Vestibular assessment and rehabilitation

About vestibular assessment

Your inner ears contain organs which help you to balance. These are known as the ‘vestibular system’. Your vestibular system measures your head movements and generates reflexes that stabilise your eyes and the rest of your body when you move.

Why your doctor has recommended a vestibular assessment

Many people experience dizziness and imbalance.

Your doctor will refer you to us if they believe your symptoms of dizziness and imbalance may be related to your vestibular system.

If we confirm a problem with your vestibular system, we may be able to offer you some rehabilitation to help you.

If we do not find a problem with your vestibular system, we may be able to give your doctor some other information that can help determine the cause of your problem or manage your symptoms.

Causes of dizziness and imbalance

There are many causes of dizziness and imbalance. It can sometimes be difficult to pinpoint a definite cause.

Common (non-vestibular) causes of dizziness include:

• variations in blood pressure or low blood pressure
• stress, anxiety, panic attacks and phobias
• heart and breathing issues
• side effects of medicines
• dehydration (not drinking enough fluids)
• tiredness
• migraines
• neck problems.

Poor balance can be caused by similar conditions. It can also be caused by physical issues with your joints and your general strength. It is normal for balance to decline as people get older.

There are other, more serious, causes of dizziness and balance but these are rare. Your doctor may refer you for an MRI or CT scan to rule out more serious causes.

How we refer you for the vestibular assessment

We will send you an appointment letter for the Vestibular Assessment Clinic in the Audiology department of Queen Mary’s Hospital, Roehampton. Your assessment will take up to 90 minutes.

Preparing for your assessment

To prepare for your vestibular assessment, do the following.

• Start to think about occasions when you feel dizzy or off-balance. When does this happen and how does it make you feel? It might help to make some notes so you can take this information with you to your assessment.
• Do not wear heavy eye makeup because this can affect some of the assessment tests.
• You can attend wearing your glasses, but it is better to avoid wearing contact lenses because these can affect measurements.

Medicines

• If you take medicines for dizziness, we recommend you stop taking these for 48 hours before your assessment. These medicines include prochlorperazine (Stemetil, Buccastem), betahistine (Serc), cinnarizine (Stugeron) or promethazine (Phenergan). If you cannot stop these, we will take this into account as it may affect measurements.
• Avoid alcohol for 48 hours before the appointment.
• Avoid caffeine for 4 hours before your appointment.

During your assessment

During your assessment, clinical scientists and audiologists who specialise in dizziness and balance will conduct some tests on your vestibular system.

• We will ask you questions about your symptoms and your general health.
• Most tests involve assessing your eye movements. Your vestibular system controls eye movements, so any problem in your vestibular system will cause unusual eye movements.
• Some tests may require us to move your head quickly or to stimulate your vestibular system with vibrations applied to your skull.
• Some tests may need you to track objects with your eyes, and to be in the dark.
• We will ask you to wear goggles so we can track your eye movements. These can feel tight and uncomfortable. You can opt out of this test if you find them too uncomfortable.
• Some tests may also make you feel dizzy or unbalanced. We only conduct these tests when we are sure they can provide us with important information.

If you wear glasses, we will ask you to remove them for some tests.

We only carry out each test after you have given us your consent.

After your assessment

• At the end of your assessment, we will explain your test results to you. We will tell you if we can identify any possible cause for your symptoms.
• We may not be able to identify a cause. If this happens, we may refer you back to the ENT (Ear, Nose and Throat) department or to other specialists for further assessment. Occasionally we need to ask a patient to come back for further tests.
• We will write a report on your assessment.
• When our report is finalised, we will send it to the doctor who referred you to us for the tests. We will also send a copy to you and to your GP.

Treatment or rehabilitation

If we identify a problem with your vestibular system, we may refer you for vestibular rehabilitation (see below) or suggest some exercises for you to try at home.

A common condition is known as BPPV, which is caused by debris floating in the inner ear. If you have this, we can try to treat it on the day by asking you to follow a set of physical movements (for example rolling over) in clinic.

Often, dizziness or imbalance are not caused by a patient’s vestibular system. It is still useful for us to know this. In these cases, we may highlight other possible causes to your doctor.

We may also suggest other referrals for more generalised physiotherapy via your GP.

About vestibular rehabilitation (VR)

If we think you will benefit from vestibular rehabilitation, we will refer you for an appointment at the Kingston Hospital Neurophysiotherapy Department.

Vestibular rehabilitation (VR) involves exercises to help you overcome any problems with your vestibular system. These are designed to help you use other elements of your balance system to compensate for problems. This can help to minimise your dizziness and improve your balance.

If your symptoms are not caused by a problem with your vestibular system, vestibular rehabilitation will be unlikely to help you.