VESTIBULAR APPARATUS

INTRODUCTION
ANATOMY
TRANSDUCTION
FUNCTIONS OF VESTIBULAR APPARATUS
VESTIBULAR FUNCTION AND GASTROINTESTINAL
RESPONSE

LABORATORY PREPARATION AND GIT RESPONSE

VESTIBULAR DISORDER
SUMMARY
 VESTIBULAR APPARATUS
Introduction

The vestibular system is a somatosensory portion of the nervous system that

provide us with the awareness of the spatial position of our head and body
(proprioception) and self motion (kinesthesia). It is composed of Central and
peripheral portions.
The peripheral portion consists of the vestibular labyrinth, vestibular ganglion and
vestibliococular nerve (CN Viii). Another structure such as a semicircular canal
and otolith organs.

Anatomy of vestibular apparatus

The sensory organ of the Vestibular System is located in the inner ear. The
inner ear lies in the petrous part of the temporal bone consisting of bony
labyrinth and membranous Labyrinth.

The bony labyrinth houses the membranous labyrinth which consists of the three
semicircular canals and the two otolith organs (utricle and caccule). Moreover, it
consists the cochlea which is a part of the hearing apparatus. The space between
the bony labrynth and membranous lahvrinth is filled with a fluid Called the perilym which
Anterior semicircular duct Anterior ampullar

Common membranous \ Utricular nerve

limb \ \

Anterior Superior part of

membranous vestibular ganglic
ampulla

Vestibular nerv
Posterior
semicircular
duct
Facial nerve
Lateral
semicircular
duct
Cochlear nerv
Lateral ampullary
nerve Inferior part o
vestibular
Lateral ganglion
membranous
ampulla Saccular nerve

Posterior
membranous Posterior ampulL;
ampulla nerve

Utricle of vestibular
labyrinth Cochlear duct

Saccule of vestibular Ductus reuniens (of Hensen

labyrinth
 SEMICIRCULAR CANAL

Shown in the diagram above, they are the membranous channels located within the
bony and circular duct of the labyrinth.They are located in the trip planes with
each canal making an angle of approximately 90 degrees with each other.They are
named according to their position as follow;
1. Anterior or superior canal
2. Posterior canal
3. Lateral horizontal canal.
The anterior and posterior canals acetated vertically and the lateral canals is
situated in the horizontal plane.
• The terminal part of each end of the semicircular canal contains a dilation
called the ampulla which opens into the utricle , the ampulla contain a
mechanical receptor organ called The Crysta ampullaris.
• Each crysta ampullaris contain a receptor organ called the hair cell.

• Ampulla of all the three canals and narrow end of horizontal canal opens
directly into the utricle.
• The narrow ends of the anterior and posterior canal opens into the utricle
jointly by forming the common Crus.
• The utricle then open into the saccule.

OTOLITH ORGAN

The utricle and saccule are collectively called the otolythic

organs,they are the two membranous cavity that lies in the
bony vestible of the inner ear.
> The utricle collides in the posterior part of the vestible on one end and it
communicates with the semicircular canals while on the other end
 communicates or forms a utriculosaccular duct with the saccule and end in a
baglike structure called endolymphatic sac.
> The saccule lies anteriorly to the utriccle and significantly smaller than it. it
communicate with the utricle via the utriculosaccular duct and with the
cochlear by doctus reuniens.
> Both the utricle and the saccule contain a sensory cell called the macular.
TRANSDUCTION

The hair cells within the vestibular system are

responsible for converting mechanical stimuli (fluid
movement or otoconia displacement) into electrical
signals which are carried by nerves cells.
Each hair cell has 50 to 70 million Celia called
stereocilia and one large cilium call the kinocilium.
The kinocilium is located to one side while the
stereocilium becomes progressively shorter at the other
end,they are connected by a microscopic filament
attachment which aid the bending of hair cells in either
direction. This movement opens the flute canals in the
neuronal membrane there by conducting large number of
positive ions which causes depolarization by the
movement of hair cells towards kynocillium and
hyperpolarization by the movement of hair cells towards
the stereocilium
This impulse generated by the hair cells that are carried
by the vestibular nerves of the first order neurons which
are bipolar in nature,the axon of the first order neuron
forms the similar division of vestibulo-cochlear nerves
which reach the medulla and terminate in the vestibular
nuclei this are also called primary vestibular fibres.
The vestibular nuclei forms the beginning of the second
other neurons which its axon forms the secondary
vestibular fibers this fibers are
1. Vestibulo-ocular tract; responsible for movement of the eye
2. Vestibulo spinal tract; responsible for movement of the head and body
3. vestibulo reticular tract; for facilitation of muscle tone
4. vestibule cerebela tract; for cordination of movement
 Antenor
Ampullae
Utricle
Maculae and
•tatoconia
Semi¬
circula Filamentous —
r attachments \
canals

