Protect Your Balance System—Or Else . . .
© November 2003 by Neil Bauman, Ph.D.
Question: Recently, a drug I took severely damaged my vestibular system. Would
you explain how the balance system works and how my lack of balance can affect
my lifestyle?—W. P.
Answer: I'd be glad to. These are important questions. Your situation, unfortunately, is all too common. There are hundreds of drugs that
can damage (either partially or totally) your vestibular (balance) system. The resulting balance problems can drastically
affect your lifestyle. Let me explain.
Our ears are incredibly complex organs. Many people just think of them as
their means of hearing, but they are, at the same time, our primary organs of balance.
Perhaps you weren't aware of this, but your vestibular system does not work
alone to maintain your balance. When God designed your body, He gave you not just one, but three separate, yet
interconnected, balance systems. That way, if anything went wrong with one system, you would not be totally without
balance and left to flop helplessly on the floor like a jellyfish.
Your Three Balance Systems
The major component regulating your balance is, of course, the vestibular
system in your inner ears. The vestibular system consists of the three semicircular canals, the saccule and the
utricle. This part of your inner ears continuously senses gravity and both straight and curved movement. Like the
cochlea, the vestibular structures contain thousands of tiny hair cells that generate and relay balance signals
to your brain.
As you likely know, if something damages the hair cells in your cochlea,
you end up with hearing problems. Likewise, if something damages the hair cells in your vestibular system, the
result is balance problems.
The second component of your balance system is your eyes (ocular system).
Your eyes see both your position in space and movement.
The final component of your balance system goes by the tongue-twisting name
of proprioceptive (proh-pree-oh-SEP-tiv) system. Your proprioceptive system uses special pressure sensors in your
muscles, tendons and joints to sense gravity and joint position. Most of your proprioceptive sensors are in your
feet and leg joints.
As long as these three systems are working properly, you seldom give your
ability to keep your balance any thought. However, if one or more of these systems ever fails, it can impose enormous
changes on your lifestyle.
These three systems cooperate closely with each other in an interdependent
manner to use the strengths of each to the best advantage.
Your Ears and Eyes Work Together
Your vestibular system works together with your eyes in what doctors call
the vestibulo-ocular reflex. What this reflex accomplishes is truly incredible. When you walk, your head moves
up and down with your body movement. This would make everything you see blurry unless you were absolutely still.
However, your vestibulo-ocular reflex normally keeps your eyes clearly focused on your surroundings by instantly
and continuously changing your eye position as you move. You think nothing of this. It is totally subconscious
However, if your eyes and ears lose this coordination due to vestibular damage,
your eye muscles do not receive the proper signals from your brain to automatically adjust for this movement. As
a result, your surroundings will appear to move, bounce, jiggle and jump about and your vision will be blurry.
This means you will not be able to drive, or even read signs as you walk. Some people can't even recognize the
faces of the people they see walking towards them on the sidewalk. The technical name for this condition is oscillopsia
If you have oscillopsia, just walking can be extremely difficult or even
impossible because it is difficult to see and respond to obstacles in your path and to sense the exact location
of the floor or ground.
Your vestibulo-ocular reflex is so sensitive that it actually senses the
tiny upward and downward motions your head makes each time you breath in and out. It sends this information to
your brain. Your brain, in turn, instructs your eye muscles to keep your eyes clearly focused on what you are doing
in spite of this movement.
Even more astounding is how incredibly sensitive your vestibulo-ocular reflex
is. In fact, it is so incredibly sensitive that it detects the miniscule movement and change in position of your
head each time your heart beats and relays this information to your brain. Again, your brain sends messages to
your eye muscles to correct for this, all unknown to you. By doing so, it reduces the movement of the image on
your retinas thus giving you clear vision so you can read fine print and see fine detail. If you are like most
people, you probably never had an inkling that day after day your ears were doing this amazing job for you.
You need your eyes to help you maintain your balance. At the same time, you
need your ears (vestibular system) to help you maintain clear vision. Anything that disrupts your vestibulo-ocular
reflex directly affects your vision. Therefore, if your vestibular system is damaged, you will likely have fuzzy
or blurred vision. You will also likely have difficulty focusing on objects or holding your eyes on a printed page
since your hands can't hold a book completely steady. (Each heartbeat not only "jerks" your head, but
also "jerks" your hands a tiny bit too.) This makes it difficult or impossible to read smaller print.
It can also make it difficult to write. At the same, you will probably have difficulty with depth perception and
focusing on or watching moving objects.
In addition, you may feel dizzy, experience nausea or have a sense of moving,
particularly at the onset, if you move your eyes, move your head and eyes simultaneously, or watch moving objects.
This can make being around traffic, riding in a vehicle, watching TV or watching a movie in a movie theater very
unpleasant. You may find moving or flickering lights bother you.
Just the act of focusing your eyes may be difficult and can lead to dizziness
and nausea. You may have a tendency to look down because it is harder to focus on more distant objects. Your ability
to accurately determine distances may also be disrupted. As a result of your poor depth perception, you may often
bump into things.
Your Ears and Proprioceptive System Work Together
Your vestibular system also works together with the muscles of your body
via your spinal cord in what doctors call the vestibulo-spinal reflex. This instantaneous reflex allows for continual,
coordinated muscle adjustments so you can maintain your balance as you change position.
Normally, your vestibular system sends balance information to those areas
of your brain and nervous system involved in the motor control of your muscles. This balance information allows
your brain to continuously make little adjustments in muscle activity and body position to allow you to stand upright
and maintain your balance.
