Balance/Vestibular (Inner Ear)

Vertigo, imbalance, spinning, wooziness, dizziness, nausea, falls, motion sickness, off-balance; all of these words have one thing in common. These terms or symptoms may be associated with an inner ear (vestibular) disorder.

The National Institute of Health statistics indicates that dizziness will occur in 70% of the nation’s population at sometime in their lives. There are many causes for dizziness and 85% are caused by inner ear disturbance and can be treated medically, surgically, or with Vestibular Rehabilitation. If you are seen at Valley Health – Ear, Nose and Throat for any of these symptoms, your physician may order testing in the Vestibular/Balance Laboratory.

Vestibular/Balance Tests

One or more of the following tests may be ordered:

• A Hearing Test. An audiologist will test your hearing and these results will help your physician begin to evaluate your inner ear. Problems with the balance portion of your inner ear can often accompany the hearing portion also.
• Dix-Hallpike Test. This test is a noninvasive office procedure used to determine or elicit evidence of Benign Paroxysmal Positional Vertigo (BPPV). BPPV is a disorder in which the person experiences symptoms of spinning (vertigo) with head pitched back, rolling in or out of bed, or simply looking up. These symptoms occur when very small crystals (otoliths) break free and float down into one of the three canals of the inner ear. In most cases if a patient is found to have BPPV, a noninvasive repositioning procedure is performed to move the crystals out of the canal and back into the inner ear where they belong.
• Electronystagmography (ENG). During ENG tests, electrodes will be taped near the eyes. These electrodes are connected to a computer, which will carefully record the movement of the eyes. This information tells the physician about the messages your inner ear is sending to your eyes through your central nervous system. For some of the test you will be seated observing light targets. For other procedures, such as the caloric sub-test, you will be lying down. This final portion of the test uses warm and/or cool water placed in the outer ear canals. Some parts of this test may cause dizziness. This is a normal response to the test and will last only two to four minutes.
• Balance and Stepping Testing. Several tests may be used to assist the physician in determining the best course of treatment. These tests may include the following: Fukuda Stepping Test, Tinetti Fall Risk Assessment, Gans Sensory Organization Testing, Motion Sensitivity Quotation Score.
• Ocular/ Visual Testing. Several noninvasive sub-tests using visual information may be collected for the use of your physician to assist in diagnosis. The following visual testing may be done: Dynamic Visual Acuity Test, Head Shake Nystagmus, Halmagyi Head Thrust, and Passive Head Rotation
• Other Tests. Your provider may order  an MRI (magnetic resonance imaging), CT scan (computed tomography scan), blood test, cardiac function, or others. If these tests are ordered the reason and information about the test will be given to you.

After the testing, what will happen? Your physician will evaluate the test results and discuss them with you.  The physician will decide on a treatment plan, which may include any of the following: vestibular rehabilitation, medication, or surgery.

What is Vestibular Rehabilitation? Vestibular Rehabilitation is a form of treatment involving exercises to relieve disequilibrium and dizziness symptoms caused by peripheral vestibular pathology.  The exercise program is designed to promote central nervous system compensation, decrease dizziness, increase balance function, and increase general activity levels.  Patients are given specific exercises, based on diagnosis of the physician.  These exercises are to be done daily at home with periodic return visits to the office.