Add Vestibular & Balance Testing to your practice

Next to back pain, dizziness is one of the most talked about symptoms of people over the age of 65. While Benign Paroxysmal Positional Vertigo (BPPV) is still statistically the leading cause of vertigo (true room spinning sensation), more research is needed, and many times the dizziness our patients are experiencing is a physiologic problem with the neural vestibular structures rather than a simple mechanical issue. With technology and research constantly evolving in the field of inner ear disorders, we now have the capabilities to correctly diagnose and treat these physiologic vestibular problems. A TRUE vestibular disorder can ONLY be properly diagnosed through vestibular neurodiagnostic testing. This testing can lead to the identification of the vestibular organs involved and leads to better treatment outcomes. We then can tailor Vestibular Rehabilitation Therapy (VRT) to the patient’s specific diagnosis.

While vestibular suppressants (the most prescribed being meclizine) have their place in the treatment of inner ear disorders, most times they should NOT be considered as a long-term solution to a true inner ear disorder. If we are treating a patient with vestibular suppressant medication, then we are admitting that as medical professionals we believe the patient may have some type of vestibulopathy or dysfunction. Again, if vestibulopathy is suspected then a proper comprehensive vestibular evaluation is necessary so that proper treatment can be provided. Not only this, but long-term use of vestibular suppressants can form dependency, whether physiological or psychological, and often leads to patients feeling dizzier than they were prior to taking a vestibular suppressant. This can also cause growing feelings of anxiety in our patients and eventually lead to a psychogenic disorder known as persistent postural-perceptual dizziness (PPPD).

At The Missouri Delta ReBalance & Dizziness Center we have the most up to date technology as well as top notch inner ear specialists to help effectively diagnose and treat your patients. This technology includes Cervical and Ocular Vestibular Evoked Myogenic Potentials (VEMPs), Comprehensive Rotational Chair testing, Videonystagmography (VNG), and Bi-Thermal Caloric Testing. When combined the testing provides a complete assessment of the Vestibular Ocular Reflex (VOR), utricle and saccule (otolith organs), inferior and superior branches of the vestibular nerves, and all six semi-circular canals, as well as ruling in or out specific labyrinthine disorders. Below is a list of symptoms you may ask patients about when considering a referral to our clinic.

  • Dizziness
  • Vertigo (true room spinning)
  • Nystagmus
  • Nausea
  • Imbalance
  • History of falls
  • History of chronic cane, walker, or wheelchair usage
  • History of vestibular suppressant usage
  • Hearing loss, especially when asymmetric
  • Tinnitus (ear ringing, roaring or clicking), especially when asymmetric
  • Ear pressure associated with dizziness
  • Dizziness or headaches associated with menstrual cycles
  • Dizziness or headaches post hysterectomy
  • History of migraines
  • Headache
  • Head fog
  • Visual auras
  • Facial numbness or tingling
  • Light, sound, smell, or motion sensitivity
  • Vertigo associated with loud sounds
  • Dizziness post Bell’s palsy (facial paralysis)
  • Dizziness post boat or cruise ride
  • Dizziness post viral/bacterial illness

The Vestibular & Balance Test battery may include:

Customized Vertigo/Balance History & Physical

Gait and Functional Activities-of-Daily-Living Analysis

Computerized Dynamic Posturography (CDP)

Comprehensive Rotational Chair Testing

Videonystagmography (VNG) with Air-Caloric Irrigation

Cervical & Ocular Vestibular Evoked Myogenic Potentials

Video Head Impulse Test (vHIT)


Audiogram and Tympanometry (only if not previously performed by your physician or audiologist)



*Please carefully read and follow instructions listed below PRIOR to your vestibular evaluation appointment:

Before your appointment:

  • Stop taking any medication used to treat dizziness or nausea 48 hours prior to your appointment. This can affect the accuracy of testing results. Your appointment will need to be rescheduled if you do not follow this instruction.
  • Do not consume alcohol 12 hours prior to your appointment. This can affect the accuracy of testing results. Your appointment will need to be rescheduled if you do not follow this instruction.
  • Do not eat anything 8 hours prior to your appointment. This is to help prevent vomiting.
  • Do not drink any fluids 1 hour prior to your appointment. This is to help prevent vomiting.
  • Be sure your EYES, FACE and NECK are free of any lotion or makeup products.
  • Be sure your neck is free of any FACIAL HAIR.

Complete Intake Form prior to your appointment.

For your appointment:

  • Bring a list of all medications including frequency of use and dosage.
  • Wear comfortable clothing.
  • Mild dizziness can be expected throughout the testing. Your Vestibular Specialist will make testing as comfortable as possible.

What to expect at your appointment and beyond:

The vestibular and inner ear system can be complex and difficult to understand. Your physician has likely referred you to The ReBalance and Dizziness Center to have some testing done. This testing is vital to rule in or out the inner ear system as a cause for your dizziness or imbalance symptoms. Do not fear, as testing for the inner ear system is non-invasive and should not cause discomfort. Brief and mild dizziness can be expected during some parts of the evaluation. Testing can last anywhere from 60-120 minutes. Testing involves simple tasks such as a hearing evaluation, visually tracking lights and measuring eye movements with infrared camera goggles during various sets of testing. Having this testing completed is very important, as many cases of dizziness and imbalance have been found to have dysfunction of the inner ear. We ask that you DO NOT take any medications prescribed to you for your dizziness as these medications can negatively impact the accuracy of your results.

If found to have an inner ear disorder it is likely that physical therapy will be needed. If therapy is needed it can be expected that your treatment will last 6 weeks. In some cases, treatment will need to be prolonged. The type of physical therapy will be different for every patient and will be dependent on what is found during the vestibular and inner ear testing. Our vestibular and balance specialists will help guide you throughout your time here to make sure that the treatment is as successful as possible.

Refer Your Patient to Rebalance & Dizziness Center