Vestibular Diagnostics and Audiology

Vestibular Diagnostics and Audiology

Vestibular Diagnostics and Audiology

Vestibular neurophysiology is the study of vestibular system function, and Audiology is a scientifically based, clinical discipline that involves the study and assessment of hearing and balance disorders.

The vestibular system uses information from motion sensing organs in the inner ear.  It combines this information with additional information from vision and body senses to create a seamless representation of our orientation within the world.  When this system is compromised, patients experience a variety of symptoms including vertigo, imbalance, disorientation, nausea, cognitive impairment, and vision loss due to oscillopsia (uncontrolled visual motion).

The Vestibular Diagnostic Service at the University of Washington Medical Center (UWMC) provides assessment of vestibular disorders.  It utilizes Ph.D. level providers with a specialization in vestibular and oculomotor neurophysiology to perform and interpret complex diagnostic procedures required to provide an accurate diagnosis of vestibular dysfunction.  A second clinical interpretation of each test is provided by physician otologists, producing a fully integrated clinical assessment.

Services offered include:

  • Comprehensive evaluation of balance, gait, and orientation function
  • Diagnosis of diseases of the vestibular end organs, the vestibular nerve, and the skull base

The Vestibular Diagnostic Service is part of the Otolaryngology/Head and Neck Surgery Center at UWMC.  It is also the diagnostic arm of the Dizziness and Balance Center, which was established in 1996 as a conjoint service of the Departments of Otolaryngology Head and Neck Surgery, Neurology, Neurological Surgery, Ophthalmology, Psychiatry and Behavioral Sciences, and Rehabilitation Medicine.   The Dizziness and Balance Center serves as an intake service into the medical center for patients with complaints of dizziness and imbalance and coordinates multidisciplinary care. In addition to providing expert diagnosis and management of patients with vestibular disorders, the Dizziness and Balance Center has a special mandate to contribute to advancing the clinical science of the vestibular system. Although current diagnostic methods are good, there is still a large gap in the sensitivity and specificity of existing test batteries. Developing new tests and treatments, evaluating their effectiveness, and applying them to patient care are a vital part of the Dizziness and Balance Center’s responsibility. This is in keeping with the reputation of the UWMC as one of the premiere teaching and research hospitals in the U.S.

The Dizziness and Balance Center conducts a multidisciplinary monthly conference for case review and coordination of patient care that is attended by representatives from the sponsoring departments, and clinicians in outside practice in the community. This is a working staffing conference in which problem cases are reviewed and joint treatment plans are instituted. The conference also features a mini-lecture program under the aegis of Dr. Phillips for basic education in vestibular disorders and treatment.

The Dizziness and Balance Center faculty and staff under the direction of Dr. James Phillips and Dr. Jay Rubinstein recently began a human safety and efficacy study of a new vestibular prosthesis for the treatment of vestibular loss and vestibular dysfunction.  The device, which is based on a cochlear implant, is designed to provide electrical stimulation to the vestibular end organs that sense rotation, and to replace balance function with the use of an external gyroscope array and microprocessor which sense head motion in 3-dimensions.  

Vestibular Diagnostic Services

Vestibular neurophysiologists use a wide variety of testing procedures to determine someone’s vestibular status. Working in tandem with a trained physician otologist, the vestibular neurophysiologist can determine what parts of the vestibular system are damaged, how balance and orientation are affected by that damage, and what adaptation has taken place in response to these changes.  These three factors are critical to the diagnosis and treatment of a vestibular disorder.  Patients who are referred for diagnostic services from outside the UWMC will receive the same level of professional assessment and care as internal patients, and the tests will be reviewed by both the neurophysiologist and interpreting otologist before they are forwarded to the referring provider.

The Vestibular Diagnostic Service at UWMC provides a range of evaluations that include:

This test places a patient in a wobbling room to assess balance function under conditions where one or more sensory cues to aid in balance and orientation are compromised. The test can also assess the integrity of the functional reflexes that allow one to maintain balance.
This test evaluates the ability of a patient to see clearly when the head is moving. This computerized test can detect functional changes associated with loss of vestibular reflexes that stabilize the eye.
These tests evaluate the ability of a patient to walk normally in situations which challenge balance, such as when turning the head, or changing direction.
These tests evaluate the function of the vestibular system by rotating the patient in various ways in a computer-controlled motorized chair. Rotational tests are especially useful in assessing bilateral loss of vestibular function, function of the utricle, adaptation to vestibular loss, and central processing of vestibular signals.
The static test evaluates the ability of a patient to perceive vertical orientation using only vestibular cues. The dynamic test evaluates the ability of one of the vestibular organs (the utricle) to inform the brain of orientation with respect to gravity.
These tests evaluate the response of the vestibular end organs to changes in sound and pressure. These tests are useful in identifying a defect in the membranes of the inner ear or in the bone surrounding the inner ear.
These potentials measure activation of reflexes that stabilize the eyes and head in response to head motion by activating eye and neck muscles, respectively. Cervical VEMP (cVEMP) looks at changes in neck muscle activity in response to stimulation of the vestibular end organs with loud sounds, taps, vibration, or electrical stimulation. Ocular VEMP (oVEMP) looks at activation of the eye muscles using similar stimuli. These tests are very good at assessing the function of the vestibular organs and pathways that detect linear motion and tilt with respect to gravity.
These tests evaluate eye movements that normally compensate for rapid head motion. They can detect loss of function in individual end organs in the inner ear. The coil test uses a small contact lens in a magnetic field and can detect very subtle changes in the function of these reflexes.
This test evaluates eye movements that result from problems with the vestibular organs of the ear or nerve, as well as evaluating eye movements that result from abnormal central (brain) processing of movement information.

