Evaluation

  • Otoscopic exam – visualizes the ear canal and tympanic membrane
  • Audiometric exam– is a subjective hearing test to evaluate the ear for different frequencies and ability to recognize words at normal or comfortable listening levels.
  • Tympanometry– evaluates the mechanical or middle ear mechanizim
  • Distortion Product OtoAcoustic Emissions– objectively evaluates the outer hair cell function of the cochlea in smaller discrete segments than the audiometric exam.
  • Videonystagmography (VNG)– evaluates the peripheral and central parts of the vestibular mechanism.
  • Vestibulo-Ocular Reflex (VOR)– Evaluates the ability to stabilize gaze to encode the visual neural signal. If the optokinetic system is impaired then normal head movements create blurred vision.

Therapy

There are 4 general categories of therapy. More than one of these may be indicated to make the patient better as quickly as possible.

  • Canalith Repositioning/Liberatory Maneuver.Commonly called Epply maneuvers Designed for an inner ear condition called Benign Paroxysmal Positional Vertigo (BPPV). This condition occurs when the salt-like crystals in the inner ear called otoconia become dislodged and float within the canals of the vestibular system. Treatment includes one or two 20 minute visits as the crystals are gently repositioned.
  • Vestibular Rehabilitation. Designed for the patients whose symptoms may be severe and who requires supervision during exercise. Therapy sessions include the use of vestibular therapy equipment which most people enjoy. For older patients, there is an emphasis on fall prevention. Typically the patient is supervised by a physical therapist or someone trained in vestibular rehabilitation.
  • Balance Re-training. For patients who have a loss of balance, unsteadiness or loss of surefootedness. Most of these patients do not report dizziness or motion intolerance Safety and fall prevention, , and improved participation in everyday activities are the primary goals rather than complete elimination of the symptoms. These activities can be guided and monitored by physical therapists and occupational therapists.
  • Self Directed Exercises. Once a level of competence is accomplished in a directed program then home based therapy can be initiated and the patient completes this on his or her own time. Individual needs and symptoms dictate this type of therapy intervention. When the plan is followed and activities are completed accurately and consistently reduction in their primary symptoms can occur within a two to four week period.