Ductus
Posterior cochieans

Crista ampullaris 1/ Ductus endolymphaticus

MEMBRANOUS LABYRINTH

t -U — Gelatinous Statoconia
mass ol 1
cupula ^Gelatinous
layer
! lAr STM I
Hair lulls
Hair - Hair tutts
cells
m■1»i! Hair cells

Nerve fibers

r|iV
‘Nerve
libers
jr»»
Sustentacular cells
htSbiT if Vltimll .
Sustentacular cells

CRISTA AMPULLARIS AND MACULA

Figure 56-9. Membranous labyrinth and organization of the crista ampullaris and the
macula.
FUNCTION OF THE VESTIBULAR SYSTEM

1. Balance and posture: The vestibular system helps us maintain our balance
and posture by detecting changes in head position and the movement it does
this by monitoring the position and movement of the head in relation to
gravity and the surrounding environment.The semicircular canals helps in
balancing dynamic equilibrium (maintenance of the body “head” in response
to sudden movement such as rotation, acceleration and decelaration) while
otolyth organs help in balancing static equilibrium (maintenance of the body
“head” position relative to gravity).
> Each semicircular canal is responsible for sensing impulse on the
head direction.
> Each of these canals are filled with fluid call endolymph and when
displacement of this fluid occurs within the canal,nerve signals are
sent to the brain informing which direction the head has just turned.
> The posterior semicircular canal determines when the head tilt down
towards the shoulder.
> Superior semicircular canal dictate when the head moves up and
down in a yes motion.
> Lateral semicircular canal dictate when the head shake side to side
like in a no motion.
All the same,circular canal determines this movement through the flow of
the endolymph in relation with the movement of the hair cell .

2. Spatial orientation: The vestibular system helps us perceive our spatial

orientation in relation to the world around us.It does this by dictating a
direction of gravity and the position of our head in relation to the horizon.

3. Eye movement: The vestibular system helps control eye movements by

allowing us to focus on objects and tract their movement,it does this by
sending signals to the brain that help us adjust our gaze and maintain focus.

4. Body position: The vestibular system helps or sense the position of our
body in space allowing us to maintain our posture and movement around
effectively it does this by detecting changes in head position and movement
 and sending signals to the brain that help us adjust our body position
accordingly.

5. Reflexes: The vestibular system helps control reflexes such as diversity blue
ocular reflex, which help us maintain our gaze on a moving object. It also
helps control the vestibulo-spinal reflex which helps us maintain our posture
and balance during movement.

6. Adaptation and Learning

The vestibular system aids in motor learning and adaptation to new
movements or changes in the environment.
It also helps the brain recalibrate and adapt to new conditions, such as after
an injury or when learning new physical skills.
7. Influence on Cognitive Functions
The vestibular system has connections to brain areas involved in spatial
memory and navigation.
It contributes to cognitive functions such as spatial awareness, navigation,
and memory, enhancing our ability to understand and interact with our
environment.

In summary, the vestibular system functions and roles are integral to

maintaining balance, spatial orientation, visual stability, and overall
coordination. These functions ensure smooth and effective movement, help
prevent falls, and contribute to various cognitive and autonomic processes
essential for daily activities.
The vestibular system, located in the inner ear, is responsible for maintaining
balance, spatial orientation, and coordinating movement with sensory input.
It includes structures such as the semicircular canals and otolith organs,
which detect rotational and linear movements respectively.
VESTIBULAR FUNCTION AND GASTROINTESTINAL RESPONSE:

When the vestibular system detects motion, it sends signals to the brain to
help maintain balance and posture. However, this sensory information can
 sometimes conflict with visual input or proprioceptive signals from muscles
and joints, especially during unusual or intense motion. This effect may
result to different response in the GIT such as mortion sickness, GIT
motility, visceral sensitivity which may lead to changes in pain perception
and discomfort in the GIT.

