A balance disorder is a condition that makes you feel unsteady or dizzy. If you are standing, sitting, or lying down, you might feel as if you are moving, spinning, or floating. Your sense of balance relies on several components, known as the vestibular system: the inner ear, the eyes, proprioceptors, and how the brain processes information it receives from the other components.
In order to diagnose a balance disorder, your physician may request a hearing evaluation along with a videoystagmography (VNG) test. VNG testing is used to determine which part of the vestibular system may be causing a balance or dizziness problem.
- How do you diagnose the causes of dizziness or poor balance?
- What inner ear problems can cause dizziness or poor balance?
- How does testing help diagnose & treat dizziness and poor balance?
- What can I expect from balance testing and treatment?
- How do I know if I should get a balance test?
How do you diagnose the causes of dizziness or poor balance?
To understand the causes of dizziness or poor balance, you need to understand how our human balance system works. The three systems responsible for our equilibrium are the inner ear, eye movement, and proprioception. The vestibular portion of the inner ear sends information to the brain about how our head is moving. In response, the brain sends commands to move the eyeballs accordingly. Proprioceptors are nerve endings throughout the body that inform the brain about our body’s interaction with the environment. If we walk barefoot from a tiled floor onto a thick carpet, the proprioceptors in our feet will give the brain this information so that we don’t trip or fall. All three of these systems must work perfectly in order for us to achieve good balance. If one system is off, it will cause dizziness and/or imbalance and also affect the remaining systems. Although there are numerous causes for dizziness and imbalance, research has shown that 85% of persons with these problems have an underlying inner ear disorder.
Dizziness and balance difficulties often result from problems in the vestibular system, which is linked with the hearing system in the ear. Testing, along with taking an extensive case history, can help determine the source of a person’s dizziness by identifying any components of the hearing or vestibular systems that are not functioning normally.
What inner ear problems can cause dizziness or poor balance?
There are a variety of causes for dizziness, vertigo or balance problems, however research has shown that 85% of persons with these problems have an underlying inner ear disorder. The two most common inner ear problems contributing to dizziness and balance issues are BPPV and vestibulopathy.
The leading cause of dizziness is a condition known as Benign Paroxysmal Positional Vertigo, or BPPV. In the vestibular portion of the inner ear are salt-like crystals called otoliths. With BPPV, these crystals break loose and gather with debris which can float into or attach itself to the semicircular canals.
The symptoms of BPPV can include dizziness or vertigo, lightheadedness, imbalance and nausea. Typically, the symptoms are brought about due to a change in head position. Common complaints are dizziness when rolling over or getting out of bed, looking up or bending down. The symptoms of BPPV may be present for a few weeks, then stop, and then come back again.
The most common cause of BPPV in people under age 50 is head injury or whiplash. It is also common to experience BPPV following a sinus infection or severe head congestion. In older persons. the condition may be contributed to degeneration of the vestibular system of the inner ear. In most cases, BPPV is said to be idiopathic, or for no known reason.
Each inner ear has two main parts, one that controls hearing (the cochlea) and one that is responsible for balance (the vestibular portion). Vestibulopathy refers to a difference (usually a reduction) in the output of one or both of the vestibular portions of the inner ears. Vestibulopathy may be caused by infection, illness, trauma or simply the natural aging process. Many times the onset of vestibulopathy starts with a severe attack of vertigo (spinning), accompanied with nausea and lasts for several days. Although the subsequent dizziness is not as severe, it can become a chronic situation if left untreated.
The symptoms of vestibulopathy can include dizziness with head or body movement, motion sickness or an uneasiness with certain visual stimuli (i.e., rows in a supermarket, flickering lights or down escalators).
How does testing help diagnose & treat dizziness and poor balance?
Behavioral hearing testing and tympanometry will be performed as part of a full evaluation for dizziness. Dizziness and balance difficulties often result from problems in the vestibular system, which is linked with the hearing system in the ear. These tests can help determine the source of a person’s dizziness by identifying any components of the hearing or vestibular systems that are not functioning normally.
At Millburn Audiology & Balance a complete comprehensive diagnostic test for vestibular disorders, including taking an extensive case history, Videonystagmography (VNG) with infrared goggles, Vestibular-Ocular Reflex (VOR) Testing, Audiological Evaluation, Tympanometry, and Acoustic ReflexesTesting.
The vital information obtained from each test is as follows:
- VNG – When a person is dizzy, the eyes generally move uncontrollably. VNG helps isolate the source of a person’s dizziness by measuring eye movements, both those that are voluntary and those that result from intentionally inducing dizziness. Analyzing the eye movements helps the audiologist isolate possible causes for dizziness. There are three main groups of sub-tests included in ENG testing: ocular mobility testing, positional and positioning testing, and caloric testing.
- VOR – Through use of active head rotation we measure gain, the amount of eye movement relative to head movement: phase, the reaction time of the eyes in response to head movement: and symmetry, the gain to rightward movement vs. the gain to leftward movement during sinusoidal head movement. Active head rotation tests more real-life frequencies of head movement than does rotational chair testing.
- Audiometry – Measures hearing acuity and speech discrimination.
- Tympanometry – Measures the status of the middle ear.
- Acoustic Reflexes – Measures the status of the reflex arc and uses this information to determine possible site of lesion.
The results from all of these tests are examined together to help determine a possible cause of the person’s problem, as well as to design a customized treatment plan.
What can I expect from balance testing and treatment?
If a complete audiogram has been done recently, and you can bring a copy of the results to your appointment, there will be no need to repeat the testing. However, the hearing testing done during a vestibular assessment is a very important aspect of the evaluation and must be accurate and recent. Testing is completed in one office visit.
If vestibular therapy is recommended, the type of therapy will determine the duration. Some therapies can be completed in as little as 2-3 office visits. However, some balance retraining may take 12-14 visits.
If you need to see a doctor, in most cases you can return to your primary care provider. However, if another referral is recommended, our staff works closely with your doctor to assure that you get the proper care.
All testing is done by licensed, certified audiologists. These specialists have had specific training in vestibular assessment and therapy.
How do I know if I should get a balance test?
If you notice any of these symptoms, you should have your balance evaluated. Do You…
- Experience a feeling of motion with certain movements such as quick head turns or getting out of bed?
- Have difficulty getting around in the dark?
- Feel uneasy walking down an aisle in the store or walking in a shopping mall?
- Sometimes feel like you have no control of your feet?
- Feel unsteady or need to touch something while walking?
- Have a fear of falling?
- Feel uneasy looking out of the window of a moving car?
- Have trouble walking from one surface to another, such as tile to carpet?
- Feel as though your are swaying or leaning toward one direction while you are walking?
- Feel like no one understands how upsetting this is?