Why have I been referred?

You have been referred to the Audiology Department by your GP as you have been experiencing problems with dizziness or your balance.

This leaflet plans to give you an overview of your balance system and what to expect from your appointment.

Insight into your balance system

Your balance system is very sophisticated. In order to maintain your balance, your brain needs information from three inputs:

• The balance organs in each of your ears (vestibular information)
• Your eyes (visual information)
• The sensors in your joints and muscles (proprioceptive information).

Your brain combines all of this information so that it can work out where your head and body are in relation to your surroundings.   This will help you move around safely by controlling eye and body movements.

As Audiologists, we are most interested in the function of your balance (vestibular) organs, which are located inside your ears.  Each balance organ comprises of three semi-circular canals and two otolith organs (the utricle and the saccule). Together your balance organs allow you to detect movements of your head such as up and down, rotation and tilt.

Will I need to do anything to prepare for my appointment?

Please bring a list of your current medications. If you have been prescribed any of the following drugs, you are advised to stop taking them for 48 hours prior to your appointment.

• STUGERON (also known as Cinnarizine)
• STEMETIL (also known as Prochlorperazine or Buccastem)
• CYCLAZINE (also known as Valoid)
• SERC (also known as Betahistine)

BUT you should NOT stop any other medication and if you are in any doubt about what tablets you take or which tablets you should stop, you should ask your own doctor for advice.

You are also asked not to drink any alcohol in the 24 hours prior to your appointment and to eat normally on the day of your appointment.

If possible, please do not wear make-up around your eyes or forehead as this may need to be removed before some of the tests are carried out.

Please ensure that you have someone to accompany you home after the appointment. It is not advisable to drive yourself home.

These detailed tests can take up to 90 minutes to complete.

What will happen in your appointment?

The tests are usually performed by two Audiologists and we will start by taking a detailed history of your case. This will allow us to obtain a first hand account of your balance problems.

One of the Audiologists will look into your ears to check that they are clear of wax and then complete a test called tympanometry, which uses air pressure to check the mobility of your eardrum and condition of your middle ear.

We then move on to a group of tests that are looking at how well you can follow a series of still and moving targets with your eyes.  The tests will be carried out whilst you are sitting in a chair and you will be wearing a pair of goggles that house a small camera to record your eye movements.  Some of the tests are carried out in the dark.

Depending on your history, one or more of the tests below may be performed.

Dix-Hallpike Test

During this test, we will ask you to turn your head to one side and then lay down on a couch as quickly as possible.  This is so that we can see if positional changes to your head and body can bring on or mimic your dizziness.  If we find that this test does bring on your dizziness, then one of the Audiologists will work with you to try and resolve the symptoms using the Epley Manoeuvre.  We will discuss this with you should it be necessary.

Video Head Impulse Test (vHIT)

You will be asked to wear a pair of tight fitting goggles that house a small video camera.  We will then gently, but firmly, move your head in certain directions and record your eye movements.  This will give us valuable information about the function of your semicircular canals.

Vestibular Evoked Myogenic Potentials (VEMP)

For this test, we will gently clean your skin before placing small electrodes onto each side of your neck about half way up. A third electrode will be placed just below the neck, on the sternum.

A variation of this test will involve the electrodes being placed close to your eyes.  The Audiologists will explain which variation of the test we will be using.

You will be asked to wear some earphones that will play you a loud clicking noise.  You will be asked to hold your head to one side, or look in a particular direction for a period of 30 seconds as you listen to the sounds. This will be repeated several times on each side.  This test is providing us with information about the utricle, saccule and a portion of your vestibular nerve.

Video Nystagmography (VNG) Test

You will be asked to look at a sequence of small white lights on a screen in front of you and to follow them as instructed.  Then you will be asked to look ahead as black and white stripes move across the board.

The Caloric Test

This test helps determine if there is any difference between the balance function of each ear. Eye movement will be recorded with a camera. The test is performed whilst you are lying on a couch and we gently irrigate the outer part of the ear with water, one ear at a time, for up to a minute.  We do this at a warm and then a cool temperature for each ear.

This change in temperature changes the density of the inner ear fluid and gives you a sense of rotation/dizziness resulting in eye movement known as nystagmus. It is this nystagmus that we are looking to observe and which lasts for a couple of minutes before gradually fading away.

It is important to remember this is a completely normal sensation in people with and without balance problems and it is not linked to any previous dizziness you have experienced, nor will it precipitate another attack of dizziness. One of the Audiologists will be by your side throughout the test.

What happens next

All the test results will be analysed carefully and explained to you on the day of your appointment.  Please be aware that in some cases it may not be possible to suggest a cause for balance problems on your first visit to the clinic.  Some of the test results may need further analysis, further testing or a referral to a different speciality may be required.

A management plan will be agreed with you at the end of your first visit to the clinic.

If you have any questions or queries, please do not hesitate to contact us:

ENT suite, Outpatients

Pilgrim Hospital, Boston

PE21 9QS

Telephone:  01205 446478

Clinic 6, Outpatients

Lincoln County Hospital

LN2 5QY

Telephone:  01522 573254

Email: [email protected]

General statements that are made in this leaflet do not apply in every case, as each patient is an individual.  Your Audiologist will advise you on any specific after care.