Understanding a balance problem is
needed
to help resolve it.
After a
person has been screened by computerized dynamic posturography and if
found to have a balance problem, diagnostic testing is the next step.
Accurate diagnosis is essential in developing an effective care plan.
A complete
audiometric assessment should be performed as part of the evaluation.
The presence of a sensorineural hearing loss, is the single strongest
incriminating factor in identifying a balance problem.
Audiological Test Battery
Much of a person's
balance system resides within the inner ear. Therefore, testing a
person's hearing can provide information about the integrity of this
inner ear. Following the hearing tests, which take about 25 minutes, the
audiologist will discuss the results with you and make appropriate
recommendations.
The relationship
between hearing and balance
The hearing and
balance organs are connected to each other within the inner ear. The
cochlea is located in the inner ear. This snail shaped structure has
approximately 20,000 hair cells that are surrounded by fluid. Also
contained in the inner car are the semi-circular canals. These help in
our orienting ourselves in space and maintaining a balanced posture.
A person who has a profound hearing
loss is more likely to have a vestibular problem than the general
population. That is a major reason why any evaluation of an individual’s
balance includes a thorough audiological evaluation. Vestibular
impairments, such as Meniere's disease, impair balance. Loss of hearing,
medications that have an effect on the inner ear, or even a benign inner
ear infection may also cause falls. The problem of dizziness and
disequilibrium is significant, second only to low-back complaints in
frequency of occurrence in adult populations. Dizziness itself is not a
disease but rather a symptom of a problem within the peripheral or
central nervous system. There are many causes of dizziness; however, a
large percentage result from pathology within the peripheral vestibular
system.
While a vestibular
dysfunction can produce clumsiness, a person may be able to maintain
some stability by utilizing his vision and abilty to feel the floor (proprioception)
as a substitute or back-up. When the proprioceptive system is also
under stress such as when walking on uneven surfaces or when there is
not enough visual information such as in darkness, poor balance and
difficulty keeping stable will result.
We can perform a
complete hearing and balance test battery. As a participating provider
in Medicare, Aetna, Blue Cross/Blue Shield and Keystone East Keycare
65,testing services by
BEFORE THE
FALL
Centers can be
billed to the applicable insurance carrier.
Video Nystagmography
During this test, miniature cameras are
used to videotape a person's eye movements in response to several types
of stimuli. Part of the balance system is a reflex between the eyes and
ears. Therefore, when your balance system is stimulated, movements by
the eyes can provide the audiologist with useful information.
This test takes about 30 to 40 minutes to
complete and it is our policy that it is only performed if a person
fails our posturography test (see above) or on our questionnaire
indicates a vestibular problem. While a person may feel a bit dizzy
during the test, it is painless and can be very useful in determining
possible causes of past or future falls.
Remediation of
vestibular problems
Once specific risk factors that may lead
to future falls have been identified, the audiologist will discuss
options to consider to prevent such falls. This information will be
sent to the primary care physician who is most familiar with all the
health aspects of the individual’s health. Recommendations for
remediation may include a visit to another healthcare professional
(optometrist, physical therapist, occupational therapist, primary care
physician, neurologist, cardiologist or an ear, nose, and throat
physician), suggestions for improvements in your home or daily routine
and/or just utilizing the present assistive devices appropriately.
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