Hearing Health

Ear Balance Service

Balance and Dizziness Service

Chime offers a full and comprehensive balance assessment and rehabilitation service including:

• Tests and treatments for benign paroxysmal positional vertigo (BPPV) – the most common cause of dizziness that we see, caused by crystals gathering in a part of the balance organ where they shouldn’t be, causing short bursts of severe spinning dizziness.
• Balance function assessment – using a variety of tests outlined below
• Individualised balance rehabilitation – dependant on your symptoms, diagnosis and provokers of your dizziness.

read more about inner ear balance 

Diagnosis

If you have a problem with your balance or dizziness, then please seek the advice of your GP. They may refer your directly to Chime, or to an Ear, Nose and Throat (ENT) doctor.

What happens in a balance assessment appointment?

The audiologist will begin by talking to you about your balance problems, and we may ask you to complete a questionnaire about your symptoms. Dependant on your symptoms, your appointment may involve one or more of the following tests:

• Epley Repositioning Manoeuvre

The Epley repositioning manoeuvre is used to treat a balance problem called benign paroxysmal positional vertigo (BPPV). BPPV is caused by small crystals moving into the wrong part of the balance system. It can cause short periods of vertigo upon rapid changes of head position.  

The Epley manoeuvre is used to reposition these crystals back to an area where they settle and no longer cause vertigo. It is conducted on a couch and consists of 5 head positions which are quite rapid but controlled.  

•  vHIT (video Head Impulse Test) 

This test assesses the vestibulo-ocular reflex, a reflex which stabilises gaze during head movement. This gives us information about the functioning of all six of the semi-circular canals in the balance system.  

You will be asked to wear video goggles which can record very small eye movements, which would otherwise not be visible. The audiologist will place their hands on your head, and move it in short, rapid movements in various directions. Throughout the test. you will be asked to keep your eyes on a fixed point on the wall during the head movements.  

• Videonystagmography (VNG) and Caloric Test

This test provides information about the functioning of your balance system, including the balance organ and nerve pathways to your brain.  

Detailed observations of your eye movements will be recorded using video goggles. A light bar will be placed in front of you, and you will be given various tasks, including following the light with your eyes and maintaining your gaze on a specified point/

In some appointments a Caloric test is also conducted. This involves air being used to warm and cool your ears to measure the symmetry between the balance in your two ears. This can make you feel temporarily dizzy, but this will subside after a couple of minutes.  

• cVEMP test (cervical Vestibular Evoked Myogenic Potentials)

This test measures the response of a specific part of your balance system in response to sound.  

Sounds are played into your ear, and the response from a large muscle in your neck is recorded through stick-on electrodes. The sounds played are fairly loud which allows them to stimulate a specific part of the balance organ, which in turn causes the neck muscle to contract.    

• Electrocochleography (ECochG)

This test allows us to investigate the functioning of your cochlea (the organ of hearing) in the inner ear. 

It involves placing two stick-on electrodes on your forehead and one on your eardrum. This should not cause any discomfort. Sounds are then played into your ear and the response of the cochlea is automatically recorded.  

Balance Rehabilitation

Balance Rehabilitation exercises are used to promote natural rehabilitation of your vertigo or balance problem. 

There are 3 main inputs to maintaining good balance: information from your eyes, the balance organ in your inner ear, and muscle tone. Rehabilitation exercises encourage these 3 inputs to work together more efficiently. The exercises provided will be tailored to your specific balance problem, and will include eye movements, head movements and body movements.  

Vestibular Rehabilitation is a journey and can take several months. Your audiologist will help you to establish an exercise routine that is manageable and achievable for you. 

Balance Therapy

Balance therapy can be offered to patients who may be undertaking, or have completed Balance Rehabilitation, when anxiety and confidence issues, relating to balance, are thought to be hindering progress.

Therapy will involve:

• Counselling
• Cognitive Behavioural Therapy approaches.