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Balance/Dizziness

BALANCE AND DIZZINESS DISORDERS

Dizziness is a term people use to describe a variety of sensations. Symptoms such as vertigo, disequilibrium, lightheadedness, and spatial disorientation can all be described as dizziness. However, each symptom and their description offers unique insight into the problem, as well as the possible cause.

Before treating your dizziness, it is important for Dr. Agresti to determine the cause of your dizziness. It is often best to contact your family physician and describe your symptoms. You may want to include how long the symptoms last, as well as movements, positions, situations, or times that seem to cause the symptoms to start or become worse. Pay attention to new or associated symptoms that occur around the same time as the dizziness, such as:

  • Headache
  • Ringing in the ear(s)
  • Changes in hearing
  • Pressure in the ears
  • Increased sensitivity to light or sound

The majority of dizziness complaints are the result of inner ear disorders that cause symptoms such as vertigo, nausea, unsteadiness, and visual blurring with head movement. Vascular disorders, such as blood pressure changes, are another common cause of dizziness. Typical symptoms of dizziness caused by vascular disorders include feeling faint or lightheaded and transient loss of balance,often made better by lying down and sometimes made worse by standing quickly.

BALANCE TESTING

Videonystagmography (VNG)

A VNG works by recording and analyzing involuntary eye movements while you look or lie in specific (but different) positions. To monitor the movements of the eyes, infrared goggles are placed around the eyes to record eye movements during testing. There are three parts to VNG testing which include:

  • Oculomotor Tests
    Used to evaluate eye movement.
  • Positional and Positioning Tests
    Used to measure dizziness associated with various head positions.
  • Caloric Test
    Used to measure responses as cold and warm air are circulated in the ear canal.

Auditory Brainstem Response (ABR)

An ABR is an objective test of the hearing nerve from the inner ear along the nerve pathway to the brain. It can be used to estimate hearing sensitivity and to help in the diagnosis of abnormalities along the nerve. The audiologist will place electrodes on your forehead and behind your ears. You will listen to loud clicking sounds in your ears. During the test, you will be encouraged to relax as much as possible with eyes closed. You may fall asleep, as you do not need to respond during the test.

Vestibular Evoked Myogenic Potential (VEMP)

The VEMP test measures the vestibular evoked myogenic potential generated by a loud stimulus in the opposite ear. It is used in vestibular testing to evaluate saccule function and the integrity of the inferior vestibular nerve. The VEMP examination is non-invasive. It is administered by placing electrodes on the patient’s neck, forehead, and sternum, as well as placing insert earphones in the patient’s ears. Loud clicking sounds are presented to each ear individually, and tiny measurable variations in neck or eye muscle contractions occur and are recorded.

Electrocochleography (ECOG)

This test helps to rule out various conditions of the inner ear, such as Meniere’s disease.

Electrocochleography measures the electrical potentials generated in the inner ear in response to stimulation by sound.  Electrodes are placed in the ear canal and on the forehead to record these impulses as loud clicks are presented to each ear individually.  These recordings are evaluated to determine how the inner ear and hearing nerve (VIII cranial nerve) are functioning.

Treatment

There are effective treatments for most causes of dizziness. Some resolve on their own, while others can be treated easily. For example, the most common cause of dizziness is benign paroxysmal positional vertigo (BPPV). Often, Dr. Agresti can treat BPPV in one office visit.