Balance is often referred to as our "sixth sense" and goes unnoticed by people with healthy vestibular systems. It’s only when things go wrong you realise how important it actually is. Our sense of balance is created by a complex interaction of the following:
• The inner ears (Labyrinth) which monitor the directions of motion such as turning, forward-backward, up-down or side-side motions.
• Eyes – which observe the directions of motion as well as where the body is in space.
• Skin – especially skin receptors in the feet – sense which part of the body is touching the ground.
• Muscle and Joint sensory receptors – these report which parts of the body are moving.
• CNS (brain and spinal cord) – processes the above information and makes sense out of it all.
What can go wrong?
Research suggests that about 60% of dizziness is of Labyrinthe origin. It is important to note that the term “dizziness” can be used to describe a lot of different sensations however. Lightheadiness or “typical” dizziness can be caused by a range of problems including: systemic illnesses, change in blood pressure, cervical (neck) dizziness and others. Inner ear dizziness, as we have both found out, is quite frankly, in a league of its own! The symptoms section will describe this in more detail but vertigo or motion is almost always involved in some form. There are a number of inner ear disorders which can cause dizziness:
• BPPV (Benign Paroxysmal Positional Vertigo) – brief, sudden episodes of vertigo and/or nausea with head movements. Usually episodic though BPPV can cause Vestibular damage which can result in similar symptoms to uncompensated Labyrinthitis.
• Menieres Disease - which is believed to be caused by fluctuating inner ear fluid levels.
• MAV – Migraine Associated Vertigo. Not inner ear related but can cause inner ear damage in some cases and can present similar symptoms to inner ear dysfunction though MAV is generally episodic.
• Mal de debarquement (MDDs) - it is unknown as to what causes this disorder. It is thought to be brain related though the symptoms are often identical to inner ear. Bouncing, rocking vertigo is experienced after a long cruise or flight. NB: Many patients with inner ear problems encounter problems with flights/boats - MDDs is primarily caused by such a journey.
For online support sites on MDDs see:
http://www.mdds.org.uk and http://www.nhffoundations.net/mdds
• Labyrinth trauma/concussion – caused by head injury. See link for Labyrinthitis as Labyrinth trauma is basically inner ear dysfunction.
• Otoxicity – certain medications/antibiotics can cause damage to the inner ear.
• Acoustic Neuroma- a benign tumor, which lies in the vestibular portion of the eighth cranial nerve. Affects balance but mainly hearing.
• Perilymph Fistula-a tear or defect in one or both of the small, thin membranes between the middle and inner ears.
• Labyrinthitis or Vestibular Neuritis – infections of the Labyrinth or Vestibular Nerve – can cause permanent damage.
If you have been diagnosed with Labyrinthitis, it will have probably started in a particular way – see symptoms. It is most commonly caused by a virus (though can also be bacterial) which can either inflame the Labyrinth or cause damage to a part(s) of it. This damage basically causes the affected ear to "fire" neurons at a different rate to the other ear.
Most patients who have not recovered within the 8 week period, have Labyrinth damage. This damage is permanent as the inner ear has little ability to repair itself. However, the brain or CNS has an amazing ability to adapt and “compensate” for the injury and if this takes place successfully, can result in the patient leading a symptom free life. For many Vestibular patients like us, the brain needs “help” to compensate via Vestibular Rehabilitation Therapy (VRT). At this point (beyond the 8 week mark) Labyrinthitis has gone and it is the residuals of the infection - the damage - instead which remains - creating inner ear dysfunction.
If you need anymore information, just ask me :)
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