The vestibular apparatus is part complex mechanism, providing a person with balance and coordination of movements. It continuously interacts with the skin, visual and nervous systems. Study vestibular apparatus required in cases where their coordinated work a malfunction occurs, as a result of which a person loses his balance and ceases to navigate in space.
The organ is complicated organized by the system, the development of which is completed by 12-15 years. He is part inner ear.
Thanks to the work of the vestibular apparatus, a person easily navigates in space and maintains body balance even with eyes closed. When you try to make any movement, the system's receptors are instantly irritated, sending an impulse to the brain and muscle tissue. At the same time, the image is recorded on the retina. Due to this, the body can take any pose and long time hold her.
Like any other system of the body, the organ of balance is extremely vulnerable. At the first signs of any disorder of the vestibular system, you should immediately contact a therapist or otolaryngologist.
Failure of the normal functioning of the organ may be due to the development of certain diseases or the use of certain medications. Often, disorders of the vestibular apparatus appear as the body ages.
The most common causes of the disorder are:
A study of the vestibular apparatus should be carried out when the following signs its violations:
Often, a failure in the system is accompanied by disorders of the gastrointestinal tract.
A study of the function of the vestibular apparatus is prescribed for:
In addition, a study of the function of the vestibular apparatus is required for the military medical commission (military medical commission) and when entering work related to increased loads to the organ of balance.
The examination is prohibited in the following cases:
An important point before examining the function of the vestibular apparatus is collecting an anamnesis. With its help, assumptions are made regarding the cause of the violation and the most suitable solution is selected. suitable method examinations.
The doctor pays special attention to the following:
Based on the medical history, the specialist prescribes the most gentle method of testing. Based on his decision, the patient may be redirected to other doctors.
Today, there are many methods for studying the vestibular apparatus. The most common are:
This diagnosis is carried out by an otolaryngologist. If symptoms of dysfunction of the vestibular apparatus appear, you must contact an ENT specialist or a therapist who will give the appropriate direction. The procedure can also be carried out on a contractual basis by contacting a private clinic.
The vestibular apparatus is a complex mechanism that provides a person with balance and the ability to navigate in space. It is closely connected with other organs. When the system malfunctions, unpleasant symptoms. If they occur, a study of the vestibular apparatus by an otolaryngologist is indicated.
In the body of every person there is a vestibular system, which is responsible for balance and maintaining the position of the body in space. Any disturbances in the functioning of this center can lead to severe dizziness, loss of orientation in space and swaying. Dizziness occurs especially often and the vestibular apparatus is disturbed in osteochondrosis.
The organ is located in the ear, so any deviations in its functioning usually cause hearing impairment and the appearance of noise.
Today we will figure out if there is a vestibular disorder, which doctor to contact to get qualified treatment? You can start with a general practitioner or go straight to an otolaryngologist who specializes in this center. Sometimes you have to undergo an additional examination by a neurologist to combat the disease.
For the treatment of the vestibular system, examination is a necessary and very first procedure. Diagnostics is necessary to determine the root cause of pathological abnormalities.
If any disturbances in the functioning of the vestibular apparatus are detected, we have already said where you can check your health - with an otolaryngologist. The specialist will perform the following diagnostic procedures:
We have figured out which doctor treats the vestibular apparatus and how the initial examination is carried out, and now we will consider the process of carrying out the main procedure - vestibulometry.
An otolaryngologist who treats the vestibular system may prescribe a study after an initial examination and study of the patient’s medical history. of this center. Two days before the procedure, the patient is prohibited from drinking any alcohol and medications- these are the main rules of preparation.
Any therapist or ENT doctor will tell you where you can check the vestibular apparatus. There are different methods carrying out examinations, among which are:
Caloric test. It is based on a gradual infusion of cool or warm water into the external ear canal.
Rotational test. The study is carried out using a special chair in which the patient tilts his head back and closes his eyes. Upon returning to the initial position, the gaze is activated and receives direction to determine the duration of the nystagmus reaction.
Finger test. The patient needs to close his eyes and try to touch the tip of his nose with his finger.
Pressor test. Using a Politzer balloon or tragus, the otolaryngologist provokes thickening/rarefaction of air in the ear, due to which the fistula or fistula is caught.
