Vestibular Testing

Balance, Dizziness, and Vertigo

According to the National Institutes of Health, 90 million Americans will experience dizziness, vertigo, or imbalance at some point in their life. Dizziness is the number one complaint of adults over age 70. The good news is that research now clearly shows that with early evaluation and treatment many cases of dizziness can be treated quickly and easily.

Roanoke Valley Speech and Hearing Center is proud to partner with the American Institute of Balance (AIB) to provide a comprehensive vestibular clinic that will evaluate a patient’s dizzy and balance concerns with state-of-the-art equipment and expert evaluation. AIB is one of the country’s best-known diagnostic, treatment, and educational facilities specializing in equilibrium disorders. As an AIB Center of Specialty Care, Roanoke Valley Speech and Hearing Center's vestibular audiologists are specialists in the treatment and identification of complex balance disorders, which often originate from the vestibular system in the inner ear.

Where does dizziness come from?

The inner ear has several different functions. In addition to housing the body’s hearing center, the inner ear also houses the body’s vestibular or balance center. According to the Vestibular Disorders Associate (VEDA), over 35% of US adults aged 40 years and older (69 million Americans) have had a vestibular dysfunction at some point in their lives. Problems with the vestibular system may cause dizziness, vertigo, and/or imbalance.

Types of Dizziness
Benign Paroxysmal Positional Vertigo (BPPV)

The most common cause of vertigo, effecting 50% of the people over the age of 70. It is a mechanical problem in the inner ear characterized by brief episodes of vertigo with changes in head position. The episodes of true vertigo is approximately seconds to one minute in duration but can be accompanied by a general feeling of dizziness and imbalance outside of the episodes of vertigo.

Imbalance

Three main systems are used to maintain balance, eyes, inner ear and sense of touch in the feet. Problems with any those three systems or the central nervous system that processes, integrates and transmits those signals can cause a general sense of unsteadiness or imbalance with standing or walking. According to American bone health, every year, more than 30% of U.S. adults 65 and older fall. Falls are the leading cause of death in this age group and in 2005, 1.8 million people were treated in hospital ERs for non-fatal falls. Direct medical costs added up to 179 million for fatal falls and 19 billion for fall related injuries. Falls can be preventable so proper assessment, therapy and preventative measure can prevent a life changing fall and improve overall balance.

Labyrinthitis

Much like vestibular neuritis, the acute phase of this problem is characterized by an abrupt onset of vertigo lasting hours to days often accompanied by nausea and emesis. This pathology is caused by a viral or bacterial infection of the inner ear structures also considered to be an inner ear infection. The course and resolution of the condition is identical to vestibular neuritis accept, unlike vestibular neuritis, this pathology also affects the hearing portion of the inner ear and the episode of vertigo is accompanied by hearing loss.

Mal de Debarquement Syndrome

A rocking or swaying sensation felt after exposure to prolonged motion such as a cruise or flight. Typically, the symptoms will not be long lasting but in a subsection of the population, therapy is warranted to return the brain and body back to resting state. Heavily linked to migraine history.

Meniere’s Disease

Episodic pathology characterized by fluctuating hearing, tinnitus, vertigo and fullness of the ear. The duration of the symptoms varies but the vertigo typically lasts from 20 minutes to 24 hours. The pathology is caused by too much inner ear fluid and a mixing of the inner ear fluids that should not mix. This pathology can be progressive in nature and can be managed by an Ear Nose and Throat physician.

Vestibular Migraine

Typically thought of as an intense headache, migraine can affect and cause many more symptoms than just a headache. About 40 percent of people who have migraines also experience dizziness or balance problems, which can accompany a migraine or occur at a totally separate time, according to VEDA. Migraines are highly associated with multiple inner ear pathologies. Inner ear evaluation can lead to a proper diagnosis and treatment.

Vestibular Neuritis/Neuronitis

Abrupt onset of vertigo that can last hours to days in duration. Often accompanied by nausea and vomiting. This pathology is caused by a viral infection of the vestibular nerve, often thought of as an inner ear infection. After the resolution of the initial long episode of vertigo the symptoms become less severe, but symptoms still exist in a different manner with blurred vision with head movements, a general lightheadedness and imbalance. Although the virus can cause permanent damage to the inner ear structure, with identification through comprehensive testing and a therapy regimen, it is possible to make a full recovery.

