Dizziness (Vertigo)
The ear has three parts, the outer, middle and inner ear. Those who collect the sound waves of the outer and middle ear structures and transfer their cells to the inner ear fluid. The inner ear, where the hearing and balance centers are located, is located in the ear code and there are inner ear fluids (endolymph and perilymph) in different compartments.
Sensitive sensory nerve endings and nerve cells of the auditory and balance nerves are in constant contact with these fluids. Sound waves reaching the inner ear are transmitted within the inner ear fluids, stimulating the nerve endings and creating an electrical impulse. Inner ear fluid movements that occur with head movements also stimulate sensitive balance nerve structures in the inner ear. When this stimulus is transmitted to the brain by the auditory and balance nerves, hearing and balance functions are realized.
Ensuring Balance
The balance system consists of a center and three different sensor systems. The brain acts as a center that collects and processes information about body position that is continuously transmitted from the eyes, balance centers in the inner ear and muscles, joints and tendons, and is responsible for maintaining balance. These three systems work independently of each other and together they function in maintaining body balance. While the eyes provide information about the position of the body relative to the environment by transmitting images from the environment to the brain, signals from the muscles, tendons and joints transmit information to the brain about the position of the head relative to the body.
The inner ear balance system, on the other hand, consists of two different parts, the semicircular canals that detect rotational movements and the vestibule, which detects linear movements. These two parts, which are filled with liquid, are called the “labyrinth” together. When the head moves, the fluid in the inner ear also moves, and different nerve endings stimulated according to the shape and direction of this movement send signals to the brain that report the movement of the head.
How Does Dizziness-Vertigo Occur?
The balance organs located in the labyrinths on both sides constantly generate signals that are perfectly symmetrical to each other. The signals generated by the rotation of the head create a warning in the semicircular canals, and the linear movements in the front-to-back or up-down direction create a warning in the vestibule. The position change of the calcium carbonate crystals attached to the cells in the balance centers in the vestibule, depending on gravity, enables the perception of the direction and intensity of the head movement.
When the balance center in an inner ear is malfunctioning, the symmetry in the signals going to the brain is disrupted, and this creates the feeling that the balance is disturbed, while the stimuli from the brain to the eye muscles cause involuntary movements of the eyes (nystagmus). The movement of the visual field with these movements of the eyes creates a false perception of movement in the patient that his surroundings or himself is spinning, causing the complaint of “dizziness – vertigo”.
With the combination of information coming from all centers that perceive movements, corrective reflexes formed in the cerebellum and voluntary responses formed in the brain, signals are sent to body muscles to make movements to maintain balance. The balance centers in the brain, cerebellum and brainstem have the ability to adapt over time to asymmetrical signals coming from the inner ear and not be affected by them. Due to this feature, it is possible to eliminate or prevent the imbalance by adapting with appropriate exercises in some diseases that cause dizziness or in some sports activities that may create an imbalance under normal conditions.
Types of Dizziness
Problems in any of the centers that play a role in maintaining balance can cause symptoms such as dizziness, imbalance, and stupor.
Inner Ear Diseases
Balance disorders originating from the inner ear occur due to changes in the pressure of the inner ear fluid, improper movements of the fluid, or directly affecting the balance centers and or balance nerves.
The sensitive ends of the auditory and balance nerves end in different parts of the hearing and balance centers in the inner ear that contain the same fluid (endolymph). Changes in the circulation, pressure or content of this fluid create a stimulus in the nerve endings, causing acute, chronic or recurrent dizziness, with or without hearing complaints.
Similar complaints occur in other problems that impair the blood circulation of the inner ear or affect the balance nerve.
Brain Related Diseases
It occurs as a result of the deterioration of the brain’s ability to interpret the signals reaching it from the balance organs and to create appropriate responses. Concomitant hearing loss and or tinnitus may also be observed. These problems may occur due to advanced age, vascular occlusions or spasms, allergic or metabolic diseases, benign and malignant tumors.
Similar complaints may occur in situations such as extreme stress, panic attacks, depression, and tension. In such problems, there may be a feeling of fullness and pressure in the head and ears, along with imbalance.
Neck Diseases
Imbalance may occur as a result of the deterioration of position information signals sent from the muscles in the neck to the balance centers in the brainstem and play an important role in maintaining balance. Spasms in the neck muscles as a result of traumas, joint diseases in the neck vertebrae or pressure on the nerves in the neck
