Introductory Chapter: Balance Disorders

1. Introduction

We owe our balance to our vestibular system to work correctly and in harmony with other systems in our body. Although the balance system is complex, we can maintain our balance due to the smooth and harmonious operation of the factors that build up this system. Knowing the anatomical and physiological factors that make up these systems is essential for the treatment of balance system disorders. Researches are still needed for the subject of balance disorders.

These systems are the following:

1. Vestibular systems

   1. Peripheral vestibular system

   2. Central vestibular system

2. Proprioceptive system

3. Visual system.

   1. The peripheral system anatomically starts from the cupulas of horizontal, superior, and posterior semicircular canals and from the utriculus and the sacculus in the vestibule.

      The system continues with the vestibular nerve and ends at the four vestibular nuclei in the brainstem.

   2. The central vestibular system consists of the connections of these four nuclei with the cerebellum, spinal cord, extraocular eye muscles, and the vestibular cortex in the brain.

When the information about the body’s position coming from the peripheral vestibular system, proprioceptive system, and the eyes reaches the central vestibular system, as inputs in the central system, these sensory stimuli are processed. The central vestibular system then creates the motor impulses to the muscles necessary to keep the body in balance (Figure 1) [1].

Figure 1.

Balance system.

Any pathology of both peripheral and central vestibular systems may cause deterioration of our balance. This disorder is described by patients as vertigo, dizziness, disequilibrium, unsteadiness, and lightheadedness [2].

Other than peripheral and central vestibular systems, the cardiovascular system, endocrine system, eye, psychic stability, and even some orthopedic disorders can cause balance disorders. For these reasons, it is necessary to think of a broad-spectrum in patients presenting with the complaints of balance disorders as described above and to approach these patients in a multidisciplinary manner. During a multidisciplinary approach, while the group of common diseases comes to mind first, it should be kept in mind that there may be more than one factor that may disturb the balance in a patient [3]. Asking the patient the style of the balance disorder, whether there are any accompanying complaints such as headaches, hearing loss, tinnitus, darkening, that is, a detailed story of the patient, will provide almost half of our diagnosis [4]. After that, we can make a definitive diagnosis by evaluating the laboratory tests together with the physical examinations that we make. To diagnose balance disorders, we have to perform a series of examinations and tests, such as neurological examinations, balance tests (VNG, Caloric tests, Posturographic tests, etc.), and imaging studies such as MRI, CT scan [5].

In this book, we wanted to gather all these thoughts together, search for more new research, and show how to approach a patient with a balance disorder.

We hope to help our physicians who are dealing with balance disorders.