Dizziness, loss of balance, and lightheadedness are among the most frequent reasons people seek medical attention. It is estimated that more than 90 million Americans will complain to their physicians about dizziness/imbalance at least once during their lifetime. Our balance is maintained by a complex interaction of the inner ear, central nervous system, eyes, joints, sensor receptors and muscles. Because there are so many systems that contribute to maintaining our balance a comprehensive approach to diagnosing and treating dizziness and imbalance is necessary. Our team of certified, licensed professionals (which include doctoral level audiologists, and physical and occupational therapists with certification in vestibular rehabilitation and expertise in balance disorders) work together with the physicians in the JFK Johnson Rehabilitation Institute, the JFK Neuroscience Institute and with our community physicians to identify the cause of the balance problem and determine a treatment plan.
Symptoms of Balance Disorders
Symptoms of a balance disorder can manifest itself in many forms, including: dizziness, nausea, giddiness, unsteadiness, imbalance, disequilibrium, spinning sensation, fogginess, vertigo and lightheadedness.
Causes of Balance Disorders
There can be many causes of dizziness or imbalance from minor benign conditions to more serious conditions. These may include: migraines, inner ear infections or disorders, side effects from medication, anxiety, aging, dehydration, heart conditions, stroke, cervical/neck disorder and head injury/concussion.
Diagnosis of Balance Disorders
Because maintaining balance involves a complicated network of systems working together it can be difficult to diagnose because there are many potential causes. Therefore, a thorough case history and comprehensive examination by your primary care provider is the first step. This is generally followed by appropriate diagnostic testing. The outcome of these tests can assist your physician in identifying the system that is contributing to these symptoms; central (brain), peripheral (ear), muscular-skeletal (soft tissue), or a combination of the above.
Testing for Balance Disorders
Specialized state-of-the-art- testing is available to assist your physician in the diagnosis of your balance disorder. Testing may include one or more of the following in the evaluation process:
Audiological Evaluation (Hearing Test) provides information about hearing, middle ear function, cochlear hair cell function and several neural aspects of the hearing-balance system. There are many ear related conditions which cause both hearing loss and balance problems.
Videonystagmography (VNG, ENG) Rotary Chair (RC) tests use infrared video recording of eye movements to detect abnormalities in both the central nervous system and the vestibular system.
Computerized Dynamic Posturography (CDP) provides information about a person’s functional balance capabilities. This information can be useful in the planning of a personalized treatment plan.
Electrocochleography (ECoG) tests for the presence of an inner ear disorder called Meniere’s disease.
Vestibular Evoked Myogenic Potential (VEMP) is designed to rule out a specific balance disorder called superior canal dehiscence as well as other vestibular abnormalities.
Brainstem Auditory Evoked Potential (BAER, ABR) evaluates the integrity of the auditory pathways beginning at the level of the ear up through the brainstem.
Treatment for Balance Disorders
The form of treatment prescribed for your balance disorder depends upon symptoms, medical history, general health, a physical examination by your physician and diagnostic test results. This treatment may include:
Canalith Repositioning Maneuver for treatment of BPPV
Adaptation exercises to facilitate recovery of eye-head coordination
Balance retraining exercises and strategies
Habituation exercises to decrease sensitivity to motion
General conditioning exercises
What kind of medical professional can diagnose dizziness or a balance disorder?
Discuss your dizziness or balance problem with your physician who will obtain a detailed history and conduct a medical exam. Your physician may refer you to an audiologist (a person who specializes in assessing hearing and balance disorders) for tests to determine the cause and extent of the problem. Information gathered from these tests can then provide useful balance-related information for you and your physician.
What is positional vertigo?
Positional vertigo refers to a variety of conditions where a change in the position of your head produces a sense of vertigo or spinning. The most common form is a condition called Benign Paroxysmal Positional Vertigo or BPPV for short. In BPPV when you lie you usually get a brief but very intense feeling of the world spinning around.
Are the physical and occupational therapists certified in vestibular rehabilitation?
All of our therapists have expertise and specialized training in treatment of patients with balance disorder. In addition, we have several who are certified in vestibular rehabilitation.
Are any of the diagnostic tests painful or invasive?
The tests utilized to assist with the diagnosis of a balance disorder are neither painful or invasive. At times patients may experience a slight sensation of dizziness or some nausea during the test but this is generally short lived and gone by the time the procedure is completed.
How long do these tests take?
Each test can take between 45 and 60 minutes. Often times your physician may recommend more than one test which can add to the time you spend with us.
Is there any preparation for these tests?
Because you may experience some slight dizziness or nausea during certain tests we ask that you eat lightly the day of the test. In addition, certain medications can impact the outcome of the test so we ask that you refrain from these medications 48 hours prior to the test. When you make your appointment our staff will review this information with you. Lastly, for some of the tests we use a headset with cameras on them to measure your eye movements so we ask that you refrain from wearing any eye makeup.
If I have a prescription from my physician how do I make an appointment?
Our friendly and knowledgeable clerical staff will assist you in making an appointment that is convenient for you as we have both day and evening appointments available.
“When my doctor told me I had to have several balance tests completed to help find out what was causing my dizziness I was very anxious. However, the audiologist that did my testing was fantastic. She was patient and kind and the tests were completed in no time at all. And best of all after several sessions of physical therapy my dizziness was completely gone. “
“Recently I had a terrible experience with dizziness and imbalance and was not able to work. My doctor ordered several balance tests to have at the JFK Audiology program. When I called to make an appointment the clerical staff was able to get me an appointment within days. The entire staff was happy, kind and pleasant to deal with. They faxed the results of my tests immediately to my doctor who was able to diagnose my problem and get me back on my feet again. “
“Therapists did a great job. They were knowledgeable and increased the difficulty of movements to allow me to continue to progress and get back on my feet. I can’t thank them enough.”
“The therapist was excellent and did everything she could to help me with my dizziness. I recommend her to anybody with this problem. I received wonderful service in the department. Everyone in the facility is very friendly.”