The Balance System

Balance is achieved when information from the visual system (eyes), the vestibular system (inner ear), and the proprioceptive system (muscles, tendons, and joints) are integrated and interpreted in the brain. Vertigo, dizziness and or imbalance can occur when one or more of these three systems, including the brain, are compromised.

The vestibular system consists of three semicircular canals in each ear that contain fluid and “sensors” that detect rotational movement of the head. There are two other structures in each ear called otolith organs (utricle and saccule) that sense gravity and change in horizontal and vertical movement.

Symptoms of vertigo, dizziness, and disequilibrium can be linked, but they have different meanings, and describing them accurately can mean the difference between a successful diagnosis and misinterpretation. Vertigo has a rotational, spinning component, and is the perception of movement, either of the self or surrounding objects. Dizziness is a sensation of lightheadedness, faintness, or unsteadiness. Disequilibrium is the loss of equilibrium, sensation of spatial disorientation or imbalance.

Our audiologists carefully assess individuals who experience vertigo, dizziness, and imbalance. Depending on a thorough case history and description of your symptoms, hearing and vestibular testing may be recommended. Tests that are potentially incorporated in assessment include the following:

  • Comprehensive Hearing Evaluation is an important part of vestibular assessment because of the close relationship between the inner ear hearing and balance organs.
  • Videonystagmography (VNG) includes the use of video cameras to record eye movements. VNG provides an objective assessment of the oculomotor and vestibular systems. There are three main subtests: oculomotor evaluation, positioning/positional testing, and caloric stimulation of the vestibular system.
  • Vestibular Evoked Myogenic Potentials (VEMP) is an electrophysiologic test used to determine the function of the otolith organs (utricle and saccule) of the inner ear. VEMP is performed by pasting electrodes on the head, neck, and chest and measuring the neck muscle contraction in response to loud sound.
  • Electrocochleography (ECoG) is an electrophysiologic test that measures how sound travels from the inner ear along the beginning of the hearing nerve. ECoG is performed by pasting electrodes on the head and one resting against the eardrum and recording brain wave activity in response to sound.
  • Auditory Brainstem Response (ABR) is an electrophysiologic test that gives information about the inner ear and brain pathways for hearing. ABR is performed by pasting electrodes on the head and recording brain wave activity in response to sound.
Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo (BPPV) is the Most Common Cause of Dizziness or Vertigo Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of dizziness or vertigo due to the inner ear. BPPV occurs when crystal-like particles (otoconia) detach from their normal location and float freely into one of the three semicircular canals. Changes in head position cause the displaced otoconia to move in the semicircular canals, which will produce a sensation of movement. Common symptoms of BPPV include: feeling of motion when rolling over in bed, lying down, sitting up, bending over, or tilting head back. Episodes of dizziness or vertigo are very short and typically last less than 60 seconds.

Diagnosis and treatment of BPPV can be completed in office by your audiologist. Diagnosis is confirmed by head and body positioning maneuvers called the Dix-Hallpike or the Head Roll. Depending on the affected semicircular canal, your audiologist will treat the BPPV with a head and body maneuver called Canalith Repositioning.