• Education
• Dizziness Evaluation
• Dizziness History
• Vestibular Exercises
• Vestibular Neuritis
• Ménière's Disease
• Motion Intolerence
• Benign Paroxysmal Positional Vertigo
• Vestibular Migraine
• Degenerative Vestibulopathy
• Cervical Vertigo/Dysequilibrium
• Post Concussive/Traumatic Vertigo or Imbalance
• Other Imbalance Disorders

Dizziness History

Dizziness is abnormal and usually treatable.

Your first visit at Tampa Bay Hearing and Balance Center as a patient having dizziness will involve an extensive interview and physical performance test evaluating your present use of three main balance systems.

The brain's ability to maintain balance employs the inner ear, the eyes and a variety of muscle and joint sensors to inform the brain so that the body moves smoothly while in action. For it all to function well, circulation of blood to the brain must be sufficient and stable.

A person who has poor balance might have abnormalities in one or more of these systems. Balance, therefore, is supported by more than the inner ear. Several other organ systems, critical to good balance, might have to be assessed to properly diagnose a person's particular balance problems.

Balance Systems

The following is a brief explanation showing how these systems work together and influence one another:

Each inner ear has five sensory organs. Three canals that sense changes in any direction of rotation and two sensors that detect changes in up-down, side-to-side, and front-to-back motion. Each ear has a duplicate set of these organs that are oriented to present mirror images of the opposite side. The resulting balance system provides an incredibly rich set of information tat keeps a person precisely oriented in space.

The eye-brain relationship has two systems that affect balance. The first, the pursuit system, keeps objects precisely focused on the central visual receptors in the eyes. The second, the saccadic system, finds objects in peripheral vision and moves the eyes with exceptional speed and precision to bring the object into the central visual field. Eye problems such as cataracts, eye muscle imbalance and altered eye position can affect precise movement and positioning of the eyes.

The muscles, tendons and joints detect position and tension with special position and pressure receptors.

The brain combines the information from the inner ears, eyes, muscles and joints in several ways. Decisions are made subconsciously that adjust eye position to keep the environment in stable focus. In other words, the environment does not normally jump or shift during running, walking or riding. Automatic brain signals adjust muscle activity to maintain balance. For common activities, the brain recognizes patterns of movement and anticipates the next actions. Muscles, eyes and thought patterns adjust automatically for expected additional sensory information.

The blood's circulatory system has several features that are critical to balance. When shifting body position from either lying or sitting to standing, the muscles in the walls of blood vessels in the legs and the abdomen contract to prevent pooling of blood in those lower areas of the body. A regular heart beat provides uninterrupted circulation of blood to the brain. In the neck and the base of the brain, blood vessel walls free of obstructions maintain low resistance to circulating blood. These multiple mechanisms insure that the head and brain receive an adequate supply of blood.

Functional Assessment

Clinical examination of sensory integration involves six tests. Three assess the ability to stand on a floor with feet together, eyes open and closed, and the ability to maintain balance with a visual conflict dome on the head. The final three tests are the same as the first three but are performed on a thick cushion. The six tests asses the patient's ability to use all parts of the balance system together.

The oculomotor function tests assess the vestibulo-ocular reflex actions of the eyes to move accurately in several situations:

• Oculocephalic reflex test measures the response of the eyes to quick head movement
• Vestibulo-ocular reflex cancellation looks for eye responses when both the head and a fixed object rotate together
• Otolithic reflex seeks subtle eye shifts with linear, non rotational head movements

Position tests take the patient through several maneuvers to determine whether they provoke dizziness or imbalance. Position testing looks more vigorously for responses to more rapid position changes. Sometimes, the use of special goggles, called Frenzel's lenses, helps the examiner evaluate responses.

Station and gait tests produce critical information about stability and action. Station testing can evaluate stability with eyes open and closed, feet in normal positions, feet spread apart and one foot directly in front of the other. Stability with a gentle push in any of several directions, can assess ability to correct for unexpected situations. Gait testing looks for unexpected situations. Gait testing looks for instability while walking normally, swinging the head up and down and side to side. For some, gait testing is repeated with the eyes closed in a controlled manner.

General sensory and motor testing allows the examiner to observe comparative strength of arms, legs, and hips; soft touch and limb position senses; and the accuracy and smoothness of movements.

At Tampa Bay Hearing & Balance Center the following treatments are available for certain balance conditions:

• Physical therapy
• Adaptation therapy (motion sensitivity)
• Canalith repositioning procedure (stone in the semicircular ear canal)
• Gait and safety training (reduces fall risk)
• Home exercise program (performed daily)