  Treatment options provided by the Dizziness and Balance Center:

  • Physicians in the Department of Neurology can provide medical treatment of balance and orientation issues related to autoimmune disorders, degenerative disease, orthostatic intolerance, stroke, syncope, transient ischemia, traumatic brain injury, and vestibular migraine.
  • Physicians in the department of Neurological Surgery can provide medical and surgical treatment of balance issues related to acoustic neuroma (Vestibular schwanoma), canal dehiscence, central nervous system tumors and stroke.
  • Physicians and optometrists in the Department of Ophthalmology can provide medical and surgical treatment of vision, eye movement and eye alignment issues produced by central vestibular loss.
  • Physicians and Audiologists in the Department of Otolaryngology - Head and Neck Surgery can provide medical and surgical treatment of many vestibular disorders including acoustic neuroma (Vestibular schwanoma), autoimmune vestibular disorders, benign paroxysmal positional vertigo (BPPV), canal dehiscence, Meniere’s disease, migraine associated vertigo, perlymphatic fistula, vestibular labyrinthitis and vestibular neuronitis.  
  • Physicians in the Department of Psychiatry and Behavioral Sciences can provide treatment of behavioral disorders associated with vestibular loss including anxiety disorders, cognitive changes, memory problems, and mood disorders.
  • Physicians and physical therapists in the Department of Rehabilitation Medicine can provide treatment of peripheral and central balance disorders providing evidence based approaches for the restoration of normal activities through strengthening, changes in postural and gait strategies, adaptation of preserved functions, and the substitution of other inputs, such as visual or body senses, for those that are lost. 

Audiologists are graduate-trained healthcare professionals who evaluate, diagnose, and provide nonmedical treatment to those with hearing loss and/or balance disorders. 

Audiology

The Audiology Service at the University of Washington Medical Center (UWMC) Otolaryngology/Head and Neck Surgery Center is dedicated to the identification, assessment, and treatment of individuals with hearing disorders. The audiology professionals employed at UWMC function as independent practitioners who consult with patients referred for hearing evaluations and rehabilitation services. The audiologists work closely with highly trained vestibular (balance) specialists, otolaryngologists (ear, nose, and throat physicians) and otologists/neurotologists (specialty trained ear surgeons) to develop treatment plans for those identified with hearing and/or balance problems. Through active research programs and collaborations the Audiology Service continually investigates new and improved ways to assess hearing and provide state-of-art treatment options.

Audiologists use various testing procedures to determine someone’s hearing status; whether that be within the normal range or not. The audiologist will determine what parts of the auditory system are damaged and how hearing is impacted (low, middle, or high pitches) and to what extent. If it is determined that an individual has a hearing loss recommendations will be provided as to treatment options such as assistive listening devices, hearing aids, auditory implants, counseling, rehabilitative therapy, and/or, appropriate medical referral.

The Audiology Service at UWMC provides a range of evaluations that include:

Patients listen to tones using headphones or earphones and a bone vibrator that sits behind the ear. The tones are presented at different levels and pitches to help the audiologist determine the degree of hearing loss, if any, and what pitches are most affected.
A rubber probe is placed into the ear that allows the audiologist to measure how well the eardrum (tympanic membrane) is moving. This helps determine whether or not the patient has a middle-ear problem (e.g., an ear infection).
Patients listen to words and/or sentences to determine how well speech can be understood. This helps the audiologist understand how communication might be impacted by any hearing loss that might be present.
These tests measure electrical signals generated in the brain in response to sound using electrodes placed on the scalp, earlobes, or through the eardrum. Results can help determine the type and degree of hearing loss, and verify function of the auditory nerve.
A type of hearing test that measures sound generated by the inner ear (cochlea). A small probe is placed in the patient’s ear that contains a speaker and a microphone. A sound is presented from the speaker and the microphone measures an echo that comes back into the ear canal. This test can be used to measure hearing but also to help the audiologist determine function of the cochlea.
The Audiology Service uses otoacoustic emission testing to screen the hearing of newborn babies.
Certain drugs used to treat patients with cancer can be harmful to hearing (ototoxic). Audiometry testing with very high pitches and otoacoustic emission testing are used to monitor the hearing of patients undergoing therapies and to identify ototoxic effects as early as possible so that alternative treatments for the cancer can be explored.
This test involves measuring the function of the facial nerve using electrodes placed on the face and near the ear.
Hearing aid services are available for patients with hearing loss that is not medically treatable.
Auditory implants are surgically placed devices for individuals for whom hearing aids are not adequate to compensate for hearing loss or for whom the use of hearing aids is not possible.
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