okay so hello everyone my name is today I will be talking about the physiology lecture which is cited by balance so let's get started okay so basically the objective for today's lecture is uh it is going to focus mostly on the vestibular system in regards to its uh structure I also get some anatomy of the ear in general either external middle or inner ear so that anybody who actually wasn't able to attend or didn't understand like the structure of the uh it can actually just start from the very draft or from scratch with me and each other we're going to just skip to understand everything from the very basic information from Anatomy all the way to physiology so it's going to be amazing so we're going to discuss more about the structure the normal stimulus the uh transduction of the receptor and we're going to focus mostly in this structure on the uh inner ear because actually the inner ear is the one responsible mostly for the balance of our body so we can also focus on the enormous stimulus as we said we're going to talk about the autolith organs we're going to talk about the connections of the vestibular nerve and we and also at the end of the next year we're going to also talk about the Gaze movements of the eye like other vestibular system and the ocular system so let's get started okay so as I said I got you some images which is like anatom images of the uh ear or the normal air structure so basically we can see this is like the ear demand this orange thing is basically the external ear there is divided into three parts the external middle internal or the outer middle and the inner ear so basically this orange thing is the outer ear we have this pinkish thing is the middle ear and this thing at the end is the uh inner ear our Focus today is going to be on the inner ear action we're going to mostly focus on the balance them on like so let's move on okay so as we said this is going to be the inner ear I just zoomed it all the way in and just assume the inner ear so basically this is the inner ear the inner ear is basically composed of couple of structures some of which is the cochlea which is this thing number one we have also over here the semicircular Canal semicircular Canal is really very important and at the end we have over here two structures or the auto lift structures which we are gonna get more to know about them throughout the lecture inshallah so let's get started okay so let's get an overview of the vestibular system now in regards to the vestibular system it's considered one of the three major sensory systems what are the three major sensory systems we have the number one is the visual number two is this tomato sensory and number three is the vestibular system so as we said the circular system is responsible for our balance and it's actually located all the way in the inner ear the mom so in regards to this thing basically our inner ear is responsible for our balance or it if we have any abnormality in the inner ear it actually causes dizziness and vertigo so uh in the inner ear we have things that are actually um like it's going to control us from preventing us from having vertigo or dizziness we have for example the gravitational pull and the rotational movement for example if I'm standing if I'm sitting if I'm moving all the way around how I'm how am I not getting dizzy for example because of the balance or the well-controlled balance in the inner ear that's going to tell me for example that right now I'm rotating right now I'm standing there's a gravitational force pulling me and so on so all of this is actually controlled by the inner ear as well as other systems and the body for example like the cerebellum or other like uh Parts in the body like the cerebellum that's for this structure we're going to focus on the inner ear the balance in the inner ear okay so moving on as we said the three most important sensory inputs is the vegetable this vestibular system and this is a matter of sensory now when you guys say somatosensor it detects for example our muscle joint movement while moving the vestibular system is for the balance and lastly for individual system just to ask for the division or the ocular movements okay so as we said for an overview of the visibility system the sensory we have actually neurons or nerves all the way into the inner ear that actually sends the Action Potential from the ear to the brain so that we're gonna know from the ear to the brain to from the brain to the uh to the eye so that we're gonna actually have connection between one another uh for example right now I'm standing I'm sitting and any abnormality induced connections actually stimulate the cause of dizziness or vertigo so in regards to the uh let's get to know more about the anatomy so as we said we have over here in neurons or nerves all the way connected to the inner ear now we have the sensory receptors that are located all the way into the semicircular Canal or in other words it's like in the Crystal and in regards to the utricle and the succulate has the macula so like those are in regards to that like we have like couple of new uh terminologies in the inner ear and the other way time you guys can like get used to it now if you have any imbalance uh usually some people actually feel vertigo or uh actually I have the stimulus of nausea and vomiting because like in the brain nausea and vomiting Center is very close to the vestibular system we also have a new question the vestibular apparatus and the inner ear is actually located into the temporal bond to be more specific into the Patriots portion of the temporal Bond or we can call it as the bunny Labyrinth like this is in regards to Anatomy I also have pictures so and as we said in regards to the inner ear we have the cochlea we have the semicircular canal and we have the auto