Vestibular Diagnostics and Audiology

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:

  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.