Index test. The patient sits on a chair and puts his hands on his knees. Next, he raises each hand in turn and tries to touch the index finger of the other hand.
Wojacek's otolithic reaction. This procedure requires a motor chair, on which the patient sits and lowers his head, closing his eyes. After stopping the movement, the otolaryngologist evaluates the deviations of the body and identifies vegetative signs(nausea, cold sweat, etc.).
Such examinations of the vestibular system help the doctor understand the condition of this the most important system body.
The vestibular apparatus is part of a complex mechanism that allows you to maintain body balance, navigate in space, and coordinate movements. It is located in the inner ear. In order for this device to perform its functions, it must interact with other organs - the eyes, brain and skin. When this interaction is disrupted, balance disorders occur, characteristic symptoms which include dizziness and loss of coordination. If such symptoms appear, a person should immediately consult a doctor.
There are three main methods for studying the vestibular apparatus - rotational, thermal and mechanical tests. There are also simple tests to determine whether a patient has motor coordination problems.
The patient sits in a special chair with his head tilted forward. Then 10 rotations are performed in 20 seconds, and the chair is abruptly stopped. The so-called nystagmus - involuntary rhythmic oscillation eyeballs. After measuring the duration of nystagmus, the procedure is repeated. Rotations are made in reverse side. Normally, in both cases the duration of nystagmus is the same - 20-50 seconds. If the difference between the results obtained is 25%, then a balance disorder can be assumed.
This test uses a small rubber bulb with a tube and oil. The external auditory canal is filled with oil, thus displacing air from it. After this, the pear is compressed and unclenched. During this procedure, the doctor checks whether the bony capsule of the labyrinth is affected.
The patient sits with his head thrown back or lies with his head tilted towards his chest. The ear canals are rinsed with water for approximately 30 seconds. During the procedure, nystagmus occurs: when washing cold water eyeballs rotate in different directions when rinsing warm water- one way. The test allows you to evaluate the sensitivity of the vestibular apparatus.
You can determine whether a person has impaired coordination of movements using simple tests, such as walking in a straight line and walking with your eyes closed. These tests are also used to determine the degree of alcohol intoxication. A test that is often used is to touch the tip of the nose with your index finger. Once the patient does this with with open eyes, and the other - with closed ones.
Similar information is provided by the Barani index test. The patient first raises his hand up with his eyes open, then slowly lowers it to a horizontal position. His index finger should be opposite index finger doctor If the patient's coordination of movements is impaired, then he misses. Or the patient sits on a chair in front of some object. He is asked to close his eyes and point to an object several times. If the function of the labyrinth is impaired, then the patient has the illusion of the object moving and misses.
The patient stands with his feet together. A healthy person stands straight, but a patient with poor coordination of movements deviates from vertical position, making an attempt to compensate for the feeling of movement he feels. It deviates in the direction on which the labyrinth is damaged.
To more accurately measure nystagmus (involuntary rhythmic vibration of the eyeballs), Frenzel glasses are used - magnifying glasses equipped with light bulbs that illuminate the eyes. The room is darkened so that not a single point is visible in it on which the gaze could be fixed. Nystagmus is also measured using electrodes. This method is called electronystagmography.
At drunkenness Coordination of movements is impaired, therefore, to determine the degree of intoxication, the pointing test and walking in a straight line are popular.
Bartsok trainings vestibular gymnastics
Balance organ diagnostics are designed to identify vestibular problems and understand what kind of training is needed
Are you familiar with the action of jumping a little to get your leg into your trouser leg? You are a trained and confident person, if this is not the case. Maybe in this case you don’t bump into the corners of furniture at home or in the office, you rarely lose your balance in a straight line and figuratively, you have no illusions about yourself and your surroundings, and you have no problems with coordination. But, if this is not entirely true, training the balance organ would be useful to you. All the exercises suggested here can be done at home without additional tips.
In this section, dedicated to training the balance organ and, above all, the vestibular apparatus, you will find 3 sets of exercises of varying complexity. But what kind of balance training do you need now? General, therapeutic, or is it better to take a complex to improve vestibular functions? Test yourself to make the right choice. The diagnostics proposed below are intended for this purpose.