list structures which are the utricle and the succul okay so moving on now what is equilibrium Equity means equal so basically it's a state of Mass once we are once everything is normal actually in regards to the distributed system and it goes to the inner ear that means that the patient that the patient or the person is actually can be in a state of equilibrium without any imbalance or without any dizziness or even vertigo so in regards to this equilibrium can be divided into dynamic or static from the words Dynamic it means the sense of rotation or movement static it means the sense of being an aesthetic position or in a linear position so so this is the equilibrium if both the equilibrium as Dynamic and static both of them are normal that means that equilibrium is going to actually be a shift if any imbalance happens in the equilibrium that means the person or the patient is going to actually have the sense of dizziness or vertigo okay so now in regards to the rotational movement everything is going to always be deducted by the semicircular canal and my business model gravitational change is going to be detected by the macule that's going to actually be present in the utricle and the disacute okay so you can actually like a like an easy way to memorize it is that semicircular Canal it's from the word it's a circle and structure so it like controls our rotation and movement they are responsible for example for the gravitational changes okay so let's have a very quick question our first checkpoint now question is so easy so question number one says which of these parts of the body plays a very important role in the balance so can you kindly just write your answers in the shot Bravo exactly exactly the answer is a which is the Labyrinth that's a very easy question Excellence okay so moving on now let's talk about the vestibular apparatus so we said we're going to mostly focus on the inner ear in the structure so the semicircular cannot have three circles or has the three semicircles which are the anterior the posterior and the horizontal we have over here each of them actually has a specific function and they are in different positions so that we usually move in different directions we usually for example for anybody who for example who's uh doing belay or gymnastics they actually they keep on rotating themselves for an enormous individual orbit they should detect all movements that we actually do in each and every direction so we have semicircular canals in different directions so that each of them is going to tell us actually the position that we are currently doing without having the stimulus of dizziness or vertigo and we have over here the otolith organs which is the electrical and the circle we have over here this is the Utica and we have in here this is this IQ so we're gonna have a better images than this one so moving on okay let's get started so we have over here this is the this yellowish thing is basically the bunny Labyrinth that the inner ear uh or the inner ear structures are actually like on it so we have the cochlea which is this circular thing it has actually a fluid all the way inside the cochlea inside the semicircular canal and also the autolip organs which is we have two uh names of lymph which is the pyramid number one and we have also the endola so we have two things the parallel and the engineer and this is just Anatomy so as we said in regards to semi-circular Canal we have three canals which are the anterior posterior and lateral they are in three different positions so that they're going to detect any movement we're going to do without feeling or without having the sense of uh dizziness or vertigo amount so at the end of each semi-circular Canal we have a very like a very big enlargement in here this is number one this is number two and this is number three so we have three semicircular Canal at the end of each of them we have one enlargement which is actually called as the ampulla this ampulla has the macule so let's repeat the names we have this is the semicircular Canal at the end of each semicircular panel we have an enlargement which is called as the macule which is called as the ampulla this ampulla has the Maxwell and this macule has actual structures it has hairy structure that actually uh hairy structure that actually is connected to the nerves and it's going to actually tell us uh it's gonna transmit action potential so that we're gonna know exactly where are we are removing the that we are doing and like this is in a normal function this is a normal uh person or a patient so that we want to feel laziness anything abnormal in the inner ear there's going to definitely stimulate the sense of dizziness okay so as you said this is the ampulla this is a utricle we have over here this is the sacral this is the electrical and this action together both of them are known as the Autodesk structures or organs and okay so I don't know so as we said we have a nerve connected to it which is the vesibular nerve as well as the cochlear nerve together we can call them as the vestibular cochlear nerve okay so as we said over here the utricle and this action which are the auto structures they are actually going to be connected to the receivable spinal system that's going to tell us the position of the head mostly it's going to focus on the linear position in compared to the semicircular Canal it's going to focus on the rotation or the rotational movement of the head and they are actually connected to the vestibular ocular system this tubular is basically a new price to balance ocular is an regret to the eye so it connects like the balance with the eye so if they have any any imbalance the eye actually reflects them actually be stimulated and we can actually have nystatus now how this thing actually happens we have