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Assessment and diagnosis

Diagnosing and testing for Balance and Vestibular Disorders

We use different assessment batteries depending on the symptoms presented. The audiologist will conduct the assessments and then provide an evaluation and report on the results of those tests.

  • Sudden/Acute/Screening/Benign Positional Vertigo (BPV) (VNG and/or VEMP, VHIT and Otolith Repositioning eg Epley Manoeuvre): For those with sudden vertigo/disequilibrium without any auditory symptoms. Quick, efficient and accurate 30-45-minute test battery assessing most areas of the vestibular system responsible for acute conditions. Sensitive to most significant pathologies such as Benign Positional Vertigo, and Vestibular Neurontis/Labrynthitis. If BPV is diagnosed then we perform the repositioning techniques to correct/cure the symptoms there and then. If Vestibular Neuronitis/Labrynthitis VEMP testing replaces positional testing it is to ascertain superior or inferior nerve site of lesion. Can be done at all sites.
  • Vertigo, Disequilibrium and Dizziness Comprehensive Balance Assessment (including full hearing test, full immittance measures, all VNG tests, vHIT, VEMP, Caloric test, Electrocochleography/Auditory Brainstem Response testing): Comprehensive 3-hour test battery assessing all vestibular areas with maximum sensitivity.
  • Suspected Meniere’s Disease/Endolymphatic Hydrops/Perilymph Fistula Assessment (full hearing test, full immittance measures, Electrocochleography, Caloric test, vHIT): Assessment targeted at identifying if the cause of dizziness is due to Meniere’s disease.

Several of these assessments can attract rebates through either Medicare and/or your private health insurance. For more information please call us 1300 252 748

If you want to know a little more about the individual tests we use you can find out more below.

Video Nystagmography (VNG)

Is conducted by using infra-red goggles that track your eyes movements and look for little “flicks” (called nystagmus) when watching several stimuli on a screen, or when moving the head into different positions. These tests assess eye movements that originate in the cerebellum and are testing how central pathways control eye movements. They help us to distinguish whether the problem with your balance is originating in pathways of the brain or if the issue is with your peripheral balance system (eg. your ears). Differentiating between a central and peripheral problem is important to plan further medical investigation and/or rehabilitation. Using VNG positional head and body tests are crucial in isolating which semi-circular canal, side and the position of the otolith responsible for Benign Positional Vertigo (BPV). With this information we are then able to do the repositioning manoeuvres to alleviate/cure the symptoms and the condition.

Video Head Impulse Test (vHIT)

The vHIT analyses very small eye movements in response to fast controlled changes in orientation of the head using infra-red goggles. Due to the very strong, fast neural projections from the inner ear to the eye muscles, our eye movements in response to changes in head orientation can be used as sensitive indications of how well the balance mechanism of the inner ear is functioning. This test examines the function of all six of the semi-circular canals and provides valuable information in pinpointing the cause of your dizziness. What we look for during this test is to see if there are any significant difference between the movement of the head and how quickly the eyes respond to that movement. If there is a significant difference between the two, depending on how your head is positioned, we can identify where part of the problem is occurring.

Calorics

Caloric testing is probably the most well-known assessments of balance function. It involves using warm and cool water to irrigate the ear and stimulate the fluid in part of the vestibular system. This stimulation induces nystagmus which is recorded using the infra-red goggles. We then examine the nystagmus to ensure it is occurring at equal strengths between the ears, with both cool and warm stimulation, and is occurring in the correct direction. This testing requires a special bed and irrigation machine, and subsequently can only be used at our main clinics in Townsville, Mackay, and Brisbane.

Vestibular Evoked Myogenic Potentials (VEMP)

The vestibular evoked myogenic potential is a neurophysiological assessment used to determine the function of the utricle and saccule of the inner ear (they tell us when we go forwards/backwards or when we go upwards/downwards). It also assists in determining the functioning of the inferior and superior vestibular nerve. It complements the information provided by caloric, VNG, and vHIT testing to obtain a full assessment of the entire balance organ and superior and inferior balance nerves. The cVEMP response is obtained by placing electrodes on a muscle in your neck (the sternocleidomastoid (SCM) and measuring the changes in tension when we deliver a sound stimulus to your ears. What we look for is that when we deliver sound to either ear the change in tension of your SCM is approximately equal in both ears. oVEMP works with the same principal however we are measurable a muscle reflex just below the eyes.

Electrocochleography (ECochG)/ABR

ECochG has evolved as an important test in the diagnosis, assessment, and monitoring of potential Meniere’s disease or endolymphatic hydrops. Meniere’s disease and endolymphatic hydrops are often associated with an imbalance of fluid in the cochlea. When there is a build-up of fluid in the cochlea it can cause episodes of vertigo and hearing loss. The ECochG involves assessing the electrical impulses of your cochlear and the hearing nerve in response to sounds by using small electrodes placed in the ear canal and on the forehead. What we look for is to see whether the electrical impulses at a particular part of the nerve are greater than they should be, suggesting a build-up of fluid in the cochlear. The ABR is a test of the hearing nerve and is performed to detect and abnormalities that may occur from viral infections. It runs close to the inferior vestibular nerve so if there is cross spread to the cochlear nerve it can assist in isolating the inferior nerve as the source of infection rather than the superior vestibular nerve.

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