Being able to maintain our balance is a vital skill as it assists us in standing, walking and moving around in our environment without falling. Balance disorders can have a significant impact on our daily functioning as it increases our risk of falling and can cause uncomfortable symptoms like; dizziness, blurry vision and nausea. At Reneé Verson Audiologists we have a special interest in the balance system. By performing specialised test we can help you learn more about your balance system, balance problems and treatment options.
What causes a balance disorder?
Balance disorders can be caused by a variety of underlying conditions.
These include, but are not limited to:
- Head injuries
- Injury to the ear and vestibular system
- Side effects of medication
- Neurological disorders or diseases
- Psychological distress
- Cardiovascular or circulation problems
- Neck and spinal cord issues
- Surgeries to the head or neck area
- Tumours of the acoustic and vestibular nerve
- Hearing related disorders like Ménière’s disease
What are the signs and symptoms?
Symptoms can present in a myriad of different ways and may affect your vestibular, visual and proprioceptive function. These symptoms can be continuous and happen all the time or just occasionally, when triggered by something like a change in body position, head movements, or visual or sound stimulation. These symptoms can also cause anxiety and change the way we move around. Common symptoms include:
- Motion sickness
- Difficulty moving around
- Visual problems
- Changes in hearing
What tests and services do we offer and what can you expect?
The balance assessments performed aid in the identification of the cause of dizziness or imbalance. The test battery is tailored to the patient’s specific needs and condition. The first assessment typically comprises of a hearing assessment, bedside assessment and vHIT and lasts about 2 hours.
The balance assessments and services we offer include:
Vestibular Evoked Myogenic Potentials (VEMPs)
VEMPs can be categorized into Cervical VEMPs (cVEMP) and Ocular VEMPs (oVEMP).
This is an objective test assessing the saccules, inferior vestibular nerves and linear vestibulo-collic reflex (VCR) pathways as well as the utricles, superior vestibular nerves and vestibulo-occular reflex (VOR) pathways respectively.
During the VEMP assessment, electrodes will be placed on your face and neck and a series of sounds will then be played into your ears while a recording is made of electrical muscle activity associated with the sounds.
Videonystagmography (VNG) including Caloric irrigation
Videonystagmography assesses the central pathways of the balance system and eye movements during certain conditions and body positions.
During these tests, eye movements will be recorded whilst you wear a pair of infrared goggles. The tests will involve following a series of lights with your eyes where your head and body may be in different positions.
Caloric irrigation is an integral part of the VNG test battery assessing the horizontal semi-circular canals and superior vestibular nerves. Caloric irrigation will involve placing cool and warm air into the ear canals to elicit further eye movements.
Video Head Impulse Test (vHIT)
The vHIT is a test that assesses all the semicircular canals and vestibulo-ocular reflex (VOR) pathways. During this assessment, a tight fitting goggle will be placed onto your eyes. You will be asked to look at a stable target, while your head is moved rapidly into different directions. The high speed camera will then record your eyes during these movements.
Vestibular Rehabilitation Therapy (VRT)
Vestibular rehabilitation therapy (VRT) is a targeted therapeutic approach designed to reduce symptoms resulting from vestibular disorders, specifically addressing issues such as vertigo, dizziness, gaze instability, imbalance and falls. A personalized exercise regimen is crafted based on clinical evaluations, laboratory tests and other relevant medical tests.
Bedside and functional balance assessments
A bedside and functional assessment includes certain subjective tests to assess how you function during everyday situations and the impact of balance difficulties on your every day life.
HOW TO PREPARE FOR A BALANCE ASSESSMENT:
- Please bring your referral letter and other results / reports from previous tests related to your dizziness on the day of your appointment. This may include any MRI/CT Scan results, Bloodwork, Neurology Reports, Physiotherapy Reports and/or ENT Reports.
- A hearing assessment is recommended prior to your balance assessment.
- Try your best to obtain a good night sleep before the test.
- Do not eat 1-2 hours before the test. A light meal is recommended.
- Do not drink caffeinated beverages such as: alcohol, coffee and fizzy sugar-filled cool drinks 24 hours prior to the test.
- Wear comfortable clothing that enables you to move easily and shoes that you can take off easily.
- Do not wear any eye make-up (eye liner, mascara, eye shadow etc.) on the day of the test as this can interfere with eye movement recordings, you will be given the opportunity to apply make-up after the test. We would prefer that you wear little to no make-up on your face, minimal moisturizer, cream, foundation or lotion is recommended.
- Medications greatly influence the test results. For 48 hours (2 days) prior to your test, do not take any of the following medications:
• Antihistamines / Decongestants / cold and Flu medications
• Sedatives / Sleeping pills
• Pain Relievers/Analgesics/Narcotics
• Stimulants/Amphetamines or Appetite suppressants
• Anti-nausea/ Anti-dizziness medications
• Alcohol (cough mixtures)
- Vital Medications should not be stopped. Continue to take medications for heart, blood pressure, thyroid, anticoagulants, birth control, antidepressants and diabetes medication.
- Do not use any products containing tobacco on the day of the test.
If you have any questions about the test, or about these instructions, please feel free to contact us at the practice.