this exercise in here now if any of the patients has a problem in the semicircular canals and the vestibular cochlear nerve is going to actually be stimulated and what is actually uh for example in this case the patient is going to be positive to the bppv benign for example position on vertigo that means and no we have mostly a problem in the semicircular canals and we have problem either in the in the left either in the calcium carbonate crystals or any other structure in the uh semicircular Canal now if the patient is actually positive to when B bpv we have a maneuver that we actually do and this thing is just extra for just so that the picture is going to be complete to you and you can understand everything this maneuver is actually called as halpike maneuver or they actually can call it as the airplane maneuver so this man over is actually going to ensure for is one of the ways or one of the techniques that actually ensure for us if the patient actually has the b ppv or not now how are we going to make sure if this patient has a pbbv first we want the patient to be in a sitting position let's say in a 45 degree position and then suddenly we're gonna all the way let the patient to be sleeping all the way downward with the head positions 45 degrees downward once to the right 30 seconds to the right 30 seconds to the left and 30 seconds straight and then we're gonna all the way at the end as we can see the patient is here 45 degree head to the left 30 seconds and then we're going to flip the head immediately 45 degree to the left and like once to the right one's to the left and then after that once the patient for example at the end for example the patient is on the right position the head is in the right position we're going to keep the patient sitting on the head on the right position and then we're gonna all the way that the patient sit with the head on the right position so if we had actually in this tag was now once we put the patient all the way down uh 45 is ahead is 45 degrees below like below the body level either to the right or to the left and we suddenly sewn a stag was either linearly stagnosed circuit a rotation on the stagness or a horizontal like either a vertical horizontal or rotation on the sun was on the patients I that means another patient has a problem and one of the semicircular canals and the patient is positive to the bppv so this maneuver ensures that if the patient has an nystagmus that means the patient is actually positive to the bptv the name of this manifer is halpite maneuver or a plea maneuver uh now what's the treatment of this patient who has BP bpv is actually like doing this maneuver a couple of times is the only uh is that like is the most and the only treatment for patients who has bppv and this manual actually stimulates dizziness because of that patients like the vestibular nerve is for example the patient feel dizziness and the for example the in the left the calcium carbonate crystals keep on moving all the way into the semicircular Canal which is going to stimulate the vestibular nerve vestibular nerves in which the ocular nerve and we can see the nystagmus or the eye reflex so the only uh treatment for the bpv is actually doing this matter a couple of times until the calcium carbonate crystals or the uh or the ambulance actually returns to its original place so this is just extra numbers for you guys okay now when you go to the semicircular canal ampulla this ampulla has a macule so for the terminology we have new terminology we have the semicircular Canal we have the ampulla and this ampulla has a macule as we said each of them are basically on different axises either on the x-axis y-axis and z-axis so that they're going to be available in all directions to detect for us the rotation that we're actually doing and prevent the uh dizziness if it's actually functioning properly now as we said over here the semicircular Canal is basically on three axis as D X Y and Z we have the horizontal uh semicircular Canal we have a superior and the posterior now with this uh the semicircular canals are actually like the the fluid in them actually is very rich in Decay or are very rich in the potassium with a concentration of 160 and basically this potassium is going to significantly help us stimulate the action potential how does this action potential starts now once we have here we're going to more about it in the next slide which is an overview once we're gonna have both both types of hair move in the same direction this will allow the K to be entering all the way and which is going to stimulate the calcium to enter now as you know once calcium is all the way inside the vesicles are going to be released and it's going to significantly help in the action potential to be all the way firing once an action potential fires it's going to tell us the position of the head either the head is on the right side left side or where exactly is the position of the head because of that semicircle looking that's really it's a very important role in regards to the balance especially in the inner ear so they're really very important now let's zoom in as we said we're going to talk now about the semicircular Canal now we set the semicircular Canal has at the end of bulging this boxing is known as the antler now this this is the bones I'm talking about which is the ampulla this ampulla there's a macule inside the ampulla so let's say this all the way is a machine now let's talk more about this structure is quite important now we have a nerve over here and we have hair cells and we have hair all the way over here now this thing is actually very important because once for example I move my head to the right or to the left those hair cells are going to actually be moving into the vice versa or to the opposite side and once