Balance Disorders

Duke's balance disorders experts specialize in inner-ear disorders that affect balance, including:

• Dizziness
• Migraine-associated vertigo
• Meniere’s disease
• Benign paroxysmal positional vertigo (BPPV)
• Vestibular neuritis and labyrinthitis
• Acoustic neuroma
• Perilymph fistula
• Intracranial hypertension
• Mal de débarquement
• Persistent perceptual-postural dizziness

Personalized Rehabilitation Program
We conduct a comprehensive consultation to determine if vestibular rehabilitation therapy will help your dizziness or unsteadiness. This includes an evaluation of your current abilities, such as finding out which positions or movements spark symptoms of dizziness or unsteadiness. Our vestibular rehabilitation therapists then design a personalized rehabilitation program to improve your symptoms, restore function, prevent falls, and enhance your quality of life. We use the initial evaluation of your abilities to track your progress over time. We also have physical therapists who are trained in cognitive behavioral therapy, which can be very helpful for specific types of dizziness.

Comprehensive Balance Function Testing

To pinpoint the cause of your dizziness, Duke’s balance lab uses sophisticated diagnostic tests, including computerized technology that's only available at a handful of centers nationwide. This comprehensive assessment of the balance system gives precise information about how your brain is processing signals from your inner ear. The results provide an accurate diagnosis and also guide decisions about the best treatment for you. Audiologists with extensive training in balance problems conduct the balance function testing and analyze the findings.

Rotational Chair

Measures how well your eyes and inner ears work together. You will sit in a dark room watching various light patterns. At times, the chair rotates while you look straight ahead and chat with the audiologist.

Vestibular Evoked Myogenic Potential (VEMP)

Checks for damage to the ears' vestibular nerves. The audiologist makes recordings from the muscles in your neck and/or eyes while you lie back in an exam chair and listen to sound through headphones.

Videonystagmography (VNG)

A group of tests that measure eye movements as you look at different light patterns and check for signs of balance system dysfunction. VNG testing includes the circulation of warm or cool water through your ear canal. During the exam, you’ll be asked a series of simple questions while the audiologist records eye movements stimulated by the temperature change.

Video Head Impulse Test (vHIT)

The Video Head Impulse Test (vHIT) measures how the eyes move in response to rapid head movements. You wear a device on your head that measures eye movements as the audiologist moves your head. This test allows assessment of parts of the inner ear that previously were not accessible to objective measurement.

Vestibular Rehabilitation Therapy

A special form of physical therapy with specific exercises designed to train your body and brain to make up for inner-ear dysfunction, help you feel steadier on your feet, and relieve or reduce disabling symptoms.

Medications

Depending on your symptoms, treatment may include drugs to reduce nausea and motion sickness (anti-emetics) or vertigo and dizziness (vestibular suppressants such as anticholinergics, antihistamines, and benzodiazepines). In some cases, steroids (such as prednisone) or antibiotics (such as amoxicillin) may also be prescribed. People with migraine-associated vertigo are treated with migraine medications.

Surgery

Some causes of vertigo can be treated with surgery. For example, people with Meniere’s disease who do not improve sufficiently with medical treatment may benefit from surgery or an office procedure.