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Vestibular & Balance Disorders

Dr. Habib Rizk

Patients suffering from vestibular disorders often experience problems with vertigo, dizziness and visual disturbance and/or imbalance. Secondary problems can also arise, such as nausea, vomiting, inability to concentrate, fatigue, anxiety and depression. These symptoms can be disruptive to everyday life. Activities that were simple before the vestibular disorder may become difficult. Patients often develop a more sedentary lifestyle to avoid worsening symptoms. A sedentary lifestyle can contribute to weakness, joint stiffness and a decrease in physical health and endurance to perform daily activities.

Treatment may include medication, in-clinic procedures, surgery along with Vestibular Rehabilitation Therapy (VRT), an exercise-based program to reduce symptoms related to inner ear and balance disorders.

Dizziness can be a description of multiple types of symptoms. The physician usually tries to categorize dizziness into one of the four categories below:

  • Vertigo: temporary, episodic or persistent sensation of spinning dizziness, sometimes accompanied by sweating, nausea, vomiting, headaches, hearing loss, tinnitus (ringing in the ear), sound sensitivity or light sensitivity; symptoms can come and go, and each episode may last from minutes to hours

  • Lightheadedness: sensation of impending loss of consciousness, sometimes accompanied by sensory disturbances, orthostatic hypotension, cardiac arrhythmia and panic attacks

  • Disequilibrium: imbalance or unsteadiness caused by diminished vision, loss of vestibular function, defects in proprioception and motor dysfunction

  • Oscillopsia: illusion of visual motion when the eyes are open

Vestibular Testing

An evaluation at the MUSC multidisciplinary vestibular clinic will include an extensive history followed by a thorough physical examination. At that point, the neurotologist will decide if the patient will require an additional evaluation by the vestibular therapist in the clinic. Occasionally, patients will meet with senior year pharmacy students to review their medication list and to check for potential interactions causing their symptoms. There is also a nutritionist available to help patients with lifestyle modifications in certain conditions which require dietary changes. Finally, a subset of patients will require paraclinical vestibular testing. These consist of a battery of experiments that evaluate the inner ear function as well as how the vestibular function integrates with the visual system and proprioceptive system to provide the patient with good balance.

Our bodies use our inner ears in conjunction with the senses of vision and somatosenses (sense of touch or vibration) in order to help us maintain our balance and orientation. We will evaluate each of these three systems as they work together and in isolation in order to identify any weaknesses.

What to expect: A harness will ensure your safety as you maintain your balance on a platform. This test typically lasts 15 minutes. Please be sure to notify the Audiologist of any knee, hip or back pain as well as any recent surgeries prior to testing.

Rotational chair tests are typically included in the VNG test battery in order to determine whether dizziness may be due to a disorder of the inner ear or brain. Rotary chair tests provide specific information regarding whether or not both vestibular systems are impaired at the same time and/or a level of compensation (recovery from an insult).

What to expect: You will wear goggles while secured in a chair. The chair will rotate at various speeds. It is common

Calorics involve the irrigation of both ears, one at a time, with either air or water. A total of four irrigations will be performed. The purpose of caloric testing is to compare the functionality between the right and left vestibular systems.

What to expect: Each ear will receive both warm and cool irrigations. Irrigations last anywhere from 20-60 seconds. It is not uncommon for people to experience a sensation of movement during this test. It is important to remember that the sensation will subside within a few minutes after the test is complete

The vestibular myogenic evoked potential (VEMP) test is used to evaluate the utricle and saccule, the organs of the inner ear that are responsible for our perception of tilt and linear acceleration relative to gravity. These organs respond when you move forward, backward, up or down and when you tilt your head side-to-side, up or down. The VEMP test is valuable in the evaluation of inner ear function and can support a diagnosis of Meniere’s disease, superior canal dehiscence or vestibular migraine.

What to expect: This noninvasive test utilizes electrodes, which are placed on the surface of the skin around the eyes and on the neck to measure responses from the muscles. Responses are evoked by a clicking sound presented through insert-style earphones; these clicks translate vibrations to the inner ear organs. You will be asked to flex the muscles around your eyes by looking up or your neck by turning your head during these tests. This test is not affected by medications or hearing loss due to inner ear damage.

Our bodies use our inner ears in conjunction with the senses of vision and somatosenses (sense of touch or vibration) in order to help us maintain our balance and orientation. We will evaluate each of these three systems as they work together and in isolation in order to identify any weaknesses.

What to expect: A harness will ensure your safety as you maintain your balance on a platform. This test typically lasts 15 minutes. Please be sure to notify the Audiologist of any knee, hip or back pain as well as any recent surgeries prior to testing.

The Video Head Impulse Test is an objective measure of the vestibular ocular reflex (VOR), which is an important component of a healthy vestibular system. The VOR allows for gaze stabilization during head movements and when impaired, can result in altered visual acuity when in motion. The vHIT measures the VOR in response to head movements representative of every-day head motion and can allow for ear-specific information to be obtained regarding vestibular function.

What to expect: The duration of the vHIT is about 15 minutes. You will wear lightweight video goggles and focus on a light in front of you. The examiner will hold your head and or chin with both hands and make a quick movement up, down, right or left. The video goggles will track any eye movement away from the target. A computer system will analyze this movement and provide information about VOR function.

Why MUSC?

MUSC Health ENT sees and manages hundreds of patients with balance and vertigo complaints each year. There are numerous causes of these symptoms, and MUSC Health ENT has developed a comprehensive team led by Habib G. Rizk, M.D. MSc to treat such patients. MUSC Health ENT is equipped to provide the most up-to-date diagnostic testing and medical and surgical treatments for all causes of dizziness.