• Exercise daily, do yoga, Pilates, swimming.
• Treat bacterial and viral diseases in a timely manner.
• If vestibulopathy occurs, consult a doctor.

Diet

Salt-free diet

• Efficiency: 5-10 kg in 13 days
• Time frame: 13 days
• Cost of products: 4500-8000 rubles for 13 days

For some diseases that provoke vestibulopathy, it is recommended to adhere to a salt-free diet or limit the amount of salt in the menu.

In general, nutrition should be rational and varied, and the diet must include fresh fruits and vegetables, meat, fish, dairy products, nuts, and vegetable oils.

You should give up alcohol.

Bibliography

1. "Biological encyclopedic dictionary." Ch. ed. M. S. Gilyarov; Editorial team: A. A. Babaev, G. G. Vinberg, G. A. Zavarzin and others - 2nd ed., corrected. - M.: Sov. Encyclopedia, 1986.
2. "Otorhinolaryngology". Textbook ed. I.B. Soldatov and V.R. Hoffman. – St. Petersburg, 2000. – p.41-45, p.75-96.
3. Soldatov I.B. "Lectures on otorhinolaryngology: Textbook." – M.: Medicine, 1994. – pp. 40-56., pp. 261-277.
4. How the vestibular apparatus works - https://theoryandpractice.ru (Access date: 07/01/2019)
5. How to train the vestibular apparatus at home - www.sovsport.ru (Date of access: 07/02/2019)

Consequences and complications

A severe complication of vestibulopathy can be purulent labyrinthitis , which, in turn, sometimes develops into meningitis . Therefore, inflammation in the inner ear must be treated under the close supervision of a doctor.

Vestibulopathy, moreover, negatively affects the overall quality of life. Dizziness and migraines impair work ability. In addition, such manifestations can cause accidents and traffic accidents.

In advanced stages, the auditory nerve may be affected, leading to the development of hearing loss.

This condition can also lead to cognitive impairment.

List of sources

• Zamergrad M.V., Grachev S.P., Gergova A.A. Acute vestibular vertigo in old age: stroke or peripheral vestibulopathy. Journal of Neurology and Psychiatry. S.S. Korsakov. Special issues. 2018; 118(6-2): 46-49.
• Parfenov V.A., Abdulina O.V., Zamergrad M.V. Differential diagnosis and treatment of vestibular vertigo // Neurology, neuropsychiatry, psychosomatics. - 2010. - No. 2. - P. 49-54.
• Suslina Z.A., Varakin Yu.Ya., Vereshchagin N.V. Vascular diseases of the brain. M. 2006.

Vestibular vertigo: symptoms and treatment in older people

Dizziness (vertigo) is manifested by the illusion of rapid rotation of objects around the patient. It may be accompanied by vomiting, nystagmus, nausea, and ringing in the ears. When vestibular vertigo develops in older people, the causes can be varied: lack of blood supply to the brain (cerebral ischemia), multiple sclerosis, head injuries, some types of brain tumors, tumors of the auditory nerve, hormonal imbalance, atherosclerosis, and other disorders. Treatment of vestibular vertigo (vertigo) in older people begins with finding the cause of the dizziness and treating the underlying disease. Vestibular gymnastics for dizziness in older people improves well-being, has a beneficial effect on the heart, musculoskeletal system, and nervous system. Treatment of vestibular vertigo is carried out with the help of drug therapy, physiotherapy, physical therapy, and reflexology.