How Can the Inner Ear Make Me Unsteady?

Helping You Understand the Inner Ear

The ear is for hearing isn't it? I've been told that it is involved in balance and that ear problems can make you unsteady. How does that work?

Inertia, Gravity and Otoconia - Detecting Our Head Movements and Positions

In addition to the hearing organ, the inner ear contains the vestibular apparatus, which detects all head movements and positions.  This apparatus includes organs that contain calcium carbonate crystals (otoconia, or “ear rocks”) in gel.  Sensory hairs poke into the gel, so when the weight of the crystals shifts the gel due to linear acceleration, deceleration or tilt, the hairs get deflected.  These hairs are attached to nerve endings, so when they get moved, a signal is relayed to the brain telling us about what sort of motion is taking place and what orientation the head is at with respect to gravity.  The brain then uses this information to orient our eye position so that we can see clearly, and to tell our bodies what adjustments to make in order to keep our balance.

So if you are stopping or starting at a light, beginning to going up or down in an elevator, rocking on a boat, or just tilting your head and body a little, you can thank this part of the inner ear for helping you understand what is happening.   If these organs are not working properly in one or both ears, then you won’t be getting accurate information about your head position or certain head movements, in which case it’s pretty easy to see how this could make a person feel unsteady!  If your inner ear(s) aren’t telling you accurately where upright is, and if this information isn’t matching what your eyes see or your body feels, then you will likely feel off-balance.   (The inner ear also contains organs that don’t rely on gravity but instead detect angular head movements.  Problems here can create dizziness and vertigo, and this area will be explained next time.)

Fortunately, well-trained vestibular rehabilitation therapists can help people compensate for inner ear problems and improve their balance and orientation.  If you or anyone you know is experiencing dizziness or imbalance, feel free to contact us – we are here to help you!  

You can also find out more information about the inner ear balance system at the Vestibular Disorders Association .

How We Help BPPV in Older Adults

BPPV a Common Cause of Dizziness in Seniors

BPPV happens when loose crystals (otoconia) fall out into one of the canals

One of the most common causes of dizziness in seniors is Benign Paroxysmal Positional Vertigo, or BPPV.  This happens when calcium carbonate crystals (otoconia), that we all have in one part of the inner ear, become displaced into one or more of the inner ear’s semicircular canals. When otoconia move into one of the inner ear’s semicircular canals where they aren’t supposed to be, that canal sends different information to the brain about certain head movement than the other ear.  Both ears should be saying the same thing about what our head movements are, and they should be agreeing with what our eyes are seeing and our joints are feeling.  When there is a mismatch in these systems, it makes us feel dizzy.  BPPV is the most common cause of vertigo, which is an illusion of the room spinning or moving.

What Happens in the Inner Ear When the Room Starts Spinning?

Taking apart what's really happening to a BPPV patients as they experience vertigo can help patients to feel less frightened by it. The start of the problem often happens at night when a person is laying down.  Loose crystals can fall out into one of the canals, and when the person gets up in the morning these crystals are trapped out in the canal.  From that point forward any time the person moves their head into a position where gravity moves the loose crystals, that canal sends a message to the brain that is an error.  The most commonly provoking movements are getting in or out of bed, rolling over in bed, bending, looking upward and quick head movements.

Because of the connections between our inner ears and our eye muscles, during the time the crystals are moving, the incorrect signal makes our eyes move in a way that makes it appear like the room is spinning.  In the most common form of BPPV, the spinning only lasts until the crystals stop moving because they’ve reached the lowest point in the canal, which takes less than 1 minute.  If things are spinning longer than 1 minute, it is either a rarer form of BPPV called cupulolithiasis, or it is a condition other than BPPV.  A well-trained Vestibular Rehabilitation Therapist, ideally using special goggles allowing for a magnified look at your eye movements, can help you determine whether or not you have BPPV, and if so, what form you’ve got and what canal the loose crystals have moved into.  This then determines the treatment maneuver that should be used.

How We Treat Bening Paroxysmal Positional Vertigo (BPPV)

To help sufferers of BPPV a vestibular rehabilitation professional uses techniques to locate the crystals that are out of place and employs maneuvers to reposition them back to the correct chamber with the help of gravity.  Typically after 1-3 visits peoples’ BPPV is corrected.   Sometimes people have some mild sensitivity to motion and/or some balance issues that persist after the BPPV is cleared, but these are typically easily remedied with some simple home exercises.

If you or anyone you know is experiencing dizziness or imbalance, feel free to contact us – we are here to help you!