forest image

Vertigo & Balance

Dizziness and balance issues are a major health concern for patients of all ages, and an estimated 1 in 3 people experience these problems at least once in their lifetime. Each year, dizziness and imbalance result in 5–8 million visits to physician’s offices, and about 1/3 of those are caused by a vestibular, or inner ear, disorder. For patients experiencing dizziness or imbalance, the first step is identifying the cause of the symptoms. Once your condition is assessed and diagnosed, a Louisville vestibular expert at Heuser Hearing Clinic will explain the best treatment options available.

Dizziness & Balance Tests

At Heuser Hearing Clinic in Louisville, vestibular testing procedures are available for patients of all ages. Our assessment procedures ensure we provide each patient with an accurate diagnosis in order to determine the right treatment plan. In most cases, you can expect to undergo a physical examination along with several different vestibular tests. These tests accurately assess whether your balance problems are associated with the inner ear. If the inner ear isn’t determined to be causing your dizziness or imbalance (vertigo), your doctor may recommend further diagnostic testing such as an MRI scan to determine if the problem is neurological or is caused by another underlying condition.

Your otologist or physician will use medical history combined with diagnostic tests to rule out causes of your dizziness and vertigo. Once other serious medical causes have been excluded, an audiologist can help. Audiologists specialize in the diagnosis and treatment of vestibular problems and can perform special tests to determine the cause and assess whether treatment is needed.

A complete vestibular assessment takes approximately two hours. The test is painless but you may feel dizzy or nauseated for some time after the appointment, so we recommend that you arrange for someone to drive you home from the Louisville vestibular center you visit.


Tests to determine the cause or source of dizziness may include a standard hearing test battery in addition to specialized balance tests, electronystagmography, rotational tests, electrocochleography, and more.

Hearing Tests

Audiometric evaluation (hearing test) is often critical to determine the type and location of the vestibular problem, regardless of the presence or absence of hearing loss. The hearing and balance systems share a common location as well as nerve position and fluids, so hearing or ear problems can often provide good information concerning dizziness and imbalance.

Electronystagmogram (ENG) or Videonystagmogram (VNG)

ENG and VNG tests evaluate the function of the vestibular or balance portion of the inner ear. Eye movements are measured while the inner ear is stimulated, either with electrodes in the case of ENG testing or a camera in the case of VNG testing. Heuser Hearing Clinic’s vestibular experts may stimulate movement by requesting eye movement, head movement, or body position changes as well as by presenting cool and warm air into the inner ear.

Balance Function Tests

A balance function exam includes a series of progressive balance challenges to determine the functional relationship between vision, the somatosensory system(skin, joints, and muscles), and the vestibular system—as well as its effects on balance.

Rotational Test

This type of testing evaluates the functioning of the inner ear and central nervous system in response to rotational stimulation. Depending on the patient, we may use different strategies. Rotational chairs tests are common. The stimulation may be either active or passive.

Auditory Brainstem Response (ABR)

ABR evaluations measure the nerve of hearing into the brainstem area. This test is used as needed for patients who may have not previously completed another site of lesion test such as a CT scan or MRI. The test evaluates the function of the auditory system including the inner ear and auditory nerve.

Electrocochleography (ECOG)

An electrocochleogram measures and records electrical responses from the cochlea. This test is often used in conjunction with your medical history and other tests to diagnose a vestibular disorder called endolymphatic hydrops.

Dizziness & Balance Treatment

Treatment is typically managed at one of Heuser Hearing Clinic’s Louisville locations, but in cases where other professionals are needed, we have an extensive referral source as well as on-site multidisciplinary management. There are multiple treatment options available for vestibular disorders. After your balance assessment at a Louisville vestibular center is complete, your doctor will explain your diagnosis and the best treatment plan options for your needs. Most vestibular disorders causing dizziness and imbalance can be treated or managed effectively. Recommendations may include physical or vestibular therapy, medication, diet management, or, rarely, surgical intervention.

Many of our patients are able to manage their symptoms effectively through vestibular rehabilitation therapy (VRT). This is a great option as it doesn’t require patients to commit to taking a long-term medication, change their lifestyle, or undergo surgery. VRT helps many patients control their symptoms completely.


VRT is an excellent treatment option for many different inner-ear conditions. It works so well, in fact, that many of our patients at Heuser Hearing Clinic don’t require any further treatment after completing VRT. This therapy program works to retrain your central nervous system to compensate for vestibular deficits. It can be used to treat most balance problems associated with the inner ear including:

  • Benign paroxysmal positional vertigo (BPPV)
  • Vestibular hypofunction from Ménière’s disease
  • Labyrinthitis
  • Vestibular neuritis
  • Other inner ear disorders
  • Post-surgery rehabilitation

Vestibular rehabilitation therapy is typically administered by a specialist, though your audiologist or otologist may also help to develop your individual treatment plan. In order to develop the right VRT process for your needs, you’ll undergo a complete evaluation that includes some basic coordination tests.

Based on this evaluation, your specialist will develop a series of head, body, and eye exercises that you’ll perform at one of our Louisville vestibular centers and at home. These exercises may intensify symptoms of vertigo or dizziness at first, which can be discouraging for some people. However, after your brain adapts to VRT exercise, you’ll be amazed at how effective these exercises prove to be.

Dizziness & Balance FAQs


Even if your dizziness or vertigo symptoms aren’t serious enough to affect your lifestyle yet, they are likely to worsen over time. We recommend that patients visit our Louisville vestibular center for balance testing before the symptoms increase, as imbalance can create a scary safety concern. If we are able to pinpoint the cause of your dizziness, treating the underlying condition or managing your symptoms may be easier now than later.


Certain medications may change the finding of the examination. Medication prescribed specially for dizziness should not be taken. A patient is encouraged to follow the provided instructions that prohibit most medications that aren’t considered life sustaining. If you’re still unsure, contact your prescribing doctor. Do not discontinue medications for blood pressure control, cardiac or circulatory problems, diabetes, or other medications for similar medical disorders. If you have any questions or concerns about medications, please call us at (502) 584-3573.

We ask that you don’t eat or drink anything for a period of three hours before the time of the test. On the day of the test, please DO NOT drink any caffeinated beverages, use any tobacco products, or wear makeup or face cream. We ask that you do not take any nonessential medications for a period of 48 hours before your appointment time, and that you avoid the following:

  • Anti-dizzy pills
  • Sleeping pills
  • Tranquilizers
  • Antihistamines
  • Narcotics
  • Over-the-counter cold or allergy medication
  • Medications which contain any of the above
  • Alcoholic beverages


The inner ear is divided into three main parts. One part, the cochlea, is the hearing organ. The other two parts, the vestibule and the semi-circular canals, play a role in balance maintenance. The vestibule is a dome-shaped area between the cochlea and semi-circular canals. Its primary role is to let you know how much you are moving forward and backward. The semi-circular canals tell you where your head is in space and provides information relative to angular acceleration. The ear works in conjunction with your vision, muscles, and sense of touch to help you to maintain your balance. Misleading information from any of these areas can cause a patient to be dizzy or unbalanced. Vestibular testing is designed to identify the weakest part or parts of the system so that correction can follow.