When you lose this reflex, your vestibular system no longer passes this information
on to your brain or it passes faulty information. As a result, your brain does not order the tiny muscle adjustments
and you get a condition known as ataxia (ah-TAKS-see-ah). Ataxia is the inability to coordinate your muscles properly
such that it affects your gait. As a result, when you walk you may lurch and stagger as if you were drunk (staggering
gait) as the other two parts of your balance system try to compensate. You will be unsteady and stumble a lot.
You may try to compensate for this by standing and walking with your legs
farther apart than normal in order to give you better control of your balance (wide-based gait). You also may keep
looking down while you are walking. Even so, you may lose your balance or stagger when turning quickly (whole body
or head only), and need to hold on to walls or furniture when you are walking.
In addition, you may have difficulty walking on slippery, soft or slanted
surfaces or on uneven ground. You may have difficulty standing or walking in dim or dark places, at night, or when
you have your eyes closed. Even under good lighting conditions, you will still tend to stagger. You may also feel
unsteady, have problems standing with your feet together, be uncoordinated and clumsy and overreach when grabbing
Two Systems Are Necessary to Maintain Balance
When they are working properly, your brain uses the separate signals from
your vestibular, ocular and proprioceptive systems to instantly and subconsciously maintain clear vision and to
make rapid muscle adjustments to maintain your balance and prevent you from falling.
These three systems are somewhat redundant, so if one stops functioning,
you can manage (with difficulty) on the remaining two. However, you cannot maintain your balance with just one
system working—you need at least two and preferably all three. Since it is your major balance system, if you lose
your vestibular system, your brain has to rely on the other two systems. However, without the critical vestibular
information, you will have a lot of trouble maintaining your balance, especially in the dark since darkness effectively
eliminates your ocular system leaving you with just your proprioceptive system to help you.
When Damage Whacks Your Balance System
So far we have been looking at how the vestibular system works together with
the other two systems and what can happen when the vestibular system totally ceases to function. However, often
the vestibular system is just damaged, not totally destroyed. This gives rise to a whole new set of problems.
When your vestibular system dies, it no longer sends any information to your
brain, so your brain does the best it can with the information from the other two systems.
However, if your vestibular system is only damaged, it continues to send
balance information—wrong information, mind you—but your brain doesn't know this. This confuses your brain and
you will experience things such as dizziness and vertigo (VER-tih-goe). If you have vertigo, you may feel that
you are spinning around or the room you are in is spinning around you.
Vertigo results from a mismatch of vestibular, ocular, and proprioceptive
inputs. When all three are telling your brain the same thing, all is well. However, when your ears tell your brain
one thing and your eyes and proprioceptive system tell it another thing, your brain doesn't know who to believe.
In this case, your brain's confusion manifests itself as vertigo. Nausea and vomiting often accompany vertigo.
Vestibular side effects generally are worse in the first few weeks after
vestibular damage occurs. In time, your brain will begin to rely less and less on vestibular information and more
and more on ocular and proprioceptive inputs. As this happens the dizziness and vertigo (with the attendant nausea
and vomiting) will tend to go away and you will tend to function as though your vestibular system were completely
dead. However, you will be left with permanent side effects that can alter your lifestyle dramatically.
Other Symptoms of Vestibular Damage
In addition to the host of visual problems, ataxia, dizziness, vertigo, nausea
and vomiting, which we have already discussed, damage to the vestibular system can cause a number of other symptoms.
Here are some of them.
If your vestibular system is only damaged on one side or damaged worse on
one side than the other, you can get a condition called nystagmus (nye-STAG-muss).
Nystagmus refers to abnormal rapid rhythmic back-and-forth side-to-side involuntary
eye movements (eye jerking). With nystagmus, both of your eyes drift slowly in one direction and then suddenly
jerk in the opposite direction. Your eyes will jerk toward the undamaged (less damaged) side and will drift back
towards the (more) damaged side. This abnormal eye movement can also cause vertigo, nausea, vomiting and a host
of other visual complaints.
Unlikely as it seems, vestibular damage can cause memory problems. Here is
why. When you damage your vestibular system, keeping your balance is now largely a conscious effort, not the automatic
effortless procedure it once was. Consequently, those areas of your brain that you once just used for thought and
memory, now must constantly work on keeping you balanced. As a result, your memory may suffer. You may grope for
words when talking. You may easily forget what is being spoken about during a conversation. You may be easily distracted.
You may have difficulty comprehending directions or instructions. You may have trouble concentrating and may feel
disoriented at times.
You may also experience fatigue because keeping your balance is now no longer
a subconscious event, but something that you must consciously work hard to maintain. All this work makes you tired!
Vestibular damage may also give rise to muscular aches and pains. This is
because when your vestibulo-spinal reflex no longer works automatically, you have to consciously control your balance
by making your muscles rigid and less relaxed as you strain to keep your balance. In addition, you may get headaches
and a stiff/sore neck from trying to hold your head absolutely still so you won't feel dizzy or nauseous.
Finally, damage to your vestibular system can include emotional problems
such as anxiety, frustration, anger and depression. Your feelings of self-confidence and self-esteem may plummet.
You may feel vaguely uneasy. You may feel that something is wrong or unreal without knowing why.
If you have a damaged vestibular system, you won't necessarily have all of
the above symptoms, but you may experience many of them.
By now you should have developed a sense of awe at the marvelous balance
system God designed for you. At the same time, you now realize the tremendous upsets that may come into your life
and lifestyle if you allow anything, especially ototoxic drugs, to damage this wonderful system.
If you are interested in learning more about your balance system and what
you can do to protect it, I suggest reading Chapters 3 and 4 in "Ototoxic Drugs Exposed."