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Balance Assessment

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Dizziness is the second most common complaint that people report to their doctors (second to backache). Many causes of dizziness are able to be diagnosed and treated, with detection facilitated by computerized diagnostic testing available today. Dizziness is experienced in a variety of ways: as lightheadedness, as if moving when still, or as if they or the world is spinning. Some people don't experience these sensations, but simply cannot maintain their balance.

Dizziness may occur along with other symptoms such as hearing loss, fullness in the ears, nausea, anxiety, or ringing in the ears (tinnitus).

Dizziness may be a symptom of a variety of health problems. Your physician's challenge is to determine the underlying cause. Often the problem involves the vestibular system - the inner ear system which works to control balance. Other possible underlying causes may be found in the central nervous system (brainstem and brain), or may point to cardiovascular problems such as high blood pressure. Dizziness may also result from bacterial or viral infections, or may be related to certain types of medications.

The diagnostic process involves good communication between patient and doctor. The patient's clear description of the sensations experienced is helpful in arriving at a diagnosis. Sometimes a specific cause for dizziness is not determined, but by ruling out a variety of possibilities, the patient and doctor can manage the symptoms and facilitate the body's self-correcting mechanisms to take effect.

As many factors may play a role in balance and dizziness issues, diagnosing dizziness may be a complex process. A complete history comes first, and then several tests are often recommended. The balance system (vestibular system) is mainly located in the inner ear, and so diagnostic hearing and vestibular test batteries are often performed.

Although the balance system is located in the inner ear, it has connections with the eyes, the brainstem and brain, and nerve pathways throughout the body. One measurable sign of activity in the balance system is a rapid, involuntary eye movement called nystagmus. By stimulating the vestibular system and monitoring the eye movement responses, much can be learned about the function of the patient's balance system.

This test is called a VNG (videonystagmography) which tracks eye movements with video recording, or ENG (electronystagmography) which tracks eye movements with electrical signals.

VNG/ENG is a set of tests that contribute information useful in diagnosing dizziness. In one test, rapid side-to-side eyes movements are measured. In another, the ability to smoothly follow a moving target is measured. Other parts of the test determine whether certain positions trigger dizziness, or whether the act of changing position brings on dizziness. Caloric tests involve the introduction of cool and warm air into the ear canal and comparing the eye movement response of the right and left ears. The test sequence takes about 45 minutes. There is no discomfort involved.

The results of the VNG/ENG tests may contribute to a diagnosis of your dizziness, and help your physician plan how to best manage or alleviate your symptoms. Some conditions can be managed medically. Some can be treated in our office with special "maneuvers" - simple movements of the head and body. Others may benefit from physical therapy and exercise.

The key to resolution of dizziness is accurate prompt diagnosis. Advanced diagnostic instrumentation allows us to make a significant contribution to this process.

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