Balance Disorders

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

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

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.

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.

Video/Electronystagmography (VNG/ENG)

A group of tests that measures eye movements as you look at different light patterns and checks for signs of balance system dysfunction. VNG/ENG 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.

Expert Care Produces Excellent Outcomes
Our balance assessment and treatment team includes neurotologists who specialize in vestibular disorders (inner-ear balance system), balance problems, and all forms of dizziness; PhD- and AuD-level audiologists trained in vestibular assessment; and PhD-level physical therapists who work only with vestibular rehabilitation patients.

Research on Balance Programs
Our specialists focus their research on balance problems, including migraine-associated vertigo; Ménière’s disease; chronic, disabling disequilibrium; and viral inner-ear diseases. We are conducting several studies that are providing insights aimed at improving therapies for these often disabling conditions. 

Clinical Trial Access
In addition to receiving the best available current therapies for a variety of vestibular disorders, eligible patients with targeted disorders can choose to participate in clinical trials for new treatments that may become tomorrow’s standard of care.