Although most people worry about skull fractures and brain damage when they sustain a head injury, the inner ear, or vestibular system, also is frequently damaged and causes long-term problems if neglected. Vestibular injury frequently goes undiagnosed and underestimated despite causing symptoms such as dizziness, anxiety, depression, moodiness, tinnitus, balance problems, irritability, and more.
Vestibular injuries cause problems with balance and dizziness, as well as anxiety and moodiness.
The vestibular system, a labyrinth of semi-circular canals, perceives motion in three-dimensional space and is known as the equilibrium center. It works with the eyes and the brain to let you know where you are in the environment. It is vital to safety, survival, and attention.
One way to think of the vestibular system is to imagine holding a glass of water while driving. When you turn, accelerate, decelerate, or stop, the water moves in opposition to the movement. Your vestibular system, which contains fluid and sensory hair cells, works in a similar manner, sending signals to your brain to keep your body stable and aware as you move throughout your daily life or in sports.
Vestibular injury in concussion and whiplash
Vestibular injury is common with concussions and whiplash. Even when there are no signs of brain injury after an accident, many people may still sustain an injury to the sensitive vestibular system.
Vestibular injury can come from direct diffuse damage or from a fracture to the skull in the surrounding area. It can also come from damage to the nerves in the brainstem that feed into the inner ear.
Distinguishing vestibular injury from brain injury
Functional neurology offers specific exams that distinguish vestibular injury from brain injury.
A test using videonystagmography is one of the most commonly used in functional neurology. This involves the patient wearing infrared goggles that capture eye movements on video the practitioner can view on a computer screen. The patient’s eyes are monitored in both light and darkness and through various ranges of motion, such as turning or nodding the head and spinning in a chair.
Using the analogy of glass of water while driving, the eyes reflect what is happening in the inner ear in response to movements. This can show in what ways vestibular function is impaired, and whether the damage is structural or due to damaged nerves in the brainstem that feed information to the inner ear.
Targeting inner ear injury determines treatment
The distinction between inner ear injury and brain injury is vital because it determines the course of treatment. Many brain injury victims are put through the same course of rehabilitation despite the nature of the injury in the hopes that the rehab will hit some of the pertinent areas in need. This can be inefficient.
However, using functional neurology to target the specific areas of impairment to both the brain and the vestibular system (or just the vestibular system) can make for much more effective rehab strategies.
Vestibular system treatments
Because the inner ear is connected to vision and movement, therapy that combines specific eye exercises with certain movements can improve function in damaged areas of the inner ear. For instance, the patient may spin to the right in a swivel chair while watching lines move upward on an iPad.
This is a much different approach to a brain-specific exercise, which might include balance and coordination exercises.
Ask my office for more information about how a vestibular system injury or disorder might be affecting you.
