Balance Assessment

Balance Assessment Clinic

Balance is something we often take for granted. However, it is a crucial part of our daily lives, helping us walk and move around with ease. Unfortunately, multiple health concerns can affect our balance, making even simple tasks difficult such as standing, sitting or moving around a room. If you experience dizziness or poor balance, it’s important to seek medical help as it can be a significant hindrance to your daily life. If you have experienced sudden bouts of dizziness or spinning that occur regularly and with similar symptoms, it’s important to consult a GP and an Audiologist soon.

We recognize at Trinity hearing clinic Sheffield and Rotherham that issues with balance can be multifaceted and can stem from a variety of causes. Therefore, it is crucial to identify the underlying reasons for your balance problems. In many cases, balance can be affected by health conditions that require immediate treatment. Our Audiologist can evaluate your symptoms during your appointment and suggest the most suitable management plan for your specific needs and lifestyle.

A balance assessment at Trinity clinic Sheffield and Rotherham consists of a collection of tests that explore potential causes of balance issues. Balance is closely connected to the operations of the eyes, ears, brain, muscles, and nerves. In some cases, an Audiologist can evaluate your balance capability by examining the functions of your inner ear, nerves, and other contributing systems to determine if there may be anything impeding your body's capacity to perceive its position and orientation in the surrounding environment. During a balance assessment, we might conduct some of the following tests:

1]Comprehensive Audiological Evaluation.A comprehensive hearing assessment is available to evaluate various ear functions and types of hearing loss you may be experiencing. Hearing loss or inner ear abnormalities are often accompanied by balance deficiencies. During the test, a physical examination will be conducted to check for wax impactions or anatomical problems in your ear canal. Following that, we will perform some tests to determine the functionality of your inner ear. These tests may involve listening to sounds or using instruments that measure your inner ear's response 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. 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 examination involves using unique goggles to observe the responsiveness and movements of your eyes while you undergo various positions and movements. By determining which positions cause particular eye movements, we can gain a more comprehensive understanding of the functioning of your inner ear and various components of your balance system.

At Trinity Hearing Clinic in Sheffield and Rotherham, we conduct balance assessments with our Audiologist that are more comprehensive than simply running a few tests. During these assessments, we review your medical history and address any health concerns that may be affecting your balance. These concerns may include issues with your cardiovascular system, endocrine system (such as diabetes), nervous system, vision, hearing, or proprioception. It's important to note that certain medications, head trauma, concussion, and neck or spine problems can also cause balance problems. In some cases, balance issues may be a sign of untreated medical problems. Many patients are worried about falling or sustaining injuries due to poor balance, which is why it's crucial to work with an Audiologist who can conduct a thorough balance assessment and recommend appropriate measures.

We begin a balance assessment at our center in Sheffield and Rotherham by collecting a complete medical history to identify any underlying medical conditions that may be affecting your balance. We will also discuss any symptoms you may have, such as dizziness, vertigo, motion intolerance, or tinnitus. You may find it helpful to keep track of these symptoms, including when and where you experience them. If you experience symptoms in specific positions, this information can be particularly useful. Once we have a better understanding of your experience, we will perform the appropriate tests to identify the root causes of your balance issues. We will then communicate our findings and recommendations to your entire balance healthcare team, including GP and ENT clinicians.

BPPV or Benign Paroxysmal Positional Vertigo is a prevalent condition that impacts your balance due to the abnormal functioning of the inner ear. In normal conditions, the inner ear accommodates small calcium crystals that activate nerve receptors whenever you move your head or switch positions. These nerve signals are then transmitted to the brain for processing, which helps you maintain balance and comprehend your location and orientation in your surroundings. However, in the case of BPPV, these calcium crystals become dislodged from their gelatinous location in the inner ear. They can relocate to another area of the inner ear and disrupt the fluid movement within the ear canals when you move your head or change positions, causing a feeling of spinning or dizziness.

If left untreated, BPPV can have a significant impact on your mobility, responsiveness, and ability to get out of bed. It is crucial to seek evaluation from an Audiologist since BPPV can result from head injuries or migraines, both of which can adversely affect your overall well-being. Moreover, BPPV can resurface over time, even if it subsides on its own. Therefore, our Audiologist's tools and knowledge can be invaluable in preventing falls or injuries caused by BPPV.