Diagnosis of the state of the balance organ is needed to identify problems. If you answered no to all questions, you have a perfectly functioning balance organ. But its work can and should be improved. Try performing a general set of exercises. And, if this is not enough, and you need greater accuracy, coordination and confidence in movements, move on to a set of exercises to improve the functioning of the balance organ. Such training is needed not only for acrobatics, rock climbing or auto racing, but also simply for excellent well-being.
Try answering the following questions:
If all your answers are negative, try performing a set of exercises to improve the functioning of the balance organ. But, if our diagnostic questions elicit positive answers, we need to address therapeutic restoration functions of your balance organ, and then move on to a general set of exercises, prioritizing them according to the importance of solving the relevant problems for you. By improving the functioning of your balance organ, you will gain greater self-confidence.
Impaired coordination, motion sickness, unrelated dizziness, lack of balance and movements with eyes closed reflect an unusual mismatch of information entering the vestibular center from different organs, including the eyes. Performing the exercises of the three proposed complexes will help eliminate these problems in the functioning of your balance organ.
If you don’t even think about answering some questions, start with exercises medical complex and only after mastering it, move on to the general set of exercises.
Go to exercises
The main structure of the organ of balance, the vestibular apparatus, is located in the inner ear and consists of an apparatus that registers changes in the speed of horizontal or vertical movement of the head and body, as well as an apparatus that sends signals to the vestibular centers of the brain about changes in the speed of turns and tilts of the head.
Motion sickness occurs when the speed of linear horizontal or vertical movement changes. Elimination of motion sickness is possible through training with the first of these devices.
Dizziness may occur due to various reasons. But the most common cause of dizziness is unpreparedness for turning and tilting another part of the vestibular system, which can also be corrected through training.
The brain receives signals from the vestibular apparatus, as well as visual analyzer and many signals from the legs and other parts of the body and coordinates them. Together these structures are called vestibular analyzer or organ of balance. Signals from different parts balance organs may be mismatched. For example, when you are riding in a vehicle, signals from your head and legs indicate that you are motionless, and your eyes register movement. It takes training to accustom the brain to such mismatches.
An examination of a patient or test subject always begins with clarification of complaints and anamnesis of life and illness.
Vestibulometry includes identifying spontaneous symptoms, conducting and evaluating vestibulometric tests, analyzing the data obtained and drawing up a general picture of the functional state of the vestibular apparatus.
The study of complaints is a targeted survey of the patient, which makes it possible to find out the functional state of physiological systems - sensory, animal, autonomic, reflexively connected with the vestibular analyzer. The most common complaints are dizziness, impaired gait and coordination, nausea, vomiting, fainting, sweating, discoloration skin etc. The nature of the complaints may be different, the symptoms described above may occur in paroxysms, may be fleeting in nature or last for several hours or days; at the same time there may be symptoms from all three physiological systems of the body, or there may be only movement disorders, or only sensory reactions. The above complaints may occur without visible reasons, under the influence of specific environmental factors and the body: in transport, surrounded by moving vehicles, during fatigue, during physical stress, under a certain position of the head, etc. It should be borne in mind that with vestibular genesis, these complaints are of a clear nature; for example, when dizzy, the patient feels an illusory displacement of objects or his body; when walking, such sensations lead to falling or staggering. Often, patients call dizziness the darkening or appearance of spots in the eyes, especially when bending over and when moving from a horizontal to a vertical position. These phenomena are usually associated with various lesions of the vascular system, fatigue, general weakening of the body, etc.
Spontaneous vestibular symptoms include nystagmus, changes in muscle tone of the limbs, and gait disturbance.
Spontaneous nystagmus is examined in the sitting position and in the supine position. In this case, the subject follows the researcher’s finger, which is 60 cm away from the eyes, and the finger moves sequentially in the horizontal, vertical and diagonal planes from one extreme abduction of the eye to the other, opposite in the corresponding planes. When examining a patient in a supine position, the head is given different positions: the head is bent towards the chest, hanging down towards the back, the head is tilted to one shoulder, then to the other. There is no consensus yet regarding the genesis of positional nystagmus. Apparently, in some cases this nystagmus is associated with dysfunction of the otolith receptors. Nystagmus detected in a sitting position is associated with dysfunction of the ampullary receptors.
