Balance Assessment

Trinity Hearing Clinic

Most often, we take our ability to balance for granted. Balance is just one of those things we do when we walk, move, and go about our daily lives. When it’s affected by a variety of different health concerns, however, it can make everyday things difficult. From standing to sitting to maneuvering from one side of a room to the other, these important functions can be much harder when you experience dizziness or poor balance. Chances are, you’ve experienced a sudden bout of dizziness or spinning at some point. If this occurs regularly and with similar symptoms, it’s important to see a GP and Audiologist soon.

At THC, we understand that balance deficiencies can be complex and have a lot of different causes, so it’s important to determine what’s causing your balance problems. Many times, balance is affected by health conditions that should be treated promptly. During an appointment with our Audiologist, we can assess your symptoms and recommend the best course of management for you and your lifestyle.

A balance assessment is a set of tests that look at possible causes of balance problems. Balance is intricately linked to the mechanisms of the ears, eyes, brain, muscles, and nerves. Often, an Audiologist can assess your balance ability by looking at the functions of your inner ear, nerves, and other contributing systems to see whether something might be affecting your body’s ability to sense its position and location in the space around it. During a balance assessment, we can perform some of the following tests:

1]Comprehensive Audiological Evaluation.This is a complete hearing assessment that can look at many different ear functions and types of hearing loss you might be experiencing. Often, balance deficiencies accompany types of hearing loss or inner ear abnormalities. This test usually includes a physical examination where we can look at your ear canal for any wax impactions or anatomical problems. Then, we’ll perform some tests to see how well your inner ear functions. This might include listening to sounds or using some instruments that can measure whether your inner ear responds to stimuli.

2] Occular Reflex Test -Many of the tests will involve looking at your eye movements as your balance organs in the ears are linked via a reflex. The audiologist will look at your general eye movements by asking you to follow their finger or pen.

3] To assess your balance you may be asked to stand with your eyes open and then with your eyes closed on a foam pad such as in the picture. This test challenges the balance system to see how much your balance system relies on the information from each of the 3 main senses.

4] Head Impulse Test- this involves focusing on a target whilst the Audiologist moves your head in different directions

5]  Hallpike Manoeuvre - 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.

If necessary we will refer for the following 2 special test which could be done in a Speciality centre;

ECochG (Electrocochleography)
This test uses electrodes to measure electrical signals generated in the auditory nerve and inner ear when sound is received. It can also assess the environment of the inner ear and nerve.

VNG (Videonystagmography)
This test uses special goggles to monitor your eyes’ responsiveness and movements when you’re put in special positions and undergo different movements. By seeing which positions cause certain eye movements, we can get a better understanding of your inner ear function and different parts of your balance system.

A balance assessment with our Audiologist includes more than some tests; we also look at your medical history and discuss any health concerns that might be causing you to lose balance. These can often include cardiovascular problems, endocrine problems (like diabetes), neurological problems, visual problems, hearing problems, or proprioception problems. Additionally, some medications can cause balance issues; so can things like head trauma, concussion, and spine or neck issues. Often, balance problems can be indicative of untreated medical issues. Many patients are also concerned about falls or injuries because of poor balance, so it’s important to partner with an Audiologist who can make a full assessment of your balance health and recommend a course of action.

A balance assessment begins with a full medical history so we can look for specific medical conditions that might be causing poor balance. We’ll also discuss your symptoms like dizziness, vertigo, motion intolerance, or tinnitus. It can be helpful to keep a record of these symptoms with notes like when and where you experience them. If you notice symptoms during specific positions, this can also be helpful for us. Once we have a better vision of your experience, we can perform the right tests to look for causes. When we have some results and a good idea of your balance deficiency causes, we can articulate it to the rest of your balance healthcare team including GP and ENT clinicians.

Benign Paroxysmal Positional Vertigo (BPPV) is a common condition that affects your balance because the inner ear doesn’t function as it normally does. Normally, your inner ear houses tiny calcium crystals that press against nerve receptors when you move your head or change potions. This stimulus is then sent to the brain to be processed. This helps you keep balance and understand your position and place in the space around you. With BPPV, these crystals become dislodged from the gelatinous part of the inner ear they normally exist in. When they fall free, they can migrate to a different part of the inner ear. Ultimately, when you move in certain positions or turn your head, these rogue crystals shift and cause abnormal fluid movement in your inner ear canals. This results in the feeling of spinning.

