ABSTRACT
Sensory information from the vestibular, visual, and somatosensory/proprioceptive
systems are integrated in the brain in complex ways to produce a final motor output
to muscle groups for maintaining gaze, head and body posture, and controlling static
and dynamic balance. The balance system is complex, which can make differential diagnosis
of dizziness quite challenging. However, this complex system is organized anatomically
in a variety of pathways, and some of these pathways have been documented. The vestibulo-ocular
reflex (VOR) is one such pathway. Understanding the anatomy and physiology of the
VOR facilitates our understanding of normal and abnormal eye movements, and research
is advancing our understanding of the plasticity of the vestibular system. This review
highlights anatomical and physiological features of the normal vestibular system,
applies these concepts to explain some clinical findings in some common peripheral
vestibular disorders, and discusses some of the research investigating the anatomical
and physiological basis for vestibular compensation.
KEYWORDS
Vestibular - anatomy - physiology - dysfunction - compensation - vestibular nuclei
- cerebellum
REFERENCES
- 1
Fuller P M, Fuller C A.
Genetic evidence for a neurovestibular influence on the mammalian circadian pacemaker.
J Biol Rhythms.
2006;
21
177-184
- 2
Fuller P M, Jones T A, Jones S M, Fuller C A.
Neurovestibular modulation of circadian and homeostatic regulation: vestibulohypothalamic
connection?.
Proc Natl Acad Sci U S A.
2002;
99(24)
15723-15728
- 3
Yates B J, Bronstein A M.
The effects of vestibular system lesions on autonomic regulation: observations, mechanisms,
and clinical implications.
J Vestib Res.
2005;
15(3)
119-129
- 4 Asher D L.
Vestibular anatomy and physiology. In: Northern JL Hearing Disorders. 2nd edition. Boston, MA; Little, Brown 1984:
195-204
- 5 Buttner-Ennever J A.
Overview of the vestibular system: Anatomy. In: AJ Beitz, JH Anderson Neurochemistry of the Vestibular System. Boca Raton, FL;
CRC Press 2000: 3-24
- 6 Luxon L M.
The anatomy and physiology of the vestibular system. In: Dix MR, Hood JD Vertigo. Chichester, United Kingdom; John Wiley 1984: 1-33
- 7 Lysakowski A, McCrea R A, Tomlinson R D.
Anatomy of vestibular end organs and neural pathways. In: Cummings CW Otolaryngology: Head and Neck Surgery. 2nd ed. St. Louis, MO; Mosby
1993: 2525-2547
- 8 Lysakowski A, Goldberg J M.
Morphophysiology of the vestibular periphery. In: Highstein SM, Fay RR, Popper AN The Vestibular System. New York, NY; Springer-Verlag
2004: 57-151
- 9 Purves D, Augustine G J, Fitzpatrick D et al..
The vestibular system. In: Purves D, Augustine GJ, Fitzpatrick D, et al Neuroscience. Sunderland, MA; Sinauer
Associates 2008: 343-362
- 10 Schubert M C, Shepard N T.
Practical anatomy and physiology of the vestibular system. In: Jacobsen GP, Shepard NT Balance Function Assessment and Management. San Diego,
CA; Plural Publishing 2008: 1-11
- 11 Hain T C, Rudisill H.
Practical anatomy and physiology of the ocular motor system. In: Jacobsen GP, Shepard NT Balance Function Assessment and Management. San Diego,
CA; Plural Publishing 2008: 13-26
- 12
Highstein S M, Holstein G R.
The anatomy of the vestibular nuclei.
Prog Brain Res.
2006;
151
157-203
- 13
Carter J R, Ray C A.
Sympathetic responses to vestibular activation in humans.
Am J Physiol Regul Integr Comp Physiol.
2008;
294(3)
R681-R688
- 14
Balaban C D, Thayer J F.
Neurological bases for balance-anxiety links.
J Anxiety Disord.
2001;
15(1-2)
53-79
- 15
Hanes D A, McCollum G.
Cognitive-vestibular interactions: a review of patient difficulties and possible mechanisms.
J Vestib Res.
2006;
16(3)
75-91
- 16
Redfern M S, Talkowski M E, Jennings J R, Furman J M.
Cognitive influences in postural control of patients with unilateral vestibular loss.
Gait Posture.
2004;
19(2)
105-114
- 17
Smith P F, Zheng Y, Horii A, Darlington C L.
Does vestibular damage cause cognitive dysfunction in humans?.
J Vestib Res.
2005;
15(1)
1-9
- 18
Gittis A H, du Lac S.
Intrinsic and synaptic plasticity in the vestibular system.
Curr Opin Neurobiol.
2006;
16(4)
385-390
- 19
Smith P F, Horii A, Russell N et al..
The effects of vestibular lesions on hippocampal function in rats.
