Vestibular / Balance Disorders

Dizziness, vertigo and imbalance are the second most common complaints heard in doctor's offices.

National Institute of Health statistics indicate that dizziness will occur in 70% of the nation's population at sometime in their lives. Although very common, acute or chronic problems with equilibrium may indicate serious health risks, or limit a persons everyday living.

Equilibrium disorders may be described in two categories.

The first is dizziness, vertigo or motion intolerance that may occur in acute or sharp attacks lasting only seconds or some times for hours. This may simply be caused or worsened by rapid head movements, turning too quickly or while walking or riding.

The second is a sense of imbalance, unsteadiness or what some people refer to as a loss of surefootedness.

We use Videonystagmography (VNG) to assess inner ear vestibular function.

The VNG test administered in our facility consists of computerized recordings which allow the audiologist to use a wide sample of informative data for analysis. It utilizes a specialized camera system housed in a lightweight goggle to record the VNG data. The data is a determinant of whether a person's dizziness is caused by the ear or if it is due to some other factor such as the central nervous system. Patient's who are referred for testing must follow pre-test instructions prior to examination.

The first step to getting better is the proper diagnosis.

At Rehder Balance & Hearing Clinic, we provide the latest techniques in the assessment of balance disorders. Our audiologists have extensive training in the field of vestibular disorders and are unmatched in quality and commitment to patient care. According to the National Institute of Health, 85% of all equilibrium problems can be directly related to an inner ear disorder.

The various inner ear disorders that cause dizziness.

Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo is one of the most common types of peripheral vertigo. This disorder can be seen following head injury, vestibular neuronitis, stapes surgery, Meniere's disease or can present alone. The disorder is related to degeneration of the salt-like crystals (otoliths) in the utricle which break free and float into or attach themselves to the semicircular canals.

Symptoms include: attacks of vertigo with rapid and pitched head motion (e.g. rolling in or out of bed or simply looking up).

Rehder Balance & Hearing Clinic provides repositioning treatment options for all forms of BPPV. There are several different approaches in the management of otolith dysfunction. These treatment protocols reposition the otoliths which have escaped from the utricle and are now floating in the semicircular canals back to the vestibule where they are reabsorbed. The procedure usually takes about 10-20 minutes. A 95% cure is usually obtained as an end result although some patients need to be treated more than once. It is nonsurgical, painless and has few if any side effects. Sometimes patients may experience mild transient vertigo for a few days afterward

Vestibular Neuronitis

Vestibular Neuronitis presents as a sudden episode of vertigo without hearing loss in an otherwise healthy person. The disorder can occur as a single attack or can present as multiple attacks. It occurs more often in spring and early summer and as a result, is often associated with an upper respiratory infection.The onset of vertigo is sudden and typically associated with nausea and vomiting and can last for a period of days with gradual improvement over the following weeks. The disorder is often followed by episodes of benign positional vertigo.


Labyrinthitis is an inflammatory process occurring within the membranous labyrinth which may have a bacterial or viral etiology. Viral infections produce symptoms of dizziness similar to vestibular neuronitis except that there is cochlear dysfunction as well. Congenital measles, rubella and cytomegalovirus infections frequently cause vestibular symptoms. Bacterial labyrinthitis can present in a superlative form with direct involvement of the membranous labyrinth by the pathogen or in a serous form. The serious form is often seen with acute otitis media when diffusion of bacterial toxins cross the round window membrane.

Labyrinthine Ischemia/Ear Stroke

Labyrinthine Infarction leads to a sudden profound loss in auditory and vestibular function and typically occurs in older patients. This phenomenon can be seen in younger patients with atheroscelortic vascular disease or hypercoagulation disorders. Episodic vertigo may herald a complete occlusion in the form of a type of transient ischemic attack. After complete occlusion, the acute vertigo that ensues will subside often leaving the patient with some residual unsteadiness and disequilibrium over the next several months while vestibular compensation occurs

Meniere's Disease

Meniere's Disease, an inner ear disorder characterized by episodic vertigo attacks, sensorineural hearing loss, tinnitus, nausea, and pressure or fullness in the involved ear. Initially the hearing loss involves the lower frequencies and fluctuates, usually worsening with each attack. The attacks are characterized by true vertigo usually with nausea and vomiting lasting hours in duration. Histopathologically, this disorder is felt to be due to dilation of the endolymphatic space (hydrops) which ruptures the membranous labyrinth. Variants of the disease do occur including dizziness without associated auditory symptoms. Recently, it has been suggested that Meniere's Disease is a form of Autoimmune Disease.

Perilymphatic Fistula

Perilymphatic Fistula represents an abnormal communication between the perilymphatic space of the inner ear and the air containing space of the middle ear. The existence and pathophysiology of this disorder is still heavily debated. Nevertheless, there is evidence to support such an occurrence in association with head trauma or barotraumatic injuries. This problem can also occur after stapes surgery and spontaneous fistula are believed to exist. Patients typically present with fluctuating progressive sensorineural hearing loss, episodic vertigo, and tinnitus.

Acoustic Neuroma/Vestibular Schwannoma

Acoustic Neuroma is more appropriately known as a Vestibular Schwannoma. It is a benign neoplasm that typically arises from the vestibular portion of the eighth cranial nerve. The lesion grows slowly and causes a progressive sensorineural hearing loss. Because of the gradual destruction of vestibular function on the involved side, patients may not present with complaints of dizziness.

90 Million Americans will experience dizziness or balance problems sometime in their lives. Listed below are common complaints or problems reported by patients.

Have you ever felt....?

  • A feeling of motion, spinning, or falling when moving your head quickly, or changing your position, e.g. getting in and out of bed?
  • Uncomfortable trying to get around in the dark?
  • Walking down grocery store aisles or through the mall is upsetting?
  • Your feet just won't go where you want them to?
  • A sense of unsteadiness? A feeling you are not surefooted?
  • A fear of falling or stumbling?
  • Looking at moving objects such as escalators or looking out the side window of a car makes you queasy?
  • Difficulty keeping your balance as you walk on different surfaces, e.g. tile to carpet?
  • A feeling like you are drifting or being pulled to one side when walking?
  • No one really understands how frustrating all this is?
If you have answered "yes" to one or more of these questions, a vestibular evaluation should be considered.