BPPV can be difficult to live with if untreated because it can affect your ability to move, respond, and even get out of bed. It’s also important to be assessed by an Audiologist because BPPV can be caused by head injuries or migraines, both of which can be significantly impactful to your overall health. Additionally, BPPV can reoccur over time even if it goes away on its own, meaning it can be helpful to have the tools and information provided by our Audiologist. This can help prevent falls or injuries because of BPPV.

BPPV treatment begins with some quick and easy tests to determine what parts of your ears might be causing the spinning sensation. We assess this by performing a test called the Dix-Hallpikemaneuver. This means that you sit on an examination table with your legs stretched out. You’ll then turn your head to about 45 degrees while aAudiologist helps you quickly lay down. This maneuver often triggers BPPV and, if you experience it, your eyes will make certain movements that we can observe. Our experienced staff can usually judge which part of the inner ear might be affected by BPPV from this so that we can target your treatment accordingly. Treatment for BPPV can include a couple of clinically-accepted maneuvers performed in our clinic.

Epley Manoeuvre. BPPV can be treated with an Epley Manoeuvre. This involves being moved through a series of positions to shift the loose crystals back to where they should be. You may feel a little dizzy during this procedure whilst the crystals are moving. One type of therapy, called vestibular rehabilitation, can be an effective option to include and we can arrange it for you..

Ear balance is an important part of a human being to have a favourable life. Vestibular disorders like dizziness and related problems may bring difficulties in your regular life. It can bring instability, spinning, feeling of passing out, floating, sensations of moving, and such issues make you more uncomfortable. The vestibular disorder may even cause secondary problems like nausea, difficulty concentrating, and chronic fatigue.

Vestibular rehabilitation is an exercise-based program designed by a speciality-trained vestibular physical therapist to improve balance and reduce problems related to dizziness.

 At THC, a physical therapist will evaluate your symptoms and review your medical history after assessment will include a multidisciplinary, collaborative approach to assessing and managing balance disorders.

Vestibular rehabilitation helps to accelerate and overcome dizziness. The dizziness treatment, imbalance, vertigo, Meniere’s syndrome, benign paroxysmal positional vertigo (BPPV), neck-related dizziness and migraines through the types of exercises you will learn in a vestibular rehabilitation program. This therapy usually includes some exercise-based therapies to help reduce imbalance or vertigo and the chance of falls or injuries through things like Habituation, Gaze stabilisation, and Balance training.

Individualised Cawthorne-Cooksey exercises and Brandt-Daroff exercises are used for the treatment of Dizziness as required. Vision stability training, Posture training, Stretching and strengthening exercises, Balance retraining, Walking exercises, Neck mobility/stretching exercises, General fitness exercises are also included.

Vestibular rehabilitation can help accelerate the rate at which you can return to your regular lifestyle. This means it can help to reduce the symptoms that prevent you from living your life the way you want. Additionally, vestibular rehabilitation focuses on full-body wellness and overall health which can help to reduce symptoms, pain, and other medical conditions that might be contributing to a vestibular disorder. Vestibular rehabilitation is usually performed by expert therapists who can target your unique deficiencies and create the right treatment plan for you.

At THC, for ear balance and dizziness treatment to get an accurate baseline and diagnosis. Vestibular diseases vary from person to person and also can be different causes. To find out the proper treatment, our Audiologist can help with your healthcare team. For advanced vestibular rehabilitation, we refer you to our experts of physical therapists. We help you with the right home care like Yoga or Tai chi to strengthen your body and increase mobility. Our audiologists are here to fulfil your needs regarding ear balance and dizziness treatments. 

The Procedure
Simple and safe use of the Dix-Hallpike test by one of our experienced and fully qualified Audiologists. The Dix-Hallpike test diagnoses a condition called Benign Paroxysmal Positional Vertigo (BPPV), which is not harmful although the symptoms can be distressing. BPPV is the most common and treatable cause of ear-related balance disorders, and, if identified, can be treated on the spot using the Epley Manoeuvre. One manoeuvre will reduce symptoms in approximately 80% of cases first time. If BPPV is not identified, then you will be referred to see ENT Doctor or a Highly specialised Vestibular Physiotherapist to investigate other possible causes for your symptoms.

Steps:
  • 1. Extensive patient history
  • 2. Dix-Hallpike test
  • 3. Epley Manoeuvre OR referral to ENT Doctor and Vestibular PT
  • 4. Follow up Balance appointment(s), or ENT/Audiology investigation
  • 5. Resolution

The VRT Sessions are generally 45 minutes .Patients typically visit our clinic 1-2 times weekly for up to 6 weeks or until their dysfunction is resolved. Additionally, select patients may be provided a personalized, home-based exercise and video therapy program that they can perform independently.