they move to the opposite side this will actually tell me for example that now I'm for example rotating my head to the right how did I know that I'm relating my head to the right because this results actually moves to the vice versa side now moving to the vice versa side is going to actually turn my opinion and now I'm moving my head to the right so always the position of the hair yourself are going to be opposite of the position of the head it feels returning to the right those hair cells will be turning to the left if you're turning to the left those hair cells should be turning to the right and this is in a normal individual and this thing actually happens as we said by the action potential to be happening how this action potential happens the potassium once both hair cells are in the same direction the potassium is going to enter calcium is going to enter actually it's gonna fire the moment so this is in regards to the Ampla which is in the bouncing part of the semicircular Canal now in this picture for example we have the patient foreign should actually move to the right this is in a normal individual okay so the exact same thing repeated we have over here the semicircular Canal it actually detects to be irritated the uh rotatory acceleration or the rotation and it has a gelatinous material all the way and here the mom so by the force of inertia uh and physics basically if we're gonna move to the right this should be moving to the left the hair follicles and if we're going to move to the left the hair cells or the hair follicles and they see they should move into the vice versa Direction okay moving next okay so this is I got this picture it's uh it's quite simple like it makes things simple so this is the inner ear this is the cochlea this is the otolith organs or structures and this is a semicircular canal and now we're going to focus mostly on the same recycler Canal it is as it is really one of the very important structures in retaining balance and that we have semicircular Canal ends with a ampulla which is this bulging this ampulla has a molecule inside it now let's assume this structure all the way as we can see it is in this like this thing this unpillar thing is basically enlarged uh into this figure now we have a nerve fiber as we said we should have no fiber so that the action potential is going to be sent from the ear to the brain and then and then we can actually feel like our position or where we are what we're actually doing and we have over here this versions plus we have we have over here the herself and we have supporting cells let's focus more on the hair cells and we have from the hair cells something going out which is the hair bundles when you go to the hair bundles we have over here two types first of all for the hair cell we have two types and for the hair bundles we have two types and now for the hearing sound we have two types type 1 and type two type one is basically bigger than type 2 as you can see type 1 is bigger from here type 2 is way more slim this is number one in regards to the hair bundles we also have two types which is the kinosaurium and the auridakynecilium and the stereo cereal so those are the two types of the hair bundles and regards to the kind of sodium it's longer than the cereal cilia normally in a normal individual if for example I'm going to move my head to the right those two hair bundles should actually move to the direction to the left and both of them should be moving in the same direction now one spot is removed in the same direction this will allow the potassium to enter which will allow the calcium after that to enter and to trigger the action potential for us to be sending all the way to an action potential is going to be sent through the near fibers to the brain and we can actually detect our movement that our head for example is moving to the right or to the left so basically this is in regards to the ampulla now this is the exact same thing as what I said we have the ampulla we have the nerve fibers we have the cupola pupil that is basically this structure that's uh hair bundles and we have the insulin which is actually the so with the surrounded semicircular Canal for example if we ask the patient to move all the way to the left the um the hair bundle should move to the right and vice versa okay the exact same thing is repeated now if I ask the patients right to the left that means no if we have for example uh if we have increased action potential this increase in the Action Potential from the nerve fibers of the inner ear or the two big brain the more we're going to have increasing the action potential the more that our head is going to actually our our brain is going to detect that I'm moving for example right now to the right if we have this action potential if we have minus action potential and we're moving our head for example to the right or to the left we won't actually be knowing that our head is moving to the right or to the left because of the less firing of the action potential and why this thing happens if for example we have low amount of potassium and telling that means we can have low amount of calcium entering that means we can have very amount of action potential and these things are going to actually decrease this expectation of us to be knowing if our head is moving to the right or to the left okay so that's the exact same idea so moving on now let's talk more about the Autodesk organs as we said the alternate organs is basically the utricle or some sometimes they say utricle and the second but you can mostly both of them are going to actually detect the leaner movement in regards to beautiful it detects the horizontal for this axial it detects the vertical movement and uh both of them are actually as we said located in the inner ear so next like