Balance Assessments

The balance system is a ‘tripod system’ of sensory information; it is the coordination of information from the visual system, the proprioceptive system (information about position from your feet, limbs and joints) and the vestibular system (information from the balance organs in the inner ear).  The brain processes the information from all these systems and ensures that the muscles in your limbs and eye respond correctly when the balance system is challenged. For example you are walking along when suddenly you trip over a stone in the pathway. Your balance system reacts to ensure that you do not fall and makes corrective movements with your limbs and eyes.  

Vertigo (an illusion of movement), dizziness and balance problems arise when there are problems in one or more of these systems or their coordination. It can be due to a number of different things including problems with the balance organ or nerve, various medical conditions or neurological problems. It is thus important that the cause for the dizziness be determined by a professional.

There are many different disorders that lead to dizziness. Common disorders include Benign Paroxysmal Positional Vertigo (BPPV) , Vestibular neuritis and Labrynthitis. A less common cause of dizziness problems is Meniere’s disease.

BPPV arises when otoconia (little calcium particles) become dislodged from where they should be in the otolithic organs (saccule and utricle) and travel into the semicircular canals . These particles then induce vertigo when the head or body is turned.  The sensation typically only lasts for seconds.

Once the condition has been diagnosed by a testing procedure know as the Dix-Hallpike Manoeuvre the prognosis is good and many cases can be resolved by repositioning these particles into their correct position. This can be done by a treatment known as the Epley manoeuvre.

With both disorders, patients experience an intense episode of vertigo for approximately 48-72 hours. Concurrent with the vertigo are symptoms of nausea, vomiting, and sometimes sweating. After the episode has settled, patients may experience unsteadiness when standing and walking.

With Vestibular neuritis only the balance organ is affected, but in Labyrinthitis the hearing is also affected. Thus with Labyrinthitis, patients would experience a sudden decrease in hearing along with the vertigo related symptoms.

Treatment may not be necessary as some patients do spontaneously recover, but if this does not occur the prescription of tailored balance exercises is recommended.

Ménière's disease is a disease of the inner ear that is long term and can be progressive. It involves recurrent episodes of vertigo, tinnitus and hearing loss, with the function of the inner ear gradually decreasing with each episode. It affects both the balance organs (semicircular canals) and the hearing organ (cochlea).

The condition is diagnosed by specialized balance function tests done in a Balance Clinic.

Treatment can include control of symptoms with medication, diet alterations, and/or balance exercises.

The balance function tests attempt to evaluate the balance system as a whole and the coordination of its individual systems to determine if their functioning is normal. The tests include the Sensory Organization Test, Video nystagmography and Vestibular Evoked Myogenic Potentials.

The sensory organization test is a test to determine how you are integrating all the information from the 3 sensory systems : vision, proprioception and balance organs.

The test involves the patient standing on a platform in a harness. The platform and its surroundings move at different times and angles. The patient is always safe and the audiologist is always present to ensure safety. The test lasts for approximately 30 minutes.

Video Nystagmography analyzes the information provided by the eyes as part of the balance system.

The test involves the patient wearing a pair of special goggles and following a beam of light across a light beam. The equipment is very sensitive and tracks the movement of the pupil of each eye.  It is thus very important that patients do not wear any form of make-up during the session as this confuses the equipment sensor.  The testing time ranges from 30 minutes to 1hour.

Bithermal caloric stimulation is a test in which warm or cool water is trickled into the ear, one ear at a time. The test modifies the temperature of the balance organs and thus causes a difference in temperature between the two balance organs. This test may make you feel dizzy, but the symptoms last for a short period of time. The test is very important for the diagnosis of dizziness problems related to the balance organs in the inner ear. The test typically lasts 20 to 30 minutes.

 See below for an attachment detailing the preperation necessary for the testing procedure.  

This is a test which assesses the functioning of a different part of the balance organ system known as the otoliths. The test involves the placement of 5 skin electrodes on the face, neck and behind each ear and listening to sound. The testing time is approximately 15 – 20 minutes.

Dizziness problems that are related to dysfunction of the balance organs are treated by prescription of Epley manoeuvre and/ or customized Balance rehabilitation exercises.  These treatments are available in the Vestibular Rehabilitation Clinic available at the Audiology Department in the Royal Surrey County Hospital.

Patients who require further medical treatment or physiotherapy would be referred onwards to the ENT Department or Physiotherapy, respectively.

If you are experiencing problems with dizziness contact your GP to arrange a referral to the Balance Diagnostics Clinic at the Royal Surrey County Hospital.