Balance Tests

Balance tests are a group of diagnostic procedures used to identify the underlying cause of balance disorders, helping patients receive appropriate treatment to improve stability and prevent falls.

Overview

Balance disorders are conditions that cause feelings of unsteadiness or dizziness. Dizziness can manifest as vertigo (a spinning sensation), a feeling of impending falls, or lightheadedness. These disorders can occur at any age but are more prevalent in older adults, contributing significantly to fall risks.

Good balance relies on the brain receiving accurate signals from the ears, eyes, and sensory receptors in the legs. The vestibular system, or "the labyrinth," located in the inner ear, is the primary organ responsible for balance. It utilizes fluid and hair-like sensors to detect head position and movement, sending these signals to the brain.

Symptoms

You may require balance testing if you experience the following symptoms:

• Dizziness or vertigo
• Falling or a sensation of falling
• Staggering while walking
• Lightheadedness, fainting sensations, or a floating feeling
• Blurred vision
• Confusion
• Nausea, vomiting, diarrhea, anxiety, or changes in heart rate and blood pressure

Causes & Risk Factors

Balance disorders can stem from inner ear conditions, head injuries, medications, or systemic health issues such as vision problems, heart disease, blood vessel disorders, migraine headaches, and arthritis. Common disorders include:

• Benign paroxysmal positional vertigo (BPPV): The most common cause of vertigo, occurring when calcium grains in the inner ear shift out of place.
• Labyrinthitis: Irritation and swelling of the inner ear, often following a cold or flu.
• Meniere's disease: A disorder involving fluid buildup in the vestibular system, causing vertigo, hearing loss, and tinnitus.
• Vestibular neuritis: Inflammation of the vestibular nerve, typically caused by a virus.
• Perilymph fistula: A leak of inner ear fluid into the middle ear, often due to injury or infection.
• Mal de Debarquement syndrome (MdDS): A persistent swaying or bobbing sensation following long periods of motion.

Diagnosis

Diagnosis often involves specialists such as an audiologist or an otolaryngologist (ENT). Common diagnostic tests include:

• Electronystagmography (ENG) or videonystagmography (VNG): Measures involuntary eye movements (nystagmus) using electrodes or special goggles while the patient is moved into various positions or exposed to warm/cool air or water.
• Rotary chair test: Measures the coordination between the eyes and inner ear while the patient sits in a computer-controlled rotating chair.
• Computerized dynamic posturography (CDP): Assesses balance while standing on a platform, often using a safety harness.
• Vestibular evoked myogenic potentials (VEMP): Measures inner ear function by recording muscle responses to sound.
• Dix-Hallpike maneuver or video head impulse test (vHIT): Checks eye movement responses to rapid head positioning.

Treatment & Management

Treatment is tailored to the specific disorder:

• BPPV: Managed via the Epley maneuver or canalith repositioning to move calcium grains back into place.
• Meniere's disease: Managed through lifestyle changes, diet, and medication.
• General management: If the cause is systemic or medication-related, adjusting treatments may help. Vestibular rehabilitation (balance retraining therapy) is also used to help patients cope with symptoms and reduce fall risks.