Dizziness and balance disorders

Testing and treatment to get you back to normal.

Dizziness, a blanket term used to describe any feeling of unsteadiness, is one of the leading health complaints in the United States, affecting an estimated nine million people annually.

The inner ears and brain do not merely sense movement. They also send reflexes to the body to control balance while standing and walking. Any time there is a disorder in this system, balance can become impaired and falls are more likely.

Fainting is usually the result of low blood flow or lack of oxygen to the brain, so it is important to distinguish this from ear or brain balance disorders, which have completely different treatments.

Vertigo is a condition that describes feelings of abnormal movement, such as a spinning feeling inside the head, or actually seeing the room spin. It is often a symptom of an inner ear disorder. Brain disorders like migraine, strokes and multiple sclerosis can also cause a sensation of motion, but usually have other symptoms as well.

Your doctor will target the underlying condition in order to reduce or eliminate your symptoms. An evaluation for dizziness consists first of taking a history of symptoms. An examination of the ears and neurologic system helps detect abnormalities of the balance system. There are several specialized tests of hearing and balance that can pinpoint the parts of the inner ear or brain that are involved. All these clues are brought together by neuro-otologic practitioners to make a diagnosis.

Treatment of these conditions depends upon the cause. Some can be treated immediately in the office with simple exercises. Others may require medications for a short course or over a long period. Serious disorders can involve surgical correction. Our neuro-otologists partner with audiologists, physical therapists and other physicians to optimize care in these complex cases.

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The vestibular system is complex and responsible for many of the body’s functions. In order to narrow down the exact cause of dizziness, it is necessary to administer a variety of tests. These measure eye movements, head movements, hearing and more. They are used to determine whether symptoms of dizziness are caused by the balance system of the inner ear.

Vestibular testing is also helpful in determining whether additional diagnostic testing, such as an MRI, is needed in your unique case.

A battery of tests is administered in most cases, the most common being:

Videonystagmography (VNG)

An infrared video camera attached to a pair of goggles. VNG tests usually consist of four parts:

  • Evaluation of rapid eye movements
  • Tracking tests to measure eye movements as they follow a visual target
  • Positional test for measuring dizziness in response to different head positions
  • Caloric test that measures responses to warm and cold water circulating through a tube in the ear canal

Vestibular Evoked Myogenic Potential (VEMP)

Used to determine whether the saccule (an inner ear organ) and vestibular nerves are functioning properly.

Video Head Impulse Test (vHIT)

An ear-specific test that detects a deficiency of the vestibular-ocular reflex (VOR) and abnormalities of the lateral anterior and posterior semi-circular canals.

MedlinePlus: National Library of Medicine. Dizziness and Vertigo (https://medlineplus.gov/dizzinessandvertigo.html)

National Center for Biotechnology Information (NCBI): National Library of Medicine. Dizziness (https://www.ncbi.nlm.nih.gov/books/NBK325/)

National Institute on Deafness and Other Communication Disorders. Balance Disorders (https://www.nidcd.nih.gov/health/balance-disorders)