now when it comes to the depolarization as we said the most important thing for sorting the difficultization is actually the potassium which is the K and as we said the K levels are actually weight increased in the inner ear and regards severe concentration so I just want to know guys if you have any questions so far we need to proceed more just kindly if you have any question or you don't have just like this up okay that's amazing come on come on so as you said the potassium is that it has very high concentration in the energy and it actually plays a significant role in fighting the action potential by all the way when both the air bundles which is the kidney Syria and the seriously move in the same direction that means okay why the potassium is going to have the chance to enter and the calcium is going to enter which is going to actually start the action potential also one of the new transmitters that actually help in the action potential is the glutamate and the aspartate those actually plays like a significant role in helping the action potential to be all the way fired so this is also the um this is as you said over here just a quick review we have over here the air cell this is the hair cell this is the hair cell we have over here type one here some back to Harrison and those reddish cells are basically the supporting sounds we have over here the interlap as we said this is like the fluid that's uh available in the inner ear we have over here the autoconium words you can see the calcium carbonate crystals so yes this is an impressive Anatomy so moving on okay so this is also a repetition of what we said we have over here this is the uh inner ear for example if we ask the patient to move his head let's say to the right that means those hair bundles should move all the way to the vice versa Direction and then moving to the vice versa Direction it's going to actually help the patient to detect that the hands is moving for example in this direction or in this direction either to divide or to the left and they're going to already be sending the action potential once it's fired it's going to always be sent to the no fibers to the vestibular nerve all the way to the brain and the brain is going to interpret this actually the hair is moving to the right or to the left so if we have any imbalance in this thing or if you have decreased action potential in other words if we have increased funded potassium this whole thing is going to affect us not knowing the position of the hand okay that's great now in regards to the alternate organs as we said uh it's a place in the inner ear for example we have in the if you have the immaculating hair cells we have this this is just Anatomy we have the immaculate hairstyles in the nutrition if for example we have um the YouTuber sometimes immigrated rehearsals usually they are up straight and if we have any movement of our head either to divide or to the left usually they should move in a normal individual into the vice versa Direction this is the exact same thing we have as we said in the alternative structures we have the YouTube and this actually called Intex the horizontal movement it's actually detects the vertical movement now in regards to the CNS with similar connections this is mostly and required to the uh like most mostly invested in neural block so they are most mostly in regards to the cranial nerves we have a couple of linear nerves that actually pay significant role in helping us to detect where the heads actually move in and where the height is actually moving now the inner ear and the cerebellum like are the bay most important structures or parts in the body that significantly help us help us maintain our balance in the body if we have any imbalance or if we have any vertical or dizziness or any abnormality in those two structures the energy of the inner ear and the cerebellum we are going to actually experience the feeling of vertical and dizziness so we have the cranial nerve number eight which is the vestibular nerve is actually plays a very important role in the uh distance of balance the moms so moving on okay so this is actually more towards memorization so I guess I was just gonna like a review it so when you guys still have a similar nuclear we have four types obviously we are nuclei we have a superior we have a medium we have the natural and the inferior vestibular nuclei all of them actually helps us in detecting where exactly we're moving all of us all of them actually help them and uh in the body and the balance of the for the amount so moving on this is basically zoomed in into the inner ear structures this is the semicircular Phenom as you can see and our Focus mostly on it on the semicircular Canal because like they have the ampulla which is actually like going to be connected to the nerves and like most of the business can actually come from any abnormality that happens mostly in the semicircular Canal so moving on this is also a reading but just we're gonna read it together here over here the brainstem medial longitudinal fasciculus or the MLF is actually also very important for helping us to know where is the position of everybody how by moving di for example this thing soon become the helps us in the eye movement if I'm moving for example my head to the right my eyes should always be concentrating straight forward if I'm moving my head to the left my eye also should be concentrating all the way straight forward if there's any abnormality in this thing that means we have one of the problems either in the nerves or and any other structure okay so we have over here that we take this uh formation and just some people ask you actually for example if they had any abnormality and regressively balance they would actually feel nausea and vomiting uh we also have over here as