Balance and Dizziness

Vertigo / Balance and Dizziness Disorders

Vertigo is usually a symptom of a pathology in the central or peripheral vestibular system which is in the inner ear.  

The assessment and management of patients with vertigo requires a team approach which includes:

  • Audiologist
  • ENT
  • Physician

The assessment of the Vestibular system is a complex diagnostic process.

Patients are referred by their ENT specialist. Many patients make an enquiry on their own. Patients usually complain of dizziness, lightheadedness, a faint feeling, or spinning.

The case history, is usually where the Audiologist will start with the assessment. A very detailed history is taken to accumulate as much information as possible to develop an idea of a possible diagnosis.

An Audiogram (hearing test) is then conducted to determine the hearing status in each ear. The presence of hearing loss is noted. The symmetry of the hearing loss is an important tool in the diagnosis of vestibular disorders.

A detailed evaluation of balance is conducted on patients using a software driven assessment.


For more information on balance and dizziness disorders contact us.

Case Study

Vestibular findings in a patient presenting with tinnitus and dizziness

Kenneth H. Brookler, MD

A 47-year-old woman presented with a 7-year history of tinnitus and dizziness. She described the tinnitus as originating in my head and louder on the left. She said the sound resembled television static. She also described another sound, this one a distant beeping in her head that was equally loud in both ears. The nature of the tinnitus had been constant until 2 weeks earlier, when its usual level increased. Moreover, the noise generally became louder 1 week prior to menstruation and returned to baseline after its onset.

The patient’s dizziness began at approximately the same time as her tinnitus. It occurred approximately six times per year, and each episode would last 2 or 3 hours. She described the dizziness as an off balance feeling, but it was not disabling. She reported no subjective hearing loss or aural fullness. She also had a history of stiff neck, for which she was seeing a chiropractor.

On physical examination, the patient exhibited difficulty performing the sharpened tandem Romberg’s test, tenderness over the right nuchal area, and a click in the left temporomandibular joint.


VNG equipment

Several weeks later, the patient returned to the office. In the interim, she reported that she had experienced a sudden hearing loss in the right ear that had been treated elsewhere with a corticosteroid. By the time she returned to the office, her hearing had returned to normal both subjectively and on audiometry. Tympanometry revealed a stiffness pattern, which is characteristic of otosclerosis.

Electronystagmography detected no spontaneous, positional, or neck torsion nystagmus. The alternate binaural bithermal (ABB) caloric test revealed a 25% reduced vestibular response (RVR) right and a 6% right directional preponderance (DP). These findings are within the normal threshold of 30% for both RVR and DP elicited by ABB testing. The simultaneous binaural bithermal (SBB) test elicited a type 2 response with an RVR left.

Ultrathin computed tomography (CT) of the temporal bones detected evidence of otosclerosis in both ears, slightly greater on the left. The patient’s history and findings dizziness beginning with the onset of tinnitus capitis that was louder on the left and that became louder prior to menstruation, findings of a stiffness pattern on tympanometry, and evidence of otosclerosis on CT were consistent with a diagnosis of otosclerosis. The ABB findings obtained shortly after the onset of a transient hearing loss in the right ear suggested a right-sided lesion. On the other hand, the SBB findings showed an asynchrony of the information entering the brainstem, which indicated a lesion on the left side, the side on which the tinnitus was louder.

The evidence was consistent with abnormalities in both vestibular and auditory function. The CT evidence of otosclerosis explained the etiology.

From Neurotologic Associates, P.C., New York City.

ENT , Ear, Nose & Throat Journal

Signs of Menieres disease

No two patients with Menieres disease are alike. Nevertheless, below is a list of specific symptoms related to Menieres disease:

The symptoms of hearing loss often occur around the time of the attacks of vertigo.

The symptoms may be experienced in only one ear, not both.

Often the patient feels that there is a pressure in the affected ear before or during the attack.

An attack usually lasts from two to twenty-four hours.

There are periods of relief from Menieres disease. During these periods, the patient feels quite well. Such periods may only last a few days, but that is normal