Comprehensive Evaluation

Our vestibular evaluation will take a comprehensive look at inner ear function through a specific battery of tests constructed from each patient’s reported symptoms. The vestibular system is very complex and cannot be directly observed so every test provides different information to be correlated and compared to provide an accurate diagnosis.

Vestibular Tests

The tests below may be used to evaluate dizziness and imbalance.

Audiometry

Evaluates the hearing portion of a patient’s ear. This allows us to define cause, type and degree of hearing loss. This testing is important for dizzy and off-balance patients because small unnoticed hearing changes can indicate inner ear damage or other medical problems. This assessment also helps us establish hearing threshold that can influence other testing in our test battery.

Cervical Vestibular Evoked Myogenic Potential (cVEMP)

This test helps to evaluate a very specific portion of the nerve that goes to the equilibrium part of the inner ear and one of our gravity detector organs, the saccule. There are two portions of the equilibrium nerve, and this test evaluates the bottom part of the nerve.

Dynamic Visual Acuity Test

This test is fairly similar to the VAT, but the test protocol is slightly modified. It may be easier for some patients to perform.

Electrocochleography (EcochG)

This technique records electricity generated in the inner ear and auditory nerve. The test helps rule out an abnormal accumulation of fluid within the inner ear that may be causing acute attacks of true room spinning vertigo.

Gans Sensory Organization Performance

This test helps us identify balance problems. With careful evaluation, it allows your audiologist to determine the cause of your imbalance and identify a potential fall risk.

Neurodiagnostic Auditory Brainstem Response (ABR)

This test helps us evaluate the neural integrity of the nerve going to the hearing part of the inner ear. This test is often used to further explain why a person might have unilateral symptoms or test findings. This test helps us evaluate the nerve quality and function of the inner ear hearing nerve.

Ocular Vestibular Evoked Myogenic Potential (oVEMP)

This test helps evaluate a very specific portion of the nerve that goes to the equilibrium part of the inner ear and one of our gravity detector organs, the utricle. There are two portions of the equilibrium nerve, and this test evaluates the superior portion of the nerve.

Rotary Chair

This advanced test utilizes a computer-controlled motorized chair to stimulate the ear at different speeds. A patient’s eye movements are also recorded with video goggles. This test allows us to assess the overall health of the inner ears and how the brain is adapting to a vestibular disorder.

Tympanometry/Immittance testing

Helps us rule out fluid in the middle part of the ear, which can impact other vestibular test results. This test also allows us to evaluate nerve responses.

Videonystagmography (VNG)

This test is composed of a number of subtests. For this testing, a patient wears video goggles or electrodes. These allow us to watch for small eye movement abnormalities, which can indicate an inner ear problem. There are also sub-tests that can help us identify positional vertigo and/or permanent ear damage. This testing also looks at the top portion of the nerve going to the equilibrium part of the inner ear.

Heather Dickey, Au.D.

CCC-A, Audiologist

Dr. Heather Dickey moved to Roanoke and began working at the Center in 2017. She graduated from Marywood University with a B.S. degree in Communication Sciences and Disorders and Deaf Studies, East Tennessee State University with a M.S. degree in Audiology and University of Florida with an Au.D. in Audiology. Dr. Dickey brings over 18 years of experience in various areas of clinical audiology, including hearing evaluation of children and adults, Central Auditory Processing Evaluation, and Vestibular (dizziness and balance) assessment. 

Additionally, Dr. Dickey has had training in preventing falls through Maine Health’s Partnership for Healthy Aging. She enjoys giving educational presentations about hearing loss, vestibular problems/dizziness and auditory processing. She holds a state license from the Virginia Board of Audiology and Speech-Language Pathology, Board for Hearing Aid Specialists and Opticians and a Certificate of Clinical Competency (CCC) from the American Speech-Language and Hearing Association.

Fun Fact: Dr. Dickey enjoys learning Taekwondo with her sons and is looking forward to earning her black belt soon.

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