While the semicircular canals respond to rotations, the otolithic organs sense linear accelerations. Humans have two otolithic organs on each side, one called the utricle, the other called the saccule. The utricle contains a patch of hair cells and supporting cells called a macula. Similarly, the saccule contains a patch of hair cells and a macula. Each hair cell of a macula has forty to seventy stereocilia and one true cilium called a kinocilium. The tips of these cilia are embedded in an otolithic membrane. This membrane is weighted down with protein-calcium carbonate granules called otoconia. These otoconia add to the weight and inertia of the membrane and enhance the sense of gravity and motion. With the head erect, the otolithic membrane bears directly down on the hair cells and stimulation is minimal. However, when the head is tilted, the otolithic membrane sags and bends the stereocilia, stimulating the hair cells. Any orientation of the head causes a combination of stimulation to the utricles and saccules of the two ears. The brain interprets head orientation by comparing these inputs to each other and other input from the eyes and stretch receptors in the neck, thereby detecting whether the head is tilted or the entire body is tipping. Essentially, these otolithic organs sense how quickly you are accelerating forward or backward, left or right, or up or down. Most of the utricular signals elicit eye movements, while the majority of the saccular signals projects to muscles that control our posture.

While the interpretation of the rotation signals from the semicircular canals is straightforward, the interpretation of otolith signals is more difficult: since gravity is equivalent to constant linear acceleration, one somehow has to distinguish otolith signals that are caused by linear movements from those caused by gravity. Humans can do that quite well, but the neural mechanisms underlying this separation are not yet fully understood. Humans can sense head tilting and linear acceleration even in dark environments because of the orientation of two groups of hair cell bundles on either side of the striola. Hair cells on opposite sides move with mirror symmetry, so when one side is moved, the other is inhibited. The opposing effects caused by a tilt of the head cause differential sensory inputs from the hair cell bundles allowing humans to tell which way the head is tilting. Sensory information is then sent to the brain, which can respond with appropriate corrective actions to the nervous and muscular systems to ensure that balance and awareness are maintained.

Experience from the vestibular system is called equilibrioception. It is mainly used for the sense of balance and for spatial orientation. When the vestibular system is stimulated without any other inputs, one experiences a sense of self-motion. For example, a person in complete darkness and sitting in a chair will sense that he or she has turned to the left if the chair is turned to the left. A person in an elevator, with essentially constant visual input, will sense she is descending as the elevator starts to descend. There are a variety of direct and indirect vestibular stimuli which can make people sense they are moving when they are not, not moving when they are, tilted when they are not, or not tilted when they are. Although the vestibular system is a very fast sense used to generate reflexes, including the righting reflex, to maintain perceptual and postural stability, compared to the other senses of vision, touch and audition, vestibular input is perceived with delay.

Diseases of the vestibular system can take different forms and usually induce vertigo and instability or loss of balance, often accompanied by nausea. The most common vestibular diseases in humans are vestibular neuritis, a related condition called labyrinthitis, Ménière's disease, and BPPV. In addition, the vestibular system's function can be affected by tumours on the vestibulocochlear nerve, an infarct in the brain stem or in cortical regions related to the processing of vestibular signals, and cerebellar atrophy.

When the vestibular system and the visual system deliver incongruous results, nausea often occurs. When the vestibular system reports movement but the visual system reports no movement, the motion disorientation is often called motion sickness (or seasickness, car sickness, simulation sickness, or airsickness). In the opposite case, such as when a person is in a zero-gravity environment or during a virtual reality session, the disoriented sensation is often called space sickness or space adaptation syndrome. Either of these "sicknesses" usually cease once the congruity between the two systems is restored.

Alcohol can also cause alterations in the vestibular system for short periods and will result in vertigo and possibly nystagmus due to the variable viscosity of the blood and the endolymph during the consumption of alcohol. The term for this is positional alcohol nystagmus (PAN):
199 PAN I - The alcohol concentration is higher in the blood than in the vestibular system, hence the endolymph is relatively dense.
299 PAN II - The alcohol concentration is lower in the blood than in the vestibular system, hence the endolymph is relatively dilute.
PAN I will result in subjective vertigo in one direction and typically occurs shortly after ingestion of alcohol when blood alcohol levels are highest. PAN II will eventually cause subjective vertigo in the opposite direction. This occurs several hours after ingestion and after a relative reduction in blood alcohol levels.

Benign paroxysmal positional vertigo (BPPV) is a condition resulting in acute symptoms of vertigo. It is probably caused when pieces that have broken off otoliths have slipped into one of the semicircular canals. In most cases, it is the posterior canal that is affected. In certain head positions, these particles shift and create a fluid wave which displaces the cupula of the canal affected, which leads to dizziness, vertigo and nystagmus.

A similar condition to BPPV may occur in dogs and other mammals, but the term vertigo cannot be applied because it refers to subjective perception. Terminology is not standardized for this condition.

A common vestibular pathology of dogs and cats is colloquially known as "old dog vestibular disease", or more formally idiopathic peripheral vestibular disease, which causes a sudden episode of loss of balance, circling head tilt, and other signs. This condition is very rare in young dogs but fairly common in geriatric animals, and may affect cats of any age.

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