Balance Center in Lancaster, PA
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Balance & The Vestibular System
The medical term for the part of the inner ear involved with balance is called the vestibular system. The vestibular system is an organ located within the inner ear which relays information to the brain about balance and orientation of the head and body. Balance is a complex interaction which requires input from our vestibular system, in addition to our vision and the sensation from our feet, muscles, and joints. If any one of these systems are not working properly, you will suffer loss of balance.
Patient Self Quiz
Did You Know…
- According the National Institute of Health (NIH), dizziness or loss of balance will affect 90 million Americans sometime during their lifetime.
- Dizziness is the number one complaint reported to medical providers in adults 70 years of age or older.
- Balance-related falls account for more than one-half of accidental deaths in the elderly.
- Balance-related falls cause over 300,000 hip fractures in individuals over 65 years of age
- Children can also be affected by inner ear disorders and are sometimes incorrectly diagnosed as learning disabled, dyslexic, or psychologically disturbed.
- Inner ear disorders or ear infections can result imbalance and vertigo affecting a person’s ability to walk, roll over in bed, see or think clearly, or to read or watch television.
- Many times, disorders of the inner ear are misdiagnosed as a more severe neurological condition such as multiple sclerosis, or as clinical depression.
- Inner ear disturbances account for 85% of dizzy disorders.
- Illness, infections, disease, head injuries and whiplash are frequent causes of imbalance, dizziness, and vertigo.
Balance Disorders
Dizziness, vertigo, or motion intolerance.
Persistent sense of imbalance or unsteadiness.
A balance disorder may be caused by viral or bacterial infections in the ear, a head injury, or blood circulation disorders that affect the inner ear or brain. Many people experience problems with their sense of balance as they get older. Balance problems and dizziness also can result from taking certain medications. However, many balance disorders can begin all of a sudden and with no obvious cause. Your physician may have referred you to our clinic as the balance experts who will help in the process of determining possible causes and best treatment options.
The Dizzy Test Battery
Technically we provide a battery of neurodiagnsotic/vestibular tests. However we realize that although accurate, that label can sound intimidating. So for the purposes of making our patients feel more comfortable, let’s just refer to our battery of tests designed to assess balance issue as “The Dizzy Test Battery”.
The inner ear is home to the hearing and balance centers. The receptors within the ear allows signals to be received and processed by a variety of locations within the central nervous system and the brain. Unlike imaging studies which show only the anatomy or structures, this family of tests allows your doctor to better understand how the system is working and where a problem may arise.
Depending on your condition, your physician may recommend evaluation of the hearing and/or balance centers as they are all part of the inner ear. The following tests are available at our center. Not all testing is necessary to diagnose every balance disorder. However, it’s much easier if our patients do not have to visit several practitioners in the event multiple tests are required. The testing is easy, comfortable utilizing the most advanced technology currently available.
An Auditory Brainstem Response (ABR) test, also known as Brainstem Auditory Evoked Response (BAER) test, is a diagnostic procedure used to assess the function of the auditory pathway from the ear to the brainstem. It is typically performed to evaluate hearing sensitivity and diagnose hearing disorders, particularly in infants, young children, or individuals who cannot participate in traditional behavioral hearing tests.
During the ABR test, small electrodes are placed on the scalp, forehead, and earlobes to detect electrical activity generated by the auditory nerve and brainstem in response to sound stimuli. The patient is usually positioned in a quiet room or sleep state to minimize interference.
A series of clicks or tones of varying intensity are presented through earphones or speakers, and the electrodes measure the brain’s electrical responses to these stimuli. The test records the time it takes for the auditory signals to travel from the ear to the brainstem, as well as the strength and consistency of these responses.
The recorded responses are analyzed by a trained audiologist or healthcare professional to determine the presence, degree, and nature of any hearing impairment or neurological abnormalities. A normal ABR waveform indicates typical hearing function, while abnormalities in the waveform may suggest hearing loss, auditory nerve disorders, or other neurological conditions affecting the auditory pathway.
The ABR test is particularly useful for diagnosing hearing loss in newborns, infants, and individuals with developmental disabilities who may have difficulty responding to traditional behavioral hearing tests. It can also help differentiate between sensorineural (inner ear) and conductive (middle ear) hearing loss and assess auditory nerve function in cases of suspected auditory neuropathy or retrocochlear pathology.
Overall, the ABR test is a valuable tool in the diagnosis and management of hearing disorders, providing valuable information about the integrity of the auditory system and guiding appropriate intervention and treatment strategies to optimize hearing health.
