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Comprehensive Vestibular Evaluations

Our vestibular audiologists have extensive knowledge of the balance system and are trained to use state of the art equipment to evaluate all parts of the vestibular organ.

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Symptoms of Balance Trouble

Common symptoms include:

  • Dizziness
  • Disorientation
  • Vertigo - the false sense of rotation without actually moving
  • Feeling lightheaded, faint, or a floating sensation
  • Experiencing a staggering gait when walking
  • Frequent falling, balance issues or feeling that you will fall without extra support
  • Blurred vision

The aforementioned symptoms merely scratch the surface. Secondary symptoms of balance disorders include:

  • Changes in heart rate and blood pressure
  • Vomiting
  • Nausea
  • Stress

Some balance disorders even evoke fear, anxiety, and panic of falling.

Long-term effects can cause overall fatigue and lead to a decreased quality of life or injuries secondary to falls.

Hearing and Balance

How do your ears relate to your sense of balance?

The inner ear consists of two parts: the cochlea and the vestibular system.

What is the Vestibular System?

The vestibular system is responsible for giving us our sense of balance.

It provides us with information regarding our:

  • Spatial orientation
  • Movements of the head
  • Motion of the body

Our brain works with our vestibular system to obtain information about our sense of space.

This helps us maintain an upright posture and coordinate movements. A functioning vestibular system is essential for normal balance and equilibrium. Any disruption of the balance system can lead to detrimental effects that can have a great impact on a person’s quality of life.

The vestibular organ

The vestibular organ has five parts.

  • Three semicircular canals (horizontal, anterior, and posterior) which respond to angular acceleration
  • Two otolith organs of the membranous labyrinth called the saccule and utricle where sensory hair cells detect inertia, including directional acceleration and the force of gravity.

How balance works

The cochlea and the vestibular system have tiny hair cells that help sense even the smallest movements of the head which then send a signal down the vestibular nerve to the brain.

When there is a malfunction of any part of the vestibular system or damage to the tiny hair cells in the vestibular system, individuals can feel:

  • light-headed
  • imbalanced
  • have a lack of coordination
  • or experience severe vertigo

Even the slightest damage to this fragile system can have debilitating effects on daily life.

Dr. Jessica Dimmick, AuD

"Crystals", technically called otoconia, sit on a gelatinous material in the vestibular organ.

In some individuals, they can become displaced and move into the wrong canals of the inner ear, causing vertigo that can be treated with one visit to our clinic in most cases.

Dr. Jessica Dimmick, AuD

Finding Answers

We offer a comprehensive battery of tests

Our vestibular audiologists have extensive knowledge of the vestibular system and are trained to use state of the art equipment to evaluate all five parts of the vestibular organ.

Videonystagmography (VNG)

This testing utilizes video camera goggles to measure eye movements in response to various tasks including tracking a moving target, moving your head and body into various positions, and caloric testing that measures your balance organ and nerve response to warm and cool air circulated in the ear canal.

Rotational Chair

Rotary testing evaluates your eyes’ movements in response to head movements. You will sit in a motorized chair that gently moves back and forth. Video goggles will record your eye movements.

Cervical Vestibular Evoked Myogenic Potential (cVEMP) and
Ocular Vestibular Evoked Myogenic Potential (oVEMP)

VEMP testing utilizes sticky electrodes placed on your head or neck to record electric potentials that occur in response to sound played in the ear through headphones. We look for a symmetric response between left and right. This testing is used to help localize which part of the balance system is contributing to your symptoms.

Auditory Brainstem Response (ABR) and Electrocochleography (EcochG)

This testing utilizes electrodes placed on the forehead and behind the ears to measure electric potentials in the inner ear in response to sound played through headphones. These tests can assist in evaluating balance disorders such as Meniere’s disease.

Modified Clinical Test of Sensory integration on Balance (mCTSIB)​

This is a bedside exam where you stand with your eyes opened then closed on different surfaces to measure you stability using sensory inputs of vision, touch, and balance.

Dynamic Visual Acuity bedside screening (DVA)​

This is a bedside test which measures your ability to maintain stable vision with head movement. You will move your head gently back and forth while reading from a Snellen Eye Chart.

The audiologist will also perform a hearing evaluation during your appointment.

Often, balance disorders present with hearing loss because the hearing organ and the balance organ share a space in the skull and have the same cranial nerve that travels to the brain.

Following your comprehensive evaluation, we will go over the results of the testing and make appropriate recommendations or referrals to help you regain your balance confidence and improve your quality of life. If test results are abnormal, treatment may include vestibular and balance rehabilitation therapy, medical management, and hearing aids.

It Takes a Village

Balance Care is a Multidisciplinary Approach

Dizziness is often considered a "puzzle" because there may be numerous factors that contribute to a patient’s symptoms and the cause may be rooted in the ear, the heart, the brain, the eyes, or elsewhere in the body. This can be very frustrating for patients! Based on the results of your testing, we will be able to recommend appropriate treatment or refer you to a specialist if needed. Other professionals that are typically involved in the care of patients with vestibular disorders include:

  • Ear, nose, and throat (ENT) physicians
  • Physical therapists (PT)
  • Neurologists
  • Primary Care Physicians (PCP)

What common disorders are associated with Vertigo and Lightheadedness?

Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is characterized by brief episodes of positional vertigo. An example might be experiencing vertigo when rolling over in bed to one side or lying back in a reclined position. You may have heard a reference to "crystals" or "rocks" being out of place causing this type of vertigo. Technically called otoconia, the inner ear "crystals" in the semicircular canals are displaced and can cause severe vertigo. BPPV is a common condition and can be corrected by maneuvering the otoconia back into place.

Meniere’s disease

This is a condition caused by abnormal fluid buildup in the vestibular organ. Often patients with this condition have fluctuating hearing, ear fullness, and tinnitus with severe vertigo episodes.

Vestibular neuritis

The vestibular nerve can become inflamed which may cause severe vertigo, nausea, hearing loss, and tinnitus.

Vestibular migraine

the peak incidence of vestibular migraine occurs between ages 30-50, but people of any age can have vestibular migraine. Migraine symptoms can present in many ways and may change over a person’s lifetime, so people with history of migraine may be diagnosed with vestibular migraines.

Maintaining Good Balance

What helps?

Our vestibular organ is the first organ to detect a change in head position or movement. We also use proprioception or our sense of touch, especially on the soles of our feet, to maintain an upright stance and move around in space. Our sense of vision is the third major part of the balance system that helps us evaluate where we are in the environment. Information from these three systems merge at the brainstem. Our brain evaluates the information and forms a coordinated response, whether that is turning the head, moving the eyes, or reaching for a supporting object to prevent a fall.