Dizziness and imbalance disorders, such as vertigo and motion intolerance, are managed by the vestibular system, which is located near the cochlea within the inner ear. Those conditions increase your risk of falls and negatively affect your health and quality of life.

About the vestibular system

The vestibular system is consists of several tiny structures that maintain our sense of balance.  Movement of these structures sense generates signals to the muscles in our eyes and various parts of the body including the arms and legs. When the vestibular system is working properly, we are able to keep our balance and keep our gaze fixed on an object, even as our head or body moves.

shutterstock_205754275What is Vertigo?

Vertigo is a feeling of movement, even though the head and body are actually still. It usually makes people feel as if they are falling or the room is spinning. In severe cases, it can be quite distressing.

Causes of Dizziness:

Dizziness, vertigo and loss of balance can be caused by many medical disorders for example:

  • Benign Paroxysmal Positional Vertigo (BPPV or BPV)
  • Meniere’s disease
  • Acoustic neuroma
  • Multiple Sclerosis
  • Stroke
  • Vestibular neuritis
  • Inner ear trauma
  • Traumatic brain injury


Balance assessments:

There are many assessments that help in determining if your dizziness is caused by problems in the vestibular system (inner ear) for example:

Electronystagmography (ENG)/ Videonystagmography (VNG):

In these tests you will be asked to view the movement of a small dot in front of you. During which, your eyes movements will be measured and analysed. You will be asked to wear a pair of goggles with built in camera to record your eyes movements throughout the tests. Recording are made whilst you are sitting still and following the dots with your eyes.

Caloric test:

In this test, your eye movements are recorded after introducing a small amount of warm and cool water into each ear canal in turn. This allows the audiologist to compare how well the two balance organs are working, and to determine whether your Vertigo may be caused by loss of function in one of the balance organs in the inner ear.You may experience a mild dizziness or off balance – that lasts for a short time- after running the warm and cold water into your ear canal.  As soon as the test has been completed you may resume your usual medication.

Dix-Hallpike test:

The Dix–Hallpike test is performed with the patient sitting upright on the examination table with the legs extended. The patient’s head is then rotated to one side by approximately 45 degrees. The clinician helps the patient to lie down backwards quickly with the head held in approximately 20 degrees of extension. This extension may either be achieved by having the clinician supporting the head as it hangs off the table or by placing a pillow under their upper back. The patient’s eyes are then observed for about 45 seconds as there is a characteristic 5–10 second period of latency prior to the onset of nystagmus. If rotational nystagmus occurs then the test is considered positive for Benign Paroxysmal Positional Vertigo (BPPV). During a positive test, the fast phase of the rotatory nystagmus is toward the affected ear, which is the ear closer to the ground. The direction of the fast phase is defined by the rotation of the top of the eye, either clockwise or counter-clockwise.