Cervical vestibular evoked myogenic potential (cVEMP) is a diagnostic test used to assess the function of the vestibular system, specifically the saccule and inferior vestibular nerve. It measures the electrical activity generated by the muscles in the neck in response to sound and/or vestibular stimulation.
During a cVEMP test, surface electrodes are placed on the skin overlying the sternocleidomastoid muscle (SCM) in the neck, typically on both sides. The patient is instructed to turn their head to one side while listening to loud clicks or tone bursts delivered through headphones. The electrodes record the muscle response, known as the vestibular evoked myogenic potential (VEMP), which reflects the activation of the saccule and the subsequent contraction of the SCM muscle.
The cVEMP test provides valuable information about the integrity and function of the vestibular system, particularly the saccule and inferior vestibular nerve, which are involved in detecting linear acceleration and head movements. It is commonly used to assess vestibular disorders such as superior canal dehiscence syndrome, vestibular neuritis, and Ménière’s disease.
Abnormalities in cVEMP responses may indicate dysfunction or pathology within the vestibular system, helping clinicians diagnose and differentiate between various vestibular disorders. The test results are analyzed by a trained audiologist or healthcare professional to determine the presence, severity, and nature of any vestibular abnormalities and guide appropriate treatment and management strategies.
Overall, cVEMP testing is a valuable tool in the evaluation of vestibular function, providing valuable insights into the health and function of the vestibular system and helping clinicians diagnose and manage a wide range of vestibular disorders.
A Videonystagmography (VNG) is a diagnostic test used to evaluate the function of the vestibular system, which includes the inner ear and parts of the brain responsible for balance and eye movements. It is commonly performed to assess patients with symptoms of dizziness, vertigo, imbalance, or other vestibular disorders.
During a VNG test, the patient wears specialized goggles equipped with infrared cameras that track eye movements. The test typically consists of several components:
1. **Spontaneous Nystagmus:** The patient sits quietly with their eyes open and closed while the technician observes for any involuntary eye movements called nystagmus.
2. **Positional Testing:** The patient’s head is moved into various positions to assess for positional nystagmus, which may indicate benign paroxysmal positional vertigo (BPPV) or other vestibular disorders.
3. **Caloric Testing:** Warm and cool air or water is gently introduced into each ear, one at a time, to stimulate the vestibular system and induce nystagmus. This helps evaluate the function of the inner ear and vestibular nerve on each side.
4. **Optokinetic Testing:** The patient watches moving visual stimuli, such as rotating patterns or moving lights, to assess their ability to visually track objects and detect abnormal eye movements.
5. **Saccade Testing:** The patient performs rapid eye movements (saccades) to assess the integrity of neural pathways involved in controlling eye movements.
The VNG test records and analyzes eye movements and nystagmus patterns, providing valuable information about the function of the vestibular system and helping clinicians diagnose and differentiate between various vestibular disorders. The results are interpreted by a trained audiologist or healthcare professional to determine the presence, severity, and nature of any vestibular abnormalities and guide appropriate treatment and management strategies.
Overall, VNG testing is a valuable tool in the evaluation of vestibular function, providing valuable insights into the health and function of the inner ear and vestibular system and helping clinicians diagnose and manage a wide range of vestibular disorders.
Electrocochleography (ECoG) is a diagnostic test used to evaluate the electrical activity generated by the inner ear, specifically the cochlea, in response to sound stimuli. It is commonly performed to assess the function of the auditory system and diagnose disorders such as Ménière’s disease, auditory neuropathy, and endolymphatic hydrops.
During an electrocochleography test, electrodes are placed on the scalp, typically near the ear or forehead, to measure the electrical responses generated by the cochlea in response to sound stimulation. A small probe or electrode may also be inserted into the ear canal or tympanic membrane to deliver the sound stimuli directly to the cochlea.
The test involves presenting a series of clicks, tones, or other auditory stimuli to the ear, and the electrodes record the resulting electrical activity, known as the cochlear microphonic (CM), summating potential (SP), and compound action potential (CAP). These responses provide information about the function of the hair cells, nerve fibers, and other structures within the cochlea.
Electrocochleography can help differentiate between different types of hearing loss, such as sensorineural (inner ear) versus conductive (middle ear) hearing loss, and identify abnormalities in cochlear function or neural transmission. It can also assist in the diagnosis of conditions affecting the balance system, such as Ménière’s disease, by detecting changes in endolymphatic pressure and fluid balance within the inner ear.
The results of electrocochleography are analyzed by a trained audiologist or healthcare professional to determine the presence, degree, and nature of any cochlear or auditory nerve abnormalities. This information can guide treatment decisions and management strategies, such as hearing aids, vestibular rehabilitation, or surgical interventions, to address the underlying condition and optimize hearing and balance function.