we said the story but now it's actually very important also in helping to maintain the balance now I've seen exact thing in regards to the spinal cord and the vestibular spinal tract this is also one of the nerves that actually also action potential and help us know where our movement exactly like we are actually moving so that we want to annually in Balance this is just a quick review of the similar system and so basically it tells us about for example the head position is it in for example for example the annotating but all the way it goes to the semicircular canal in terms of rotational position and goes to the circle and Musical and University linear position everything all the way goes to the brain or it goes to the central nervous system and then from that the brain is going to actually interpret RV or for example are we having an imbalance are we having any balance and normally in a normal individuals at the same place greatly the patient isn't actually going to experience any imbalance now let's talk more about the vestibular reflexes we have over here the vestibular ocular reflects as it says vestibular is an opacity balance ocular is in regards to the eye so this thing actually just concentrates as we said if for example I remove my head to the right or to the left I want my eye to be focused all the way straight forward and I don't want my eye for example when I'm going to divide my eyebrows with my head movement and if I'm moving to the left my eye move with the head movement in a normal individual they can actually maintain their eyes straight forward while the head while the other head can move all the way to the right or to the left and some people actually doesn't maintain this thing that means they have some of the abnormality either in the nerves either in the muscle to supply the nerve so so they like to actually experience nystagmus or abnormal eye movements and systems are considered abnormal so we'll get more to know about it okay so basically that's good to know like how the pathway actually happens if I'm moving the head to the right or if I'm going to head to the left as we said normal individual if I'm moving the head to the right or if to the left I want for example the I to be maintained all the way straight forward and this change should and this thing actually get the sheet by having a normal individual without any abnormality in regards to the uh you got to the nerve and regard to the balance in the inner ear and it goes to the uh eyes so what actually happens we're gonna get started muscle we have an example over here you ask somebody to move to the right side your left hand a patient wants to the left side usually if I'm going to move to the right side you guys can try it in any of like here runs so that any when you see it practically it just sticks in your brain so for example if I move all the way in my head to the right that means I want my eyes to be straight uh to be focused straight forward or in other words it's going to move to the left and when you move your head to the right your eyes if you want it to be focused straight forward that's going to go to the left now we want to understand how this thing actually it works so let's have to know more about it the other hand we have over here two eyes we have the left eye and the right eye as we said we have three cranialness that play a very significant role in maintaining the balance between the uh between the inner ear between the eyes like in general so we have number one cranialism which is the opening Water nerve or nucleus we have the tropia and we have the abducens the sweeteners actually simulated like it supplies the muscle so if actually we have a normal stimulus from the nerve fibers in the inner ear to those nucleuses or to those nerves and those nerves are going to supply the muscles of the eye so if everything is normal in them that means the eye is then actually for example when I move to the right the eyes are going to move to the left this is in a normal integrate one so basically how this thing happens that's what started we told the patient to move his head today right that means the eyes you move to the left now what are the nerves that actually help in this thing we have some nerves I can actually stimulate and inhibit other nerves now if we can stimulate any with other nerves those things like if we're going to stimulate an inherited other nerves in the eye this thing are going to help the eye for example to stay straight or to to be on the left side why I while I move my head all the way to the right so let's get started okay so now we set the patient to move his head to the right now what's going to happen exactly we can have it first first thing as we said the hair bundles should move to the opposite side if I'm gonna move my head to the right okay bundles remove to the left so that I'll detect that my very and my um like my head is moving to the right now this thing is a shifts congratulations the second thing is that my eye should be on the way focusing straight forward over to the left side even my head is moving to the right how does is going to happen she's gonna get stimulated or inhibited hashan to be in a normal uh like any normal individual so what physical we're going to have is that we have the vestibular nerve as we said that comes all the way from the inner ear it's going to get Supply number one by the median and Superior vestibular nuclei this happened now what's going to happen exactly where you can now talk about the excitatory pathways that are executive Pathways of the nerves that will stimulate or contract the muscle of the eyes so that both eyes now should move to the left because my my face or my heads are mostly divide now any bites to the nerves that are going to get stimulated is number one the left