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Vestibular Function and Anatomy

The vestibular system, defined as the peripheral vestibular motion detectors and related central nervous system structures, senses motion in space and converts that motion into information that the remainder of the central nervous system can use to generate appropriate motor reflexes or facilitate complex processes such as the coordination of head, eye, and trunk movements or updating one's perception of his or her orientation in the world. The vestibular system, like the auditory system, converts physical stimuli into neural signals, but the vestibular system detects angular and linear acceleration, rather than sound. The vestibular system is present in all vertebrates and many invertebrates. Yet, despite the importance of spatial orientation in all mobile animals, the vestibular system is largely underappreciated until a malfunction occurs, at which point patients present to a physician, often an otolaryngologist, for treatment and education. This chapter discusses the anatomy of...
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Balance Function Tests

Colin L. W. Driscoll J. Douglas Green Jr Balance is maintained through complex interaction of the vestibular, visual, and somatosensory information that is combined within the brainstem to generate a motor response correcting the perturbation. Abnormalities within any portion of the system can cause a sensation of imbalance or dizziness. Dizziness is one of the most common reasons for seeking medical evaluation, and the otorhinolaryngologist is often the primary contact. Evaluating patients for dizziness can be frustrating for both patient and physician. The symptoms are difficult for patients to describe, the differential diagnosis is broad, and many tests have to be considered. An understanding of the balance tests currently available and the pathophysiologic principles on which they are based improves treatment of these challenging patients. The particular approach to dizziness is affected by type of practice, available resources, and patient population. The main goals of the diagno...
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Pumping Action of the Heart

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Blood Flow Through the Heart Blood is pumped through the chambers of the heart and out through the great vessels by a simple squeezing action of the heart chambers. You have probably seen a bulb syringe with a glass nozzle like the one pictured in Figure 3-1. Suppose it is full of water. If you squeeze forcefully, expelling the water, you would be imitating the contraction of a heart chamber. This is called systole (sis-toe-lee). After the syringe had been emptied, imagine that you placed the nozzle in a container of water and let the bulb expand so that it filled. This is what a heart chamber does when it relaxes and fills with blood. The movement is called diastole (die-as-toe-lee). You can picture the process by holding your left hand over your right, fists clenched. If your left hand represents the atria, your right hand will represent the ventricles. Now clench your left fist (the atria) while opening your right fist (the ventricles). This is what happens during atrial systole whe...
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