Greater Peoria Metro Area, IL

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The Dizzying Success of Vestibular Testing


By Lori Lovely

Vertigo encompasses more than just conditions resulting in fear of heights, like James Stewart suffered from in the Hitchcock film of the same name. Vertigo is a symptom of an inner ear disorder. Dizziness and imbalance issues account for approximately six million doctor visits every year in the U.S.

All ages are susceptible, with some as young as eight years old reporting dizziness, but the majority of patients are older, says Sarah Winborn, Au.D., CCC-A. “It’s a common problem in geriatrics and can be compounded by medications, circulatory issues, or blood pressure.”

In addition to dizziness, symptoms can include nausea; vomiting; visual disturbances; and light-headedness, or the feeling of being about to faint. Stress, lack of sleep, and changes in barometric pressure can increase the severity of symptoms.

Positional Vertigo
Of those who seek medical attention for their condition, somewhere between 17 and 42 percent are diagnosed with benign paroxysmal positional vertigo (BPPV). This disorder of the inner ear is symptomized by repeated episodes of positional vertigo, which are characterized by a spinning sensation. This sensation usually lasts around 30 seconds. When calcium crystals known as otoconia become dislodged from the utricle and migrate into one of the semicircular canals, the result is a false sensation of movement, also known as canalithiasis. The utricle and semicircular canals are located within the inner ear. “A person with positional vertigo experiences spinning dizziness when bending over or rolling over in bed,” explains Winborn, one of two doctors of audiology at the Midwest Ear, Nose & Throat Hearing Center in Peoria.   

BPPV can be triggered by looking up or down, sudden head movements, rolling over in bed, or tilting the head. It can also be the result of a head injury or brought on by any action that stimulates the posterior semi-circular ear canal. If the vertigo is a result of BPPV, a test called the Dix-Hallpike will reveal a positive response of nystagmus lasting 30 seconds or less. A simple treatment called the Epley maneuver can be administered that day in office using a series of five head and body movements. The total treatment time is about 15 minutes in the office. The patient is then advised to limit their head and body movements for the next seven days to ensure the effectiveness of the treatment. 

“However, even with effective treatment, the condition can come back,” notes Jennifer Ragusa, Au.D., CCC-A, the other doctor of audiology at the Center. In fact, a person who has experienced BPPV is more likely to have repeat occurrences. Fortunately, she says, patients typically recognize symptoms sooner in subsequent occurrences and can come directly to the Center for treatment. The body tries to fix itself, but that’s easier when we’re young, Ragusa continues. Without treatment, she says, BPPV can go away in three to five months. “But no one wants to wait that long.”

Famous Disease
Another condition often seen at the Center is Meniere’s disease, another disorder of the inner ear affecting hearing and balance, characterized by vertigo, tinnitus (ringing or noise in the ears), ear pressure, and hearing loss, which can become progressively worse or even permanent. “It’s episodic,” Winborn explains, “not a constant feeling.” Typically, it occurs suddenly, and it can occur randomly.

Meniere’s disease has no definitive test. It is diagnosed by exclusion through eliminating other possible causes of the symptoms. If frequent and severe, Ragusa says patients may be referred to an otologist for surgical options. “That’s only in extreme cases.”

There is no cure for Meniere’s disease, but a number of treatments can help reduce the severity and frequency of vertiginous episodes. A low-sodium diet helps lessen occurrences but is not a treatment, Ragusa says.

Vestibular Tests
Vertigo is accompanied by an eye movement called nystagmus, an eye reflex that allows you to keep a steady visual field when your body moves. This reflex is checked to assess the vestibular system, which tells you how your body is moving. Nystagmus is easily measured. The main test is called videonystagmography, otherwise referred to as a VNG. The test is comprised of different sub-tests that record pupil movement to detect nystagmus in a variety of conditions.

Initial testing involves following a visual target (usually a red light in a dark room) with the eyes while keeping the patient’s head still. The types of tests include: smooth pursuit, which measures your ability to track a target moving slowly from one direction to the other; saccades, which measures your ability to find a randomly-moving target; gaze, which measures your ability to maintain direct focus in a specific location for a set amount of time; and optokinetic, which measures your rapid eye movement abilities. These all give a picture of how well your reflexes are able to track objects and your environment. An abnormality in these tests provides information about your vestibular system’s function.

Positional testing involves recording eye movements while the patient is kept still in specific positions: sitting, supine, head facing right and left, and body facing right and left with vision allowed and vision denied. During this test, the staff is looking for nystagmus in any condition.

Caloric testing involves presentation of cold and/or warm air or water into an ear canal to elicit vertigo. The strength of expected nystagmus is compared from one side to the other and one temperature to another.

Office Visit   
Founded in 1987, the Midwest Ear, Nose & Throat Hearing Center is one of the leading otolaryngology practices in Central Illinois, at the forefront of diagnosis and treatment of disorders of the head and neck. They also treat sinus disorders, chronic sinusitis, snoring, sleep apnea, voice and swallowing disorders, and allergies.

Audiological services include:

  • Hearing evaluations—adult, pediatric, and newborn
  • Special evaluations—videonystagmography, oto-acoustic emissions, and screening for central auditory and processing disorders
  • Assistive listening devices—FM systems/listening systems and amplified phones
  • Swim plugs and musician plugs
  • Custom hearing protection
  • While complaints of dizziness account for 3 percent of primary care visits, Ragusa says their offices see a higher percentage of cases. “It’s probably 15–20 percent for us.”

    Winborn estimates that they conduct testing two times a week, although that number increases as the seasons change. “Sinuses, allergies, medications, and a virus, plus weather changes can affect it,” she says. “One patient had surgery that kept her inverted for over an hour, which made her condition worse.” Air travel and head trauma can also impact the condition.

    Two physician assistants and three ENT doctors at both Midwest Ear, Nose & Throat Hearing Center locations in Peoria and Morton can order the testing, which is performed by any of the Center’s four audiologists. All are state licensed and certified by the American Speech-Language-Hearing Association.

    It doesn’t take a private detective to figure out that vertigo is not something to be ignored. Getting help at Midwest Ear, Nose & Throat Hearing Center is easy and convenient.

    For more information, contact Midwest Hearing Center in Peoria, located in the OSF Center for Health at 8600 State Route 91, Suite 300. Phone number: 309-691-6616. The Morton office is in the Morton Medical Center at 1600 S. Fourth Street. Phone number: 309-284-0164.