BPPV treatment starts with simple and quick tests that aim to identify the parts of your ear that may be causing the sensation of spinning. To determine this, we perform a test called the Dix-Hallpike maneuver. During this test, you will be asked to sit on an examination table with your legs stretched out and then turn your head at a 45-degree angle while an Audiologist helps you lie down quickly. This maneuver is known to trigger BPPV, and if you experience it, your eyes will make specific movements that we can observe. From this, our experienced staff can typically determine which part of the inner ear might be affected by BPPV, so we can focus your treatment accordingly. BPPV treatment may include a couple of maneuvers that are clinically accepted and performed in our clinic.

The Epley Manoeuvre is a treatment for BPPV that involves moving the patient through a sequence of positions in order to reposition loose crystals to their correct location. During the procedure, you may experience dizziness as the crystals shift. Vestibular rehabilitation is another form of therapy that can be helpful in treating this condition, and we can help arrange it for you.

Vestibular Rehabilitation

Having a good ear balance is crucial for leading a comfortable life. Any vestibular disorders such as dizziness may cause various problems that can disrupt your daily life. Symptoms like instability, spinning, feeling of passing out, floating, or sensations of movement can make you feel uncomfortable. In addition, vestibular disorders may lead to secondary issues such as nausea, difficulty concentrating, and chronic fatigue.

A program called vestibular rehabilitation, which involves exercises, has been created by a specialized physical therapist or audiologist to enhance balance and alleviate dizziness-related issues. At THC, a specialist physical therapist or audiologist will assess your symptoms and medical history. The assessment will be a collaborative, multidisciplinary approach to diagnose and treat balance disorders.

Vestibular rehabilitation is a type of therapy that helps to overcome dizziness and related symptoms. This treatment can address various conditions such as imbalance, vertigo, Meniere’s syndrome, benign paroxysmal positional vertigo (BPPV), neck-related dizziness, and migraines. Vestibular rehabilitation programs typically involve exercise-based therapies aimed at reducing these symptoms and improving balance to prevent falls and injuries. These programs may include various types of exercises such as Habituation, Gaze Stabilization, and Balance Training. The treatment plans may also include specific exercises such as Individualized Cawthorne-Cooksey and Brandt-Daroff exercises, as well as Vision Stability Training, Posture Training, Stretching and Strengthening Exercises, Balance Retraining, Walking Exercises, Neck Mobility/Stretching Exercises, and General Fitness Exercises.

Vestibular rehabilitation has the potential to speed up the process of returning to your normal lifestyle. This implies that it can aid in reducing the symptoms which are preventing you from leading the life you desire. Moreover, vestibular rehabilitation focuses on whole-body well-being and overall health which can help to mitigate symptoms, pain, and other medical conditions that could be contributing to a vestibular disorder. Usually, vestibular rehabilitation is carried out by skilled therapists who can assess your individual deficiencies and create an appropriate treatment plan for you.

At THC, for an accurate baseline and diagnosis of ear balance and dizziness treatment, we can help. Vestibular disorders vary from person to person and can also have different causes. To determine the correct treatment, our audiologist can assist you in working with your healthcare team. For advanced vestibular rehabilitation, we refer you to our team of physical therapy experts. We can aid you in finding the right home care such as Yoga or Tai chi to strengthen your body and improve mobility. Our audiologists are committed to meeting your needs when it comes to ear balance and dizziness treatments.

The Procedure
We have experienced and fully qualified Audiologists who can conduct the Dix-Hallpike test safely and effectively. This test is used to diagnose Benign Paroxysmal Positional Vertigo (BPPV), which is a condition that may cause distressing symptoms but is not harmful. BPPV is the most common cause of ear-related balance disorders and can be treated with the Epley Manoeuvre if identified during the test. In most cases, one manoeuvre is enough to reduce the symptoms by 80%. If BPPV is not identified, you will be referred to an ENT Doctor or a Highly specialised Vestibular Physiotherapist to investigate other possible causes for your symptoms.

  • 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 typical duration of a VRT Session is 45 minutes. Patients usually come to our clinic once or twice per week and continue for up to 6 weeks or until their dysfunction is resolved. In some cases, select patients may receive a customized home-based exercise and video therapy program that they can perform independently.