Motion sickness:
This can be defined as the syndrome of physiological response during
movement to which the person is not adapted. It is a condition that occurs
commonly when one is in motion.

Mechanism of Motion Sickness:

1. Sensory Conflict: Motion sickness often arises from a conflict between the
vestibular system (which senses movement) and the visual system (which
may not detect the same movement).
For example, if you're inside a cabin of a moving ship, your inner ear senses
motion, but your eyes may see a relatively stable environment. This
mismatch leads to confusion in the brain about the body's orientation and
movement.
2. Autonomic Nervous System Activation: The sensory conflict triggers the
autonomic nervous system, leading to symptoms such as nausea, vomiting,
dizziness, and sweating. The brain interprets the conflicting signals as a
potential toxin or threat, activating a stress response.
3. Gastrointestinal Involvement: The vagus nerve, which is a critical part of
the parasympathetic nervous system, plays a significant role in this process.
It connects the brain to the digestive tract and can be stimulated by
vestibular inputs. When activated, the vagus nerve can slow down gastric
motility (the movement of the stomach and intestines), leading to nausea and
vomiting. This is part of the body's way of expelling perceived toxins.
4. Neurotransmitter Release: Additionally, neurotransmitters such as
histamine, acetylcholine, and serotonin are involved in the regulation of
vomiting. Medications that target these neurotransmitters (e.g.,
antihistamines, anticholinergics, and serotonin antagonists) are often used to
treat motion sickness.
 In summary,the vestibular system's detection of motion, especially
when it conflicts with other sensory inputs, can lead to motion sickness. This
condition involves activation of the autonomic nervous system and the
vagus nerve, resulting in gastrointestinal symptoms like nausea and
vomiting. Understanding this connection helps in developing treatments for
motion sickness and other vestibular-related disease.
LABORATORY DEMOSTRATION OF VESTIBULAR FUNCTION

Laboratory demonstrations of vestibular function typically involve various

tests and procedures to assess the integrity and performance of the vestibular
system. Here are some common methods used in a laboratory setting:

The vestibular system is stimulated using different methods, such as:

Caloric Test: Warm or cold water or air is introduced into the ear canal to
stimulate the semicircular canals by using syringe. The transmission of
change in temperature into the labyrinth alters the specific gravity of
endolymph, which in turn causes the movement of cupular and stimulation
of receptor cells.
Rotational Chair Test (Brany chair): The patient sits in a motorized chair that
rotates to stimulate the vestibular system.
Eye movements (nystagmus) are recorded and analyzed.
1. Electronystagmography (ENG) or Videonystagmography (VNG):
These tests measure eye movements to evaluate the vestibular system's
function.
Procedure:
- The patient wears special goggles (VNG) or electrodes are placed around
the eyes (ENG).
- The patient is asked to follow moving lights or patterns on a screen.

2. Posturography:
This test assesses balance and posture
control.
Procedure:
- The patient stands on a platform that measures their movements and
responses to various conditions.
- The platform can tilt, shift, or remain stable while visual and
proprioceptive cues are manipulated.
- The patient's ability to maintain balance is recorded.
3. Head Impulse Test (HIT):
This test evaluates the function of the semicircular canals.
Procedure:
- The examiner rapidly moves the patient's head in a small, quick motion
while the patient focuses on a target.
- Normal vestibular function allows the eyes to remain fixed on the target
despite the head movement.
- Abnormal function results in corrective eye movements (catch-up
saccades).
4. Vestibular Evoked Myogenic Potentials (VEMPs):
These tests assess the function of the otolith organs (utricle and saccule).
- Procedure:
-Cervical VEMP (cVEMP): Electrodes are placed on the neck muscles.
A loud sound or vibration is presented, and the muscle response is recorded.
- -Ocular VEMP (oVEMP):
Electrodes are placed around the eyes. A loud sound or vibration is
presented, and the eye muscle response is recorded.
5.Dynamic visual Acuity (DVA) :This test assesses
the vestibulo-ocular reflex (VOR).
-Procedure:
-The patient reads letters from a chart while the head is moved passively or
actively by the examiner.
-The test measures the patient's ability to maintain visual acuity during
head movements.
6. Subjective Visual Vertical (SVV) Test:
This test assesses the perception of verticality, which can be affected by
otolith organ dysfunction.
-Procedure:
 - The patient is asked to adjust a line or rod to what they perceive as
vertical while sitting in a dark room or using a specialized device.
- Deviations from true vertical are measured and analyzed.
These tests collectively help to diagnose various vestibular disorders, such
as benign paroxysmal positional vertigo (BPPV), vestibular neuritis,
Meniere's disease, and central vestibular dysfunctions. They provide
valuable information on the functioning and integrity of different
components of the vestibular system.
ABNORMALITIES OF THE VESTIBULAR SYSTEM