Changes in the tone of the muscles of the limbs can be ascertained by measuring the strength in the arms with a dynamometer, and changes in the tone of the torso can be observed when studying balance in the Romberg position.
The study of gait can be done visually, using a trace method, or using an ichnograph. In a visual method of studying gait, the patient is asked to walk five steps forward and five steps back with his eyes open and closed, and the degree of deviation from a straight line and the length of the step are noted in degrees. With ichnography, the results of the study can be recorded on paper using a special device.
Vestibular tests. Excitation of vestibular receptors with the help of adequate and inadequate dosed influences is the essence of vestibular tests. Adequate stimuli for the ampullary receptors are angular accelerations; a dosed rotational test on a rotating chair is based on this.
Cooling or heating of the inner ear with cold or hot water during dosed washing of the external auditory canal causes, according to the law of convection, the movement of endolymph in the horizontal semicircular canal, which is closest to the middle ear. Excitation occurs in the ampullary receptor caused by an inadequate stimulus. Other inadequate stimuli of the vestibular receptors are also possible, for example, galvanic current, mechanical displacement of the endolymph during compression and decompression in the external auditory canal, when this change in pressure is transmitted to the liquid media of the labyrinth through its windows or a pathologically occurring hole - a fistula of the bone wall of the labyrinth.
An adequate stimulus for the otolith receptor is rectilinear acceleration in the horizontal and vertical planes; the vestibular test on a regular, four-bar swing, etc. is based on this.
With the help of vestibular tests, they determine not only dysfunction of the analyzer, but also characterize its characteristics and endurance in healthy people for the purpose of professional selection.
1. Rotational test according to Barany. To conduct this test, the subject sits in a Barany chair and is given angular acceleration at a speed of 2 revolutions or 180° per second, a total of 10 revolutions in 20 seconds. This speed exceeds the threshold stimulation by approximately 100 times. At the beginning of rotation, the human body experiences positive acceleration, at the end of rotation - negative; at the moment of acceleration, the receptor cells of the semicircular canals are excited, which causes the occurrence of a number of vestibular reactions. With this test, the parameters of post-rotational nystagmus are visually studied, which make it possible to assess the functional state of the vestibular apparatus.
To determine the nature of nystagmus and subsequent analysis of the research results, it is necessary to take into account the following patterns, called Ewald's laws: 1) the plane of nystagmus corresponds to the plane of the excited semicircular canal; 2) the slow component of nystagmus, protective motor reactions are directed towards the movement of the endolymph in the horizontal semicircular canal; 3) the semicircular canal in which the movement of the endolymph is directed towards the ampulla (ampulopetal movement) is irritated many times more strongly.
If the functional state of the horizontal semicircular canals is being studied, the subject sits in a Barany chair with his head lowered forward by 30°. If the functional state of the frontal semicircular canals is being studied, the subject sits in a Barany chair with his head thrown back 60°. If the function of the sagittal semicircular canals is being studied, the subject sits with his head tilted to the opposite shoulder at 90°. At this eyes are always closed, feet on a stand, hands on the armrests. The chair is rotated by hand 10 times in 20 seconds; the chair stops not gradually, but suddenly.
After the chair stops, the countdown begins, the subject fixes his gaze on the doctor’s finger, while the degrees of nystagmus are checked, then the subject’s eyes are fixed in the direction of the fast component to subsequently determine the nature of the amplitude and liveliness of the nystagmus, its duration. It is necessary to avoid extreme abductions of the eyes and placing the finger close to the eyes, on which the gaze is fixed, since this can affect the characteristics of nystagmus due to overstrain of the eye muscles.
When rotating clockwise, i.e. to the right, at the moment the chair stops in the right ear, the movement of the endolymph will be ampulofugal, in the left ear - ampulopetal. According to Ewald’s law, the horizontal channel in which the endolymph moves ampulopetally is irritated, and the direction of the slow component of nystagmus always corresponds to the direction of the endolymph flow. Consequently, post-rotational nystagmus, etc. vestibular reactions in this case will be due to the excitation of the left labyrinth. The movement of the endolymph, the slow component of nystagmus, protective motor reactions will be directed to the right, and the direction of nystagmus, its fast phase, will be directed to the left, i.e. towards the excited ear. When rotating counterclockwise, i.e. to the left, at the moment the chair stops in the right ear, the endolymph current is ampulopetal, in the left ear it is ampulofugal, i.e. the nystagmus will be directed to the right, towards the excited ear.