Overall, electrocochleography is a valuable diagnostic tool in the evaluation of hearing and balance disorders, providing valuable insights into the function of the inner ear and auditory pathway and guiding appropriate intervention and treatment options for patients.
The ocular vestibular evoked myogenic potential (oVEMP) is a diagnostic test used to assess the function of the otolith organs, specifically the utricle, and the superior vestibular nerve. It measures the electrical activity generated by the extraocular muscles, particularly the inferior oblique muscle, in response to sound and/or vestibular stimulation.
During an oVEMP test, surface electrodes are placed on the skin below the eyes, typically along the lower eyelid, to record the muscle response. The patient is instructed to fixate on a visual target while listening to loud clicks or tone bursts delivered through headphones. The electrodes detect the eye movement response, known as the vestibular evoked myogenic potential (VEMP), which reflects the activation of the utricle and the subsequent contraction of the inferior oblique muscle.
The oVEMP test provides valuable information about the function of the otolith organs, which are involved in detecting linear acceleration and head tilt. It is commonly used to assess vestibular disorders such as superior canal dehiscence syndrome, vestibular neuritis, and Ménière’s disease.
Abnormalities in oVEMP responses may indicate dysfunction or pathology within the otolith organs and the superior vestibular nerve, helping clinicians diagnose and differentiate between various vestibular disorders. The test results are analyzed by a trained audiologist or healthcare professional to determine the presence, severity, and nature of any vestibular abnormalities and guide appropriate treatment and management strategies.
Overall, oVEMP testing is a valuable tool in the evaluation of vestibular function, providing valuable insights into the health and function of the otolith organs and helping clinicians diagnose and manage a wide range of vestibular disorders.
Rotational chair testing is a diagnostic procedure used to assess the function of the vestibular system, particularly the semicircular canals of the inner ear, which are responsible for detecting angular head movements and maintaining balance. It is commonly performed to evaluate patients with symptoms of dizziness, vertigo, imbalance, or other vestibular disorders.
During rotational chair testing, the patient sits in a specialized chair that can be rotated in various directions, including side-to-side (yaw), back-and-forth (pitch), and up-and-down (roll). The chair is equipped with sensors that measure the patient’s head movements and eye movements using infrared cameras or electro-oculography (EOG).
The test typically involves two main components:
1. **Sinusoidal Rotations:** The patient is subjected to slow, sinusoidal rotations of the chair in different planes of movement, while their eye movements are monitored. This assesses the patient’s ability to detect and respond to angular head movements and helps identify abnormalities in vestibular function.
2. **Step Rotations:** The patient experiences abrupt changes in chair position (steps) to induce nystagmus, which is an involuntary eye movement. This helps assess the patient’s vestibulo-ocular reflex (VOR), which is responsible for stabilizing gaze during head movements.
Rotational chair testing provides valuable information about the function of the vestibular system and helps clinicians diagnose and differentiate between various vestibular disorders, such as bilateral vestibular hypofunction, unilateral vestibular hypofunction, and central vestibular disorders. The results are interpreted by a trained audiologist or healthcare professional to determine the presence, severity, and nature of any vestibular abnormalities and guide appropriate treatment and management strategies.
Overall, rotational chair testing is a valuable tool in the evaluation of vestibular function, providing valuable insights into the health and function of the semicircular canals and helping clinicians diagnose and manage a wide range of vestibular disorders.
Therapies/Treatment
The Epley Maneuver and the Canalith Repositioning Maneuver (CRM) are both therapeutic techniques used to treat benign paroxysmal positional vertigo (BPPV), but they differ in their specific protocols and movements.
The Epley Maneuver is a sequence of head movements designed to reposition displaced calcium carbonate crystals (canaliths) within the semicircular canals of the inner ear. It typically involves a series of four sequential positions that aim to guide the crystals out of the affected canal and into a less sensitive area, ultimately alleviating symptoms of vertigo.
On the other hand, the Canalith Repositioning Maneuver (CRM), also known as the Semont Maneuver or the Gufoni Maneuver, is a broader term that encompasses various repositioning techniques used to treat BPPV. These techniques may include the Epley Maneuver as well as other maneuvers, such as the Semont Maneuver or the Barbecue Roll. The specific maneuver chosen depends on the location of the displaced crystals and the individual patient’s presentation.
In summary, while the Epley Maneuver is a specific sequence of head movements within the broader category of CRM, CRM refers to a range of maneuvers used to treat BPPV, including the Epley Maneuver and others.