Abnormalities in the vestibular system can manifest in various forms and

can significantly impact balance, spatial orientation, and coordination.
These disorders can be caused by issues in the inner ear, the vestibular
nerve, or central processing centers in the brain. Here are some common
vestibular abnormalities:
1. Benign Paroxysmal Positional Vertigo (BPPV)
-Cause: Dislodged otoconia (calcium carbonate crystals) in the
semicircular canals.

-Symptoms: Sudden episodes of vertigo triggered by head movements,

dizziness, nausea.
-Mechanism: The misplaced otoconia cause abnormal fluid movement in
the semicircular canals, sending incorrect signals to the brain about head
position.
2. Vestibular Neuritis.
-Cause: Inflammation of the vestibular nerve, often due to viral infection.

-Symptoms: Severe vertigo, dizziness, imbalance, nausea, but typically no

hearing loss.
-Mechanism: The inflammation disrupts the transmission of sensory
information from the inner ear to the brain.
3. Meniere’s Disease
-Cause: Abnormal fluid buildup in the inner ear.
-Symptoms: Episodes of vertigo, tinnitus (ringing in the ears), hearing loss, a
feeling of fullness in the ear.
-Mechanism: The excess fluid affects the inner ear's ability to function correctly,
leading to episodic symptoms.

4. Labyrinthitis.

-Cause: Infection or inflammation of the labyrinth (inner ear structures).

-Symptoms: Vertigo, dizziness, balance difficulties, hearing loss.

-Mechanism: Similar to vestibular neuritis but also affects the cochlea, leading to
hearing symptoms.
5. Bilateral Vestibulopathy

-Cause: Damage to both vestibular systems, potentially due to ototoxic drugs,

genetic conditions, or age-related degeneration.
-Symptoms: Chronic imbalance, oscillopsia (visual blurring with head movement),
difficulty walking, especially in the dark or on uneven surfaces.
-Mechanism: Reduced or absent vestibular function in both ears impairs balance
and spatial orientation.
6. Vestibular Migraine
-Cause: Migraine-related mechanisms affecting the vestibular system.

-Symptoms: Episodic vertigo, dizziness, motion sensitivity, headache, visual

disturbances.
-Mechanism: The exact mechanism is unclear but may involve abnormal
brainstem and vestibular system interactions.
7. Superior Canal Dehiscence Syndrome (SCDS)
-Cause: Thinning or absence of the bone overlying the superior semicircular canal.

Symptoms: Vertigo, oscillopsia, hearing loss, autophony (hearing one's own voice
loudly).
-Mechanism: The dehiscence allows abnormal movement of inner ear fluid,
leading to incorrect vestibular and auditory signals.
8. Persistent Postural-Perceptual Dizziness (PPPD)

-Cause: Often follows an acute vestibular disorder, but can be triggered by

psychological stress.
-Symptoms:Chronic dizziness, unsteadiness, hypersensitivity to motion, visual
stimuli.
-Mechanism: Maladaptive changes in the brain's processing of vestibular and
visual inputs
9. Central Vestibular Disorders

-Cause: Stroke, multiple sclerosis, tumors, or other central nervous system

conditions affecting vestibular pathways.
-Symptoms: Vertigo, dizziness, imbalance, nystagmus, ataxia (lack of muscle
coordination).
-Mechanism: Lesions in the brainstem, cerebellum, or other central areas disrupt
vestibular processing.
Understanding and diagnosing these vestibular abnormalities require
comprehensive vestibular testing, detailed patient history, and often imaging
studies. Treatment varies based on the specific condition and may include
medications, vestibular rehabilitation therapy, lifestyle changes, and in some
cases, surgery.