Post-rotational nystagmus when studying the function of healthy labyrinths has the following characteristics: the duration of nystagmus when studying the horizontal semicircular canals is 25"-35", when studying the frontal and sagittal canals 10"-15"; the nature of nystagmus in the study of horizontal semicircular canals is horizontal, frontal - rotatory, sagittal - vertical; in amplitude it is small- or medium-wide, I-II degrees, lively, quickly decaying.
Bilateral absence of post-rotational nystagmus indicates a switch off of vestibular function in relation to angular acceleration.
Different durations of post-rotational nystagmus when examining the right and left ears indicate a unilateral lesion of the vestibular analyzer. The same, but greatly reduced duration of post-rotational nystagmus may be due to central compensation, which gradually occurs when one of the labyrinths is turned off. Perverted post-rotational nystagmus may indicate damage to the central parts of the vestibular analyzer.
Pronounced post-rotational protective-motor reactions (in particular, deviation of the torso, arms) and autonomic reactions (such as changes in heart rate, breathing rhythm, skin color, sweating, nausea, etc.) in healthy people are often weakly expressed; while in patients during periods of exacerbation of vestibular disorders they arise quickly and proceed violently.
Caloric test. During this test, a weaker artificial stimulation of the labyrinth is achieved than during rotation, with convection displacement of the endolymph columns mainly in the horizontal semicircular canals. It is also important that the vestibular apparatus is examined in isolation on one side.
During a cold caloric test, using a Janet syringe or another method, the external auditory canal of the subject is washed with 100 ml of water at 1° + 19°C for 10 seconds; the water jet is directed along the posterior-superior wall of the external auditory canal. With a thermal caloric test, the water temperature is +42°, +45°C. To study the functional state of the horizontal semicircular canals, the head of the subject is tilted back 60° with a slight tilt towards the shoulder towards the ear being examined. Then the time is determined: from the moment the ear is washed until the appearance of nystagmus, a latent period is noted, normally equal to 25-30 seconds, then the duration of the nystagmus is recorded, normally equal to 50-70 seconds. The characteristics of nystagmus after a caloric test are given according to the same parameters as after a rotational test.
The pressor test is performed by condensing air into ear canal either by applying pressure to the tragus or using a rubber bulb. If nystagmus occurs in response to thickening of air in the external auditory canal, then the fistula test is positive, which indicates the presence of a fistula in the wall of the labyrinth, most often in the horizontal semicircular canal. If there is a large perforation in the eardrum, direct pressure can be applied with a probe with rolled cotton wool onto areas of the labyrinthine wall that are suspicious for a fistula.
Otolithic reaction (OR). The subject, sitting in a Barani chair, bends his torso at an angle of 90° forward and down, in this position he is rotated 5 times for 10 seconds, then the chair is stopped and waited for 5 seconds, after which the subject straightens, at this moment a reaction occurs in the form tilting the body and head to the side. In this reaction, the magnitude of the angle of deflection of the body is noted. If the subject deviates by an angle from 0° to 5°, the otolithic reaction is considered weak, with a deviation of 5-30° - medium, with a deviation of more than 30° - strong. After a few minutes, the experiment is repeated, rotating the subject in the opposite direction.
The angle of reflex inclination in this reaction depends on the degree of influence of otolith irritation during straightening of the body on the function of the frontal semicircular canals; this influence can be zero, weak, medium and strong. If the subject under the influence of otolith irritation gives a very strong tilt reaction (30°) emanating from the frontal semicircular canals, then the sensitivity of the otolith apparatus is considered to be diminished. With a weak tilt reaction (from 0 to 5°), the otolithic apparatus is considered to be of little sensitivity. This double rotation experiment is usually used to study healthy people during professional selection.
Based on a comparison of the results of studies of the vestibular apparatus, a conclusion is made about the functional state of the vestibular analyzer and, in particular, about receptor cells that can be in a state of normal, increased and decreased excitability. An altered nature of excitability compared to the norm may be due to congenital properties, pathology within the labyrinth, or central compensation due to pathology of one of the labyrinths.
