Philadelphia University + Thomas Jefferson University

Balance & Dizziness

Over half of the population of the United States will experience a balance or vestibular disorder in their lifetime.  Balance disorders are the number one health complaint of patients over the age of 70.  Less than 10% of patients with balance and vestibular disorders are ever evaluated by a specialist (otologist, neuro-otologist, audiologist, neurologist).  Vestibular disorders cause 50% of falls experienced by the elderly.

The Balance System

Balance System

There are several sensory systems that help us keep our balance. They provide input about our head and body movement and our position in space. 

Three dominate senses that participate in this action are the somatosensory, visual, and vestibular system.  All three of these systems are interrelated and communicate with each other.  If there is a problem with any one of these systems, it may result in dizziness, disequilibrium and/or falls.

Common Inner Ear Disorders

The most common type of vertigo is peripheral vertigo.  This is usually caused by inner ear inflammation from a cold or virus. Other common inner ear disorders that may elicit vertigo, dizziness or disequilibrium are:

Benign Paroxysmal Positional Vertigo (BPPV) is caused by problems in the inner ear.  It is probably caused by pieces that have broken off from otoliths, located in the utricle, that have slipped into the semi-circular canals.  Symptoms are repeated episodes of vertigo, a spinning sensation that is provoked  by a change in the position of the head.

Ménière's Disease is an inner ear disorder that can affect both hearing and balance. It can cause episodes of vertigo, hearing loss, tinnitus and the sensation of fullness in the ear.

Labyrinthitis is an inflammation of the inner ear.  It is usually caused by a virus, but can also be caused by a bacterial infection.

Vestibular Neuronitis is an inflammation of the vestibular nerve that connects the inner ear to the brain.

Diagnostic Tests

Patients referred to our office for complaints of vertigo and dizziness typically will go through a battery of diagnostic tests requested by our neuro-otologist.  The results of these tests help our physicians diagnose the problem and plan a course of treatment.

The Jefferson Balance and Hearing Center has available a variety of diagnostic tests to evaluate balance and dizziness disorders.  Our otolaryngologist along with our audiologists work together to rule out inner ear pathologies that cause balance and dizziness problems.  Some of the tests which may be performed include:

Hearing Test

A hearing test is easily completed. A typical hearing test starts with looking into the ear with a small light or otoscope. This is done to examine the ear canal and look at the ear drum. It is a quick procedure that you have had done most likely many times before. 

The audiologist will also take some measurements with a small soft tip attached to the computer. This will be measuring the middle ear system and part of the auditory pathway with immittance measurement. You may hear a buzzing and beeping sound, and feel a small change of air pressure during this part of the test. 

Using similar equipment, the audiologist may also measure the inner part of your ear, the cochlea. It is a test of otoacoustic emissions; this is another easy test. You will sit and listen to some tones and the audiologist and otolaryngologist will use these results to better understand the cause of your hearing loss. 

The actual hearing test will be done in a sound treated room, with either headphones or foam earphones. The audiologist will use an audiometer that is calibrated to measure your hearing precisely. You will be asked to respond when you hear a tone, and the audiologist will track this level across frequencies. Measurements with speech will also be made. At the end of your testing, the audiologist will review the results with you.

Auditory Brainstem Response (ABR) tests the integrity of the hearing nerve (VIII nerve) and/or auditory brainstem function.

Electrocochleaograpy (ECOG) is a test that measures the electrical potential generated by the inner ear in response to stimulation by sound.  This may be used to confirm a diagnosis of Ménière's Disease.

VNG Testing

Videonystagmography (VNG) testing is used to determine if a vestibular (inner ear) disease may be causing a balance or dizziness problem. A VNG test can decipher between a unilateral (one ear) and bilateral (both ears) vestibular loss. VNG testing is a series of tests designed to document a person's ability to follow visual objects with their eyes and how well the eyes respond to information from the vestibular system. This test also assesses the functionality of each ear and if a vestibular deficit may be the cause of a dizziness or balance problem. 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. 

There are three parts to VNG testing:

  • Ocular and Optokinetic Testing
    These may indicate a central or neurological problem, or a problem in the pathway connecting the vestibular
    system to the brain.
  • Positional Nystagmus.   This test is looking at your inner ear system and the condition of the endolymph fluid in your semi-circular canals. The audiologist is verifying that small calcium carbonate particles called otoconia are not suspended in the fluid and causing a disturbance to the flow of the fluid.
  • Caloric Testing
    This test assesses your vestibular system for each ear and reveals whether they are working and responding to stimulation. This test is the only test available that can decipher whether the vestibular deficit is unilateral or bilateral.

Please see VNG Instructions for testing.

To make an appointment, please call 1-800-JEFF-NOW.