Audiology for Dizziness

It is estimated that 90 million Americans will experience dizziness in their lifetime. This condition can range from mild dizziness to vertigo that is so debilitating a person cannot get out of bed. The most common complaints of dizziness are loss of balance, faintness, lightheadedness, disorientation, unsteadiness, feeling of falling, sensation that the room is spinning, tinnitus (ringing in the ears), problems reading, and difficulty seeing.

Treatment for dizziness is necessary when symptoms are severe and persistent. Anti-nausea medications and prescription sedatives such as Antivert and Meclizine can help patients cope with their dizziness, but don't heal the condition. The side effects of these drugs may also increase the chances of falling by delaying a person's reaction time. The best method is to treat the underlying cause of the dizziness, such as an ear infection. However, if the cause can't be treated medically or surgically, the next step is to deal with the dizziness itself. That's where an audiologist comes in.

Audiological Help for Dizziness

Audiology is the science of treating individuals with hearing loss or balance problems. Audiologists are trained to perform hearing and balance tests to help determine possible causes of dizziness or balance disorders. Tests that help diagnose inner ear disorders such as dizziness are available at many audiology clinics.

Treatment for dizziness varies depending upon the type of dizziness and the severity of it. In the case of dizziness caused by an ear infection, a course of antibiotics often clears up the problem. Changes in diet, such as a reduction in fluids and salt, are often successful in helping treat Meniere's disease, an inner ear fluid balance disorder. More severe cases of dizziness will require balance retraining exercises called vestibular rehabilitation.

What to Expect at the Audiologist

During an office visit, the audiologist takes a detailed history of the symptoms, records the patient's medical history, examines the ears, and performs a hearing test. Then, the audiologist conducts a balance test to determine the origin of the problem. Next, the audiologist performs some tests to assess the cause of the dizziness and determine the extent of it.

The following are two types of tests that may be performed:

Electronystagmography (ENG) test
This test is useful in determining what is or is not causing dizziness and in identifying how or if the inner ear is working. The Electronystagmography (ENG)records and measures involuntary eye movement, or nystagmus, that occurs when a person becomes dizzy. During this test, electrodes are taped onto the skin around the eyes. In the first part of the test, the patient watches lights move on a light bar. In the second part of the test, the patient's head and body is moved into different positions to see where the dizziness is provoked. The third part of the ENG is called the caloric test. In this test, warm and cool air or water is put into the ear canal in order to stimulate the balance organs and determine if they are functioning properly. During the ENG, the audiologist records the patterns of normal and abnormal eye movements.

Videonystagmography (VMG) test
This test is similar to the Electronystagmography (ENG)test, but is performed with video imaging technology. The patient wears video goggles with infrared cameras while going through the test. The cameras measure the involuntary eye movements and display them on a screen.

The results from these tests are used to determine the cause and proper treatment for the dizziness.

Audiological Treatment for Dizziness

Audiologists can provide rehabilitation for a patient or may serve on a multidisciplinary team that includes an otolaryngologist (ear, nose, and throat doctor), physical or occupational therapist, and/or a primary care physician to work up a treatment plan.

Vestibular Rehabilitation Therapy
This is a balance retraining exercise program designed to decrease dizziness and improve balance through simple head, eye, and body movements. This therapy is most successful in treating vestibular dysfunction. It helps retrain the brain thereby lessening or eliminating symptoms. Many audiologists provide limited vestibular rehabilitation treatment. They may refer the patient to a physical therapist or occupational therapist for this therapy.

Canalith Repositioning Therapy (CRT)
This is the most well-known treatment for Benign Paroxysmal Positional Vertigo (BPPV). In this treatment the patient's head is moved into several different positions. The goal is to move the crystals out of the ear canal. This treatment is often a one-time office visit and has a 90% success rate.

What is Dizziness?

Balance is regulated by the body's vestibular system, a tiny network of fluid-filled sacs located in the inner ear. The vestibular system works with the eyes, bones and joints, and brain to regulate the body's position. Balance problems occur when one or more of these are not operating correctly and can be a result of the following:

• Inner ear conditions, such as ear inflammation or infection
• Meniere's disease
• Head injury
• Result of aging
• Motion sickness
• Medical conditions (colds, infections, pregnancy)
• Side effects of medications
• Brain or nerve disorders
• Anxiety and stress

Dizziness often triggers other conditions such as fear/anxiety/panic, nausea and vomiting, diarrhea, changes in heart rate and blood pressure, fatigue, depression, and difficulty in concentration. Contact your physician immediately if the dizziness is accompanied by severe headache, blurred vision, hearing loss, impaired speech, numbness or chest pain, as these symptoms may indicate a serious problem.

Types of Inner Ear Disorders That Cause Dizziness

Bilateral Vestibular Dysfunction
This condition occurs when there is weakness on both sides of the vestibular system. Symptoms include imbalance, loss of surefootedness, and an illusion that objects are bouncing up and down with movement.

Benign Paroxysmal Positional Vertigo (BPPV)
This condition is the leading cause of dizziness. It occurs when salt-like crystals in the inner ear break free and float throughout the ear canal. A patient with this condition will experience a brief but intense vertigo that is caused by a change of head position.

Labyrinthitis
This condition is an inner ear infection or inflammation that causes dizziness, severe vertigo, nausea, and vomiting.

Meniere's disease
This is an inner ear fluid balance disorder. It occurs when there is a buildup of fluid pressure in the ear. Symptoms include sudden vertigo lasting 30 minutes or longer, fluctuating hearing loss, tinnitus, and a sensation of fullness in the ear.

Unilateral Vestibular Dysfunction
This condition occurs when there is weakness on one side of the vestibular system. Symptoms include positional vertigo, dizziness when turning the head, and motion sickness.

Additional Resources

The American Academy of Audiology website offers additional information on Audiology treatments and research.

The American Speech-Language-Hearing Association (ASHA) is the professional, scientific, and credentialing association for Audiologists and Speech-Language Pathologists.