Our Evaluation Process
A comprehensive battery of dizziness and balance testing may be performed during your evaluation. In some cases, testing may take up to two hours. Prior to each test, we will give you a detailed explanation so you can gain a better understanding of what we are measuring and what to expect.
Evaluating and Managing Equilibrium Disorders
Problems with the equilibrium system can result in dizziness, vertigo, and imbalance. The equilibrium system is very complex and cannot be directly observed. To truly understand a patient’s equilibrium, a number of sophisticated tests must be performed, correlated, and compared.
Balance disorders are often accompanied by changes in hearing and/or ear function. These changes can be obvious or hardly noticeable by the patient. Your testing will include comprehensive testing of your outer, middle, and inner ears. These dizziness & balance tests include audiologic, tympanometry/immittance, and otoacoustic emission evaluations.
A number of complex pathways control our equilibrium. Your evaluation will include sophisticated measures of these pathways and your central nervous system. These tests are:
Auditory Brainstem Response (ABR)
Video Head Impulse Test (vHIT)
Sensory Organization Performance (SOP)
Vestibular Evoked Myogenic Potential (VEMP)
Inner Ear Balance Tests Used to Evaluate Dizziness & Imbalance
Audiologic Testing: Evaluates the hearing portion of a patient’s ear. This allows us to define cause, type and degree of hearing loss. This testing is important for dizzy and off-balance patients because small unnoticed hearing changes can indicate inner ear damage or other medical problems.
Auditory Brainstem Response (ABR): This test helps us evaluate the neural integrity of the nerve going to the hearing part of the inner ear. This test is often used to further explain why a person might have unilateral symptoms or test findings. This test helps us evaluate the nerve quality and function of the inner ear hearing nerve.
Video Head Impulse Test (vHIT): Evaluates the patient’s vestibulo-ocular reflex (VOR), both branches of the vestibular nerve, each of the six semicircular canals individually, and central vestibular compensation.
Dynamic Visual Acuity Test: This test is fairly similar to the VAT, but the test protocol is slightly modified. It may be easier for some patients to perform.
Electrocochleography (ECOG): This technique records electricity generated in the inner ear and auditory nerve. The test helps rule out an abnormal accumulation of fluid within the inner ear that may be causing acute attacks of true room-spinning vertigo.
Electro-oculography: This testing evaluates very specific eye movements that are coordinated by the equilibrium centers of the brain. Damage to these brain areas can cause dizziness.
Otoacoustic emission (OAE) testing: This test helps us evaluate the function of the inner ear. This test also helps us further differentiate where an individual’s hearing loss is coming from. This is important for patients who have equilibrium disorders, as it further defines the location of an inner ear problem.
Rotary Chair: This advanced test utilizes a computer-controlled motorized chair to stimulate the ear at different speeds. A patient’s eye movements are also recorded with video goggles. This test allows us to assess the overall health of the inner ears and how the brain is adapting to a vestibular disorder.
Sensory Organization Test: This test helps us identify balance problems. With careful evaluation, it allows your audiologist to determine the cause of your imbalance and identify a potential fall risk.
Tympanometry/immittance testing: Helps us rule out fluid in the middle part of the ear, which can impact other vestibular test results. This test also allows us to evaluate nerve responses.
Vestibular Evoked Myogenic Potential (VEMP): This neurological test helps to evaluate a very specific portion of the nerve that goes to the equilibrium part of the inner ear. There are two portions of the equilibrium nerve, and this test evaluates the bottom part of the nerve.
Video/Electro-nystagmography (VNG/ENG): This test is composed of a number of subtests. For this testing, a patient wears video goggles or electrodes. These allow us to watch for small eye movement abnormalities, which can indicate an inner ear problem. There are also sub-tests that can help us identify positional vertigo and/or permanent ear damage. This testing also looks at the top portion of the nerve going to the equilibrium part of the inner ear.