Audiologic Assessment

Some inner ear disorders can manifest as both dizziness and hearing deficits, thus a comprehensive hearing test can provide the physician with important information. Acoustic immittance studies provide information regarding the integrity of the middle ear mechanisms. Pure tone and speech audiometry allows us to know the type and degree of hearing loss, as well as word discrimination abilities.

Posturography

This assessment of functional balance ability determines how a patient utilizes visual, somatosensory, and vestibular inputs to maintain balance. It also assesses a patient’s ability to coordinate their lower and upper body reactions to maintain their stance when equilibrium is disrupted. During this procedure the patient is simply asked to stand still while they stand on a computerized platform. The visual-surround and platform may move subtly during the test. The computerized surface can measure the patient’s sway and reaction time in response to these disruptions of equilibrium. The patient wears a safety harness at all times and the examiner will explain what will happen before each set of movements. The information obtained from this study can provide important information about functional compensation status and can assist in developing individualized treatment plans.

Videonystagmography (VNG)

VNG evaluates the vestibular-ocular reflex, which allows the inner ear to sense motion, and provides stable vision during head and body movements. This interaction of the eyes and inner ear is evaluated by recording a specific type of eye movement. These computerized recordings are taken by small video cameras mounted on a pair of goggles worn by the patient. During the initial part of the VNG the patient is asked to follow a small light with their eyes as it moves to various locations on a projector screen in front of them. Next, the patient is asked to move into a variety of positions while the eye movement recordings are taken. Finally, warm and/or cool water will be inserted into the patient’s outer ear by the audiologist. This is not painful, but may make the patient slightly dizzy or lightheaded for a very brief period of time. VNG results provide the physician with extremely important insight about certain parts of the brain responsible for balance, whether one inner ear is functioning weaker than the other, and important information regarding physiologic compensation status.

Rotational Chair Test

The rotational chair test evaluates how the inner ear responds to various types of motion. The patient sits in a computerized chair housed in a relatively dark chamber for a short period of time. The computer moves the chair in a gentle, circular motion while the special video cameras record the eye movement response. The motion of the chair is very slow and occurs in complete darkness. Since the movement is so slow, and the patient has nothing to visually reference to know that they are moving, generally little to no symptoms are experienced during this procedure. The rotational chair test provides important information about physiologic compensation status. In cases where both inner ears are weak, this test can provide insight into the extent of this bilateral weakness.

Vestibular Evoked Myogenic Potentials (VEMPs)

VEMPs provide assessment of the part of the inner ear responsible for sensing gravity and various movements of the head and body. Recording electrodes are placed on the patient’s neck. The electrodes measure neck muscle contraction changes in response to relatively loud clicking sounds. The patient is asked to turn his/her head in certain positions to facilitate the muscle contraction while the recordings are taken.

 

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