Prog Neurobiol.
2005;
75(6)
391-405
- 20 Rabbitt R D, Damiano E R, Grant J W.
Biomechanics of the semicircular canals and otolith organs. In: Highsten SM, Fay RR, Popper AN The Vestibular System. New York, NY; Springer-Verlag
2004: 153-201
- 21 Herdman S J, Tusa R J.
Physical therapy management of benign positional vertigo. In: Herdman SJ Vestibular Rehabilitation. Philadelphia, PA; FA Davis 2000: 233-260
- 22 Baloh R W, Honrubia V.
Clinical Neurophysiology of the Vestibular System. 2nd ed. Philadelphia, PA; FA Davis 1990
- 23
Rajguru S M, Ifediba M A, Rabbitt R D.
Biomechanics of horizontal canal benign paroxysmal positional vertigo.
J Vestib Res.
2005;
15(4)
203-214
- 24
Cakir B O, Ercan I, Cakir Z A, Civelek S, Sayin I, Turgut S.
What is the true incidence of horizontal semicircular canal benign paroxysmal positional
vertigo?.
Otolaryngol Head Neck Surg.
2006;
134(3)
451-454
- 25
Honrubia V, Baloh R W, Harris M R, Jacobson K M.
Paroxysmal positional vertigo syndrome.
Am J Otol.
1999;
20(4)
465-470
- 26 Curthoys I S, Halmagyi M.
Vestibular compensation: Clinical changes in vestibular function with time after unilateral
vestibular loss. In: Herdman SJ Vestibular Rehabilitation. Philadelphia, PA; FA Davis 2000: 76-97
- 27
Gacek R R, Schoonmaker J E.
Morphologic changes in the vestibular nerves and nuclei after labyrinthectomy in the
cat: a case for the neurotrophin hypothesis in vestibular compensation.
Acta Otolaryngol.
1997;
117(2)
244-249
- 28
Campos Torres A, Vidal P P, de Waele C.
Evidence for a microglial reaction within the vestibular and cochlear nuclei following
inner ear lesion in the rat.
Neuroscience.
1999;
92
1475-1490
- 29
de Waele C, Campos Torres A, Josset P, Vidal P P.
Evidence for reactive astrocytes in rat vestibular and cochlear nuclei following unilateral
inner ear lesion.
Eur J Neurosci.
1996;
8(9)
2006-2018
- 30
Cawthorne T.
Vestibular injuries.
Proc R Soc Med.
1946;
39
270-273
- 31
Cooksey F S.
Rehabilitation in vestibular injuries.
Proc R Soc Med.
1946;
39
273-278
- 32 Leigh R J, Zee D S. The Neurology of Eye Movements. 4th ed. New York, NY; Oxford
University Press 2006: 53-62
- 33
Darlington C L, Smith P F.
Molecular mechanisms of recovery from vestibular damage in mammals: recent advances.
Prog Neurobiol.
2000;
62(3)
313-325
- 34
Smith P F, Curthoys I S.
Neuronal activity in the contralateral medial vestibular nucleus of the guinea pig
following unilateral labyrinthectomy.
Brain Res.
1988;
444(2)
295-307
- 35
Smith P F, Curthoys I S.
Neuronal activity in the ipsilateral medial vestibular nucleus of the guinea pig following
unilateral labyrinthectomy.
Brain Res.
1988;
444(2)
308-319
- 36
Ris L, Godaux E.
Neuronal activity in the vestibular nuclei after contralateral or bilateral labyrinthectomy
in the alert guinea pig.
J Neurophysiol.
1998;
80(5)
2352-2367
- 37
Ris L, de Waele C, Serafin M, Vidal P P, Godaux E.
Neuronal activity in the ipsilateral vestibular nucleus following unilateral labyrinthectomy
in the alert guinea pig.
J Neurophysiol.
1995;
74(5)
2087-2099
- 38
Graham B P, Dutia M B.
Cellular basis of vestibular compensation: analysis and modelling of the role of the
commissural inhibitory system.
Exp Brain Res.
2001;
137(3-4)
387-396
- 39
Beraneck M, McKee J L, Aleisa M, Cullen K E.
Asymmetric recovery in cerebellar-deficient mice following unilateral labyrinthectomy.
J Neurophysiol.
2008;
100(2)
945-958
- 40 McElligott J G, Spencer R F.
Neuropharmacological aspects of the vestibule-ocular reflex. In: Beitz AJ, Anderson JH Neurochemistry of the Vestibular System. Boca Raton, FL;
CRC Press 2000: 199-222
Sherri M JonesPh.D.
Associate Professor, Department of Communication Sciences and Disorders, East Carolina
University
Room 3310 Health Sciences Bldg., Greenville, NC 27858
Email: jonessh@ecu.edu