objection nerve is going to get stimulated or it's going to get excited once this thing is going to get excited it will not all the way its muscle which is called the less natural muscle is going to get all the way contracted why it's going to contract now what's it contract the left eye will be all the way moving to the left a couple of nerves in the right eyes so that the right eye is going to also be moving to the left so and you guys didn't have that's gonna get uh stimulated by the vestibular nerve is actually the right arterial motor nucleus and this is nucleus is done all the way do you see me they think it's muscle which is formed as the right medial lactose muscle by the help this thing actually they write oculomotive nerve it's going to get stimulated by the help of the mnf or the medial longitudinal fasciculus now once this right median rectus muscle is actually stimulated it will also contract now the contraction was the muscles which is the left flat lactose muscle and if you like the media lattice muscle then both of them are contracted that means the eye is going to always be going to be left side which is a normal thing because the head is moving all the way to the right and we want the eye to be focused into for example a specific point forward so both eyes should be all the way moving to the left side now if they simulated those nerves which are simulated or contracted muscles which is actually also inhibit other things what are the other names we can inhibit now in regards to the uh which we're going to inhibit the first nerve that's going to be inhibited for the right eye is the right adjacent nerve or the write everything here this is going to be inhibited which will inhibit the right adjacent now now if this thing is inhabited that means enough the eye the right eye isn't going to move to the right side so this thing is excellent and the second uh negative should also be inhibited is known as the left is not as the left n on the left or the left medial longitude and particularness once this thing is inhibited we can also be inhibiting the uh left ocular motor nerve which is going to already be inhibiting the muscle of the left eye if this thing is inhibited and the left lateral rectus muscle is excited and they have uh later on the right median rectus is excited or it for example is Contracting at that time which means both eyes will simultaneously at the same time be moving to be left so basically like this is the whole mechanism of how when we move our head all the way to the right our eyes should remember individual our eyes can be focused straight forward or can be focused all the way to the left side both eye string moves simultaneously together to the left side so this is only by its two as you can see over here very successful with both eyes move to the left side okay excellent okay so basically we can also call this reflex as the dot I or the vesticular ocular reflex this is the exact same thing as like we sent okay now let me go to this tabulous the stagnosis is basically a normal eye movement either horizontal vertical or rotational anything that happens abnormal in the balance system either in the inner ear or in the servo to be more with specific in the inner ear that means the stagnosis is going to be always stimulated which is basically two and well a circulation of the eye and as we said in regards to their people who are other patients who are positive children being tpmb and their manifest as one as the Epson maneuver they will be positive to nystagmus which is Gonna Let You Give a definitive diagnosis that this patient suffers from b b so this is an impressive and stagnosis it's an abnormal eye movement either as a horizontal vertical or rotational okay so now in regressive understand this but how this thing actually happens is basically a slow phase of the vestibular and the stagness that happens because of course anxiety and inhibitory as we said it is now once we have acidity and inhibitory simulations of the neural system can actually abnormally prosperacy this the atmos which is the abnormal um eroding or the ice okay so exactly we're gonna just review everything now if we ask the patient you know they head to the right normal compensation mechanism for the eyes is to move to the left because everything is impacted all the neurons or nerves everything's impacted so normally the eyes should move all the way to the left right if something happens I'm never in the patient in any of the cell and any other things we discussed before that means they are if they move the head to the right the patient isn't going to be able to focus his or her eye to the left side so the I will move to the right the same direction as the head is moving and this thing is considered to be abnormal now if we ask the patient to move to Minnesota that means normally the eyes should be focused straight forward or to the right tail line now I move my head to the left I should always Focus my uh my eyes straight forward or to the right this is in a normal individual anything a normal the eyes are going to be all the way rotating same direction as they had which is abnormal and same goes over here for example we ask the patient to be a forward towards the right shoulder in other words looking downward normal motivation should always the eyes should always be looking upward if any abnormality happens that means the patient will be looking in the same direction as their head is moving and this thing is conservous okay now let's sort of focus more on the semicircular Canal as you said those are actually like the most important structures in regards to the balance in the inner ear even though everything is important but like those are the like most common abnormalities that happens and done now let's talk more about the water