The purpose of a balance assessment is to evaluate the possible cause of dizziness, imbalance and vertigo.
A full balance assessment at Beacon Audiology includes the following tests:
Balance Platform / Sway Test
The Balance Platform provides an objective measurement of sway or movement when standing in four positions (eyes open/eyes closed on a solid surface and eyes open/eyes closed on a dynamic surface). The test provides information about your balance control and estimates the potential fall risk. The test takes less than 5 minutes to complete.
Visualnystagmography(VNG) /Electronystagmography (ENG) Test
VNG is used to determine if a vestibular (inner ear) disease may be causing a balance or dizziness problem, and is one of the only tests available today that can differentiate between a unilateral (one ear) and bilateral (both ears) vestibular loss.
VNG testing is a series of tests assessing balance (vestibular) function by recording a person’s ability to follow visual objects with their eyes and how well the eyes respond to information from the vestibular system.
To monitor the movements of the eyes, infrared goggles are placed around the eyes to record eye movements during testing. VNG testing is non-invasive, and only minor discomfort is felt by the patients during testing as a result of wearing goggles. VNG consists of three components:
- Ocular-Motor Evaluation: This part of the test evaluates eye movements and the central nervous system. You will be asked to follow a red light during different tasks for 10-15 minutes.
- Positional Evaluation: This part of the test evaluates both your central nervous system and the balance organs of your inner ear. You will be asked to sit, lie down and turn your head to the left and to the right.
- Caloric Evaluation: This part of the test evaluates the function of the balance organs of the inner ear. During the test, you will be lying comfortably on your back while wearing the capped goggles. Cool air, followed by warm air will be introduced into each ear canal for approximately 1 minute at a time. The change in the temperature of the ear canal will induce some dizziness. It is important to remember that while you may feel dizzy during this test, you should feel better by the time you leave.
Video Head Impulse (vHIT) Test
The test involves wearing special goggles which monitor the eye movements as the head is moved abruptly in different directions. Individuals with normal balance can maintain a steady gaze but those with defective semi-circular canal function cannot keep up. The vHIT provides an independent assessment of each ear (similar to the caloric test which assesses the lateral canals and superior vestibular nerve) but also assesses the anterior and posterior semi-circular canals.
Computerized Dynamic Posturography (CDP)
Computerized Dynamic Posturography (CDP) is defined by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) as the test protocol comprised of the Sensory Organization Test and motor coordination tests (Motor Control Test and the Adaptation Test). Computerized Dynamic Posturography (CDP) assesses the integration of the sensory (vestibular) system, motor system and visual system. CDP is considered the gold standard in the impairment diagnosis of patients with dizziness/vertigo and disequilibrium of both known and unknown etiologies. It is recognized as a necessary component in the disability evaluation of patients with chronic balance or dizziness disorders and is considered to be medically appropriate in the evaluation or treatment of patients with suspected vestibular disorders. CDP is being used as part of the assessment of concussion in sports injuries and medical case management. CDP is also used in assessing falls risk and is a useful rehabilitation tool.
Vestibular Evoked Myogenic Potentials (VEMP’s) Test
The vestibular evoked myogenic potential or VEMP is a neurophysiological test used to determine the function of the otolithic organs (utricle and saccule) of the inner ear.
It complements the information provided by VNG and the vHIT. VEMP's is a useful test which can identify the presence of Superior Semi-circular Canal Dihiscence (SSCD).
Electrocochleography is a technique used for recording electrical potentials generated in the inner ear and auditory nerve in response to sounds presented in the ear. The responses are elicited by placing an electrode in the inner ear and recording the electrical potentials elicited in response to sounds presented. ECochG is useful in assisting in the diagnosis of Meniere's Disease and is part of the balance assessment.
This screening test evaluates the individual’s level of pro-prioception (balance) on a sold surface and on a dynamic surface (cushion) with vision (eyed open) and vision denied (eyes closed). This test also evaluates the individuals fall risk.
Vestibular Rehabilitation Exercises
Various exercises with varying levels of difficulty on solid and dynamic surfaces are carried out with vision and vision denied. The level of difficulty is increased as the individual is able to perform the tasks successfully.