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Balance & Vestibular


Vestibular Ocular Reflex (VOR)

When we think of our ear we mostly think of the function of hearing. It is true the ear has a main sensory function involving the processing of sound in our environment. However, for many the concept of a “balance” mechanism connected to the ear is a bit of a foreign or ambiguous concept.

Even medical science has been unable to correct the notion that we have only 5 senses (hearing, taste, smell, touch and vision). In fact we have an actual 6th sense (no not ESP or the ability to speak to the invisible or spiritual world – although, I’m not saying this does not exist…..) it’s just confusing to discuss our actual physical senses of “balance” or what is called the Vestibular System as a separate sensory system because of the historic attachment of the 6th sense as something else. Please check out our blog called the 8th Sense for more thoughts and discussions about this issue.

So, for now let’s focus on what is called the Vestibular System to understand what role this plays in our daily life and how it is associated with symptoms you may be experiencing.

First we can break up the “ear” system into 3 parts:   

1) outer ear: (basically the ear canal that leads to your eardrum)  


2) middle ear: (this includes the eardrum and the bones of the middle ear that transmit sound to the inner ear 


3) inner ear: this contains two organs, the “cochlea” for hearing  and the “vestibular system” for what’s sometimes called your balance sense.

So, here we will be discussing the “Vestibular System” so you can better understand how it works and its relationship to some of the symptoms you might be experiencing.

Basically, the Vestibular System is located in both the left and right inner ear area (located next to the hearing organs in both your left and right ear). This balance sensor basically sends signals to the brain monitoring the position and movement of your head. This helps the brain to monitor your balance (and vision – we will discuss more about that in a moment).

First let’s break the Vestibular System into basically two parts: 

1) The Semicircular Canals:

Let’s discuss the “Semicircular Canals” and the role they play in our sense of balance. There are 3 canals (posterior/anterior/horizontal) that are filled with fluid which move though the canal to stimulate a sensor (called the cupula). There are 3 cupulas "one located" at the ends of each of the 3 canals to pick up the direction of head movement when rotating, turning or scanning in various directions. Even the smallest movements of the head are detected by these sensors (located in both the right and left inner ear). These sensors send signals to parts of our brain that then process and use the information instantly to keep us oriented as we move around. 


Also, this part of the Vestibular System is connected to the muscles surrounding the eyes and help to control our vision through a mechanism called the Vestibulo-Ocular Reflex (VOR). Whenever we move around our environment or move our head to scan for objects, this “VOR” mechanism goes automatically to work on keeping our two cameras (our eyes) focused on whatever we are looking at. Imagine you attached a camera to the top of your head, and you recorded your movements as you walked around, went shopping or played a sport like pickleball (or tennis). As you would imagine, when you went to look at the recording, it would most likely be very blurry and difficult to watch (if you were being active). Well, the semicircular canals act as a mechanism (the VOR) to adjust to every head rotation or turn by sending signals to the brain processors that then take in the information from both sets of semicircular canals and then instantly send messages to the muscle of your eyes to adjust to keep your vison clear and focused. 

If this system is not working properly (from injury, infection or inflammation or other causes….. ) then your visual world will not feel or seem right and you may experience feelings of wooziness, dizziness, visual disturbances and more. In severe cases, you may find that the world feels like it’s in motion even when you are not.  

2) Otolith Organs:

The Otolith Organs involve two different sensors that pick up the sensation of gravity (helps to tell us which way is up). It also picks up linear head movement (getting up from a chair and stepping forward) as well as tilting your head. These two organs are called the Utricle and the Saccule. They house little “crystals” or sometimes referred to as “tiny rocks” called “otoconia” that act like little weights and are connected to sensors that monitor the head's position in relation to gravity or the forces of gravity (rapid acceleration in a car or sometimes called G-forces). 

Together, the Vestibular System uses the information from these sensors to track our movement in our environment so we can maintain our balance, stability and posture along with keeping our vision in focus. This system is constantly monitoring our movements and is vital for our every day function.   

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