We have basically something called as the calorie test this calorie test is basically flushing a water in there can be warm water or it can actually be a cold water now let's talk more about the irrigation of warm water all the way into the ear now you don't exactly exactly I think there's more important all the way it feels less warm water all the way into the air and uh normally like the warm water reflex is exactly the same reflex as what we see why because of where water increases the firing of the action potential which is going to increase the potassium increase the calcium increase the action potential to be on the way filing this is what do you want what this thing is going to do for us for example when I move my head to the right my eyes are always Focus straight forward so this thing uh straight forward or it's enough to this thing is that at the moment I think that should happen so this is by having the irrigation of warm water the vice versa happens actually in the navigation of reformed water once you get cold water the action potential is going to decrease the potassium is going to decrease the calcium is going to decrease the firing of the action potential also decreases that means and not once the patient moves his or her head to the right that means the eyes might not significantly move to the left and they may stay on the way to the right and this is just known as the calorie dust so just review the warm medication is going to increase the action potential another cold irrigation is going to decrease the action potential which is going to decrease the filing the same thing is repeated this is a calorie test we have over here we are flushing water flushing water and it goes to the warm water and an effective warm water usually warm water increases the action potential so for example we told the patient to uh to move his or her head all the ways for example today right side that means the eyes to move to the left side and in the cold water irritation actually removes the head to the right side the eyes are going to actually move to the right side as well which is not considered to be normal Hashem the ice normal should move to the vice versa side come on now in regards to the brainstem if it's intact and there is not any abnormality the eyes move opposite direction to the patient's head which is normal if they have any abnormality for example the inner acceleration or low brainstem lesion that means the eyes aren't actually going to move into the vice versa reduction of the head for example the exhibition to move to the right I should move normal to the left and this thing isn't going to happen if we have any single abnormality either into it either in the energy or either in the inner ear structures or in the either brain stem or even in the nerves in general ity that happens it was the cold and warm a calorie test we're going to have a normal eye movement in both tests okay so we have our second checkpoint so this is the question so we have what do our eyes monitor that uh that's tied to your position and balance so what do you guys think okay it does Bravo excellent exactly so basically the answer is the it basically maintains all of the above level now as you said let's talk more about the b tv as we saw before bpv stands for the P9 pixel smart position on vertical and this actually happens because of any other Melody that happens in the semicircular canal and because your carbonate Crystal or anything in general in regards to the semester right now and especially stac if you have any abnormality the patients don't actually experience the B bpv and the only maneuver that actually significantly helps the patient to be released totally often symptoms of bpv is known as the Apple manager or the helpline number as you said big enough uh we're gonna decrease the patient's organization to be sitting and then suddenly we're gonna add it they had to be 45 degrees uh below the body level once to the right 30 seconds and then the amounts to the left and then we're gonna with the patient's piece you think as as the last head position and we can actually find find patients who are positive to the ppv will be actually having nystagmus and will be disease when they are doing this maneuver business manager is like a physiotherapy for the uh abnormal structures that are or fluid or casting permanent crystals that are in the inner ear to be all the way returned to its normal position so moving on so basically this is the end of my lecture I hope you guys understand and you are yet having balance so if you have any question kindly feel free and you can feel free to contact me anyways anytime you guys want so any questions so far you're welcome I hope you guys enjoyed the lecture and as I said feel free to approach me anytime the castle carbonate crystals actually help in the uh they are found as you said in the inner ear and they significantly held in the balance now if they are removed or if they are moved for example either the custom permanent crystals can actually move from their places either because it is either idiopathic or either because somebody had for example a hit in their head so this that because Improvement is so small and the only thing that returns them back is this maneuver they don't feel significantly help in the action potential as they are quite far from the action potential and from the nerve Place let's see any if any abnormality happens in that in general in determatical structures uh basically we're gonna have the BP B positive and positive steps so any other question thank you if you guys as I said if you have any questions please feel free to approach me either via email Buy Mobile or if you if you want to commit face to face and inshallah thank you so much so have a nice day everyone thank you bye bye