The vestibular department at AHBC works closely with the Ear Nose and Throat (ENT) service to help manage patients with dizziness and/ or balance problems. The clinic performs a wide range of specialist assessment and rehabilitation including;
- Tests of eye movements (Oculography) with video (Videonystagmography) or electrode recording (Electronystagmography)
- Caloric Testing
- Subjective Visual Vertical testing
- Rotary chair assessment
- Posturography platform testing and rehabilitation options
- Vestibular Evoked Myogenic Potentials (VEMP) testing
- Electrocochleography (ECochG)
- Static and dynamic Positional testing
- Video Head Impulse Test
Patients for balance assessment are usually seen by our ENT team prior to undergoing vestibular investigation. Not all patients with dizziness or imbalance will require all of these assessments, sometimes a simple consultation is all that is required. From these tests, information regarding the possible cause of the balance problems can be determined and with the help of the ENT, the treatment given will depend on the cause and severity of the condition. Occasionally problems with dizziness or balance get better over time without any intervention and occasionally people require formal rehabilitation exercises, medication or surgery.
What to Expect at your Balance Assessment
A vestibular assessment can take up to 2 hours. The tests performed will depend on the problems you are having, what the ENT has requested, and what the audiologist decides is most appropriate for you. The tests are designed to look at the way your brain combines information from your balance organ, vision and joints.
Following a detailed history from you; recording your balance problems, general health and lifestyle; the Audiologist will then look in your ears (otoscopy) and carry out a simple test of middle ear function (tympanometry).
Many of the tests will involve looking at your eye movements as your balance organs in the ears are linked via a reflex. Several tests simply involve following a light with your eyes while we record your eye movements using a pair of goggles that contain a small camera. Alternatively, a set of recording leads can be placed around the eye if the goggles are not suitable for you. Another test which we may perform involves putting a small amount of either water or air into each ear. This directly stimulates the balance organ in the ear allowing the balance function of each ear to be assessed independently, and helps the audiologist to determine whether your balance problem is the result of a mismatch between the ears.
To assess your balance you may be asked to stand with your eyes open and then with your eyes closed on a platform and a foam pad. This test challenges the balance system to see how much your balance system relies on the information from each of the 3 main senses.
To look for positioning or positional vertigo the audiologist may look for any eye movements or dizziness that occur when you move your body into different positions on the couch (this may already have been carried out by our ENT team).
Vestibular Rehabilitation
Some patients who have balance problems might benefit from a specific type of exercise therapy known as vestibular rehabilitation. This treatment is not suitable for all types of dizziness or balance problem. Most patients will be given simple exercises to do at home and will then be followed up by the Audiologist who will change these exercises as necessary. Vestibular rehabilitation requires an initial 1 hour appointment with follow up appointments, usually on a weekly basis, lasting 30 to 45 minutes. You may require several visits to complete your program of rehabilitation.
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