The brain can suppress the ear

sometimes.  There are moments when this is helpful and there are moments when central suppression is not helpful.  Central suppression of the inner ear is helpful when the power of focus is used to control nystagmus caused by an inner ear problem.  In other words, the brain has the power, through intense concentration on maintaining clear vision, to slow down abnormal eye movements caused by an inner ear problem.  This can help some have less perception of dizziness.

Central suppression of the inner ear is not helpful when an individual has good balance but does not believe they have good balance.  In other words, when individuals do not trust their abilities to walk without falling, they use their brain too much to control balance.  They "overthink" their balance.  As a result, the brain has the ability to cancel out the natural reflexes that help us maintain balance.  These reflexes are greatly controlled by the inner ear.

Driving without a speedometer

is like trying to walk with a vestibular system that is not working properly.  In high school, I had a sweet 1979 GMC three quarter ton black pick up truck.  I really liked this truck, but the speedometer did not work.  So, I had to learn to use other ways to determine how fast I was going.  Since I had driven the truck one whole year with a working speedometer, I learned to rely upon the following techniques to determine my speed:
1.  My memory of what 55 mph felt like when the speedometer worked.  I know this sounds crazy, but I could just feel how fast I was going.  If I was going very slow, the truck barely seemed to wobble, but going fast would make the suspension much more alive. 
2.  I considered how far down I pushed the accelerator with how loud the engine sounded.  In addition, my precious truck had a manual transmission which added to the reliability of my guesstimates.
3.  The amount the bug reflector on the front of the hood bent down from the wind was somewhat valuable.  If it bent down too far I knew I was going too fast!

My parents always reminded me that if I ever got a speeding ticket that my driving privileges would be revoked.  Therefore, I always had to err on the side of going too slow.

What does this have to do with our vestibular system?  Our central vestibular system remembers how movement should feel and combines that information with what the peripheral vestibular system tells it about movement.  When one system is not working properly, it is able to get more valuable information from other systems in the body.

The labyrinth

is amazing.  There is one set of three canals in each inner ear.  They are aligned in different planes of motion so that we can perceive movement in different directions.  They are full of fluid called endolymph and perilymph.  This fluid can change in it's consistency.  Sometimes it may be thick like honey and sometimes it may be "runny" like water. 

When we move our heads, the fluid in the inner ear moves and causes the cupula to deflect like a sail.  The cupula is a thick hair inside the ampulla of the semicircular canals.

Click here to learn the function of the inner ear, to learn how the inner ear works and to view a picture of the inner ear.

"You can't even describe it...

it's so terrible," claimed one of my clients when trying to describe what she meant by dizzy.  Everyone speaks their own dizzy language and, when fear/anxiety is involved, the perception of the sensation is escalated and changed.   I have now collected over 150 words clients have provided (I have been keeping track since October 2010) when I ask them what they mean by dizzy.

When does vestibular rehabilitation work best?

Vestibular rehabilitation works best (provides the most relief) for individuals battling a stable peripheral vestibular problem.  Stable means that the problem is no longer in the process of getting worse.  The condition is either improving or is staying the same.  Here are some examples of stable vs. unstable vestibular problems.  Central vestibular problems, that are stable, can improve with vestibular rehab.  However, less improvement is expected with a stable central vestibular problem.

Unstable peripheral and central vestibular problems are very challenging to manage and can be life threatening.

What are the four types of vestibular rehabilitation?

The type of vestibular rehabilitation one receives depends upon the type of vestibular problem the client has.  There are four types of vestibular rehabilitation:
1.  Repositioning: Provided for BPPV.
2.  Adaptation: Provided for a unilateral vestibular hypofunction.
3.  Substitution: Provided for a unilateral vestibular hypofunction, bilateral vestibular hypofunction and other causes of dizziness/imbalance when appropriate.
4.  Habituation: Provided for stable peripheral and central vestibular disorders when appropriate (proceed with caution).

But....I was told my inner ear is fine!

What are the benefits of vestibular rehabilitation?

The most obvious benefit we see daily is that many people battling dizziness from vestibular problems experience significant relief from their dizziness quickly. Health care providers who specialize in vestibular rehab are able to help determine the presence of a vestibular problem and provide individuals with education regarding why they are dizzy and how they can receive help.

But... I was told I don't have an inner ear problem!

Another benefit of vestibular rehabilitation is that the vestibular rehab specialist will, often times, be able to examine the client with dizziness on "dizzy days."  Too often, people are told there is nothing wrong with their inner ears for the following reason: the day their inner ears were tested was on a day when they were not dizzy and the problem, at that moment, was stable. Health care providers trained in using a video eye movement recorder can usually get a person with dizziness in quickly to see them and it sometimes only takes a few moments with a few simple tests to determine the presence of a vestibular problem on a "dizzy day".

What is vestibular rehabilitation?

Vestibular rehabilitation (VR) is a form of specialized therapy that promotes healing in the peripheral and/or central parts of the vestibular system.  Vestibular rehab is therapy aimed directly at improving the functional relationship between the inner ear, brain, eyes, muscles and nerves through central nervous system compensation.  Vestibular rehabilitation can provide very quick relief from symptoms and is a powerful tool that can help empower individuals battling dizziness due to vestibular dysfunction.

The Elderly and Post Concussion Syndrome

I have been working with older individuals who have a variety of types of dizziness and have been reporting a history of concussions.  I sometimes wonder how many of these individuals had undiagnosed post concussion syndrome.  For instance, I have had individuals complain of dizziness that began around 20 years ago following a head injury that resulted in a concussion.  From that point on, I am hearing individuals report hypersensitivity to motion, visual and auditory hypersensitivity with severe headaches with exertion that lasted for years.  These individuals report never being the same.   Vestibular Rehab and Physical Therapy in general should be considered to help battle these symptoms.