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Home > Hearing Care Resources > Dizziness, Balance and Vertigo

Dizziness, Balance and Vertigo

Dizziness & Balance Services

Richard A. Roberts, Ph.D. serves as our Director of Vestibular Services. Dr. Roberts’ experience in the areas of dizziness and imbalance is extensive.

The test and treatment protocols we use at Alabama Hearing & Balance Associates were developed and refined while Dr. Roberts served as Director of Clinical Studies at The American Institute of Balance.

Dizziness, vertigo and unsteadiness are symptoms associated with problems in the human equilibrium system and cannot be physically examined. Your physician will request any and/or all of the following studies to assist in the proper diagnosis.



Vestibular (Inner Ear Balance Structure) Tests
These sophisticated computerized tests evaluate the inner ear fluids, nerve conduction pathways, the central nervous system, and the connections between the inner ear, eye movement and the brain.

  • Electronystagmography (ENG) / Videonystagmography (VNG)
  • Auditory Brainstem Evoked Potentials (ABEP)
  • Electrocochleography (ECochG)
  • Electro-oculography (EOG)
  • Dynamic Visual Acuity (DVA)
  • Vestibular Evoked Myogenic Potentials (VEMP)


Sensory Organization Performance (Balance Testing)
Normal balance requires correct information from the balance center portion of the inner ears (vestibular structures), the eyes (vision) and the pressure sensors in the feet, ankles, muscles and joints (somatosensory systems). This test evaluates your postural stability. The seven sensory test conditions isolate each of the three principle balance senses of vision, vestibular, and somatosensory to determine the function of each.

Gans SOP Test


Audiologic Measures
Balance disorders are often accompanied by changes in hearing or other ear function. A thorough evaluation includes computerized testing of the outer, middle and inner ears.

  • Hearing
  • Immittiance
  • Otoacoustic Emissions


Positional Vertigo
Positional vertigo is the most common cause of spinning dizziness and results from displaced calcium carbonate particles (otoconia) into one of the balance structures of the inner ear. The great news is that most patients can be treated using a special “in-office” repositioning maneuver. Only professionals who have received special training should attempt to reposition these particles.

Various Treatment Maneuevers with 80-96% treatment efficacy:

  • Semont Liberatory
  • Canalith Repositioning (Epley)
  • Gans Repositioning
  • Appiani
  • Casani

Our clinicians have expertise in treatment of all subtypes of positional vertigo using appropriate repositioning techniques.

Vestibular Rehabilitation Therapy (VRT)
VRT is a specialized area of rehabilitation that attempts to help patients who have experienced an inner ear (vestibular) problem compensate to the deficit. This is done through an individualized program of vestibular exercises designed to help using three main principles:

  • Adaptation
  • Habituation
  • Substitution

This is another area of therapy that requires special training. Many times, patients with vestibular problems are given traditional balance therapy instead of VRT and they do not improve. Comprehensive vestibular evaluation is the only way to truly differentiate a vestibular problem that may respond to VRT from a more generalized balance problem that will not improve with VRT.

Balance Therapy
This type of therapy is often coupled with fall prevention, activities of daily living, and exercises for strengthening and conditioning. This type of therapy is conducted by Physical Therapists. For the appropriate patient, Balance Therapy works great.

Unfortunately, patients with vestibular (inner ear) problems are sometimes referred for Balance Therapy without an appropriate diagnostic workup by a professional trained in vestibular assessment. They often become frustrated during the therapy process and may give up when VRT would have helped.

This problem underscores the importance of comprehensive vestibular evaluation prior to referral for therapy.

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Alabama Hearing & Balance Associates, Inc.
149 W Peachtree Ave
Foley, AL 36535

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