At our balance disorders clinic we will help diagnose and treat conditions that affect your balance.
A balance disorder is a condition that makes you feel dizzy or unsteady and can be associated with vertigo (a spinning sensation), nausea, vision problems, fatigue, tinnitus (ringing or other noise in the ears), falls and hearing loss.
If you are worried about any of these symptoms, contact your doctor.
The brain controls balance using feedback received from the inner ear, eyes, and sensors in the joints, muscles and tendons that sense position or movement. A balance disorder can be caused by conditions affecting one or more parts of this system.
The following information provides a brief explanation of the mechanisms, symptoms and causes of balance disorders, as well as balance disorder treatments, lifestyle modifications and research.
This information will help you understand balance disorders, treatment, lifestyle modifications and help you prepare for an appointment at the balance disorders clinic.
The body’s balance system works through a constant process of position detection, feedback and adjustment. It uses communication between the inner ear, eyes, muscles, joints and the brain.
Key terms
Vestibular system: This is the inner ear balance mechanism. Deep in the inner ears, it sends information to the brain’s movement and balance control centre (the cerebellum) about the position of the head.
Cerebellum: The brain’s movement and balance control centre.
Otolith organs: Two pockets in the ear’s vestibular system, which together provide constant feedback to the cerebellum about head movement. They are called the saccule and utricle.
Cupula: The internal sensor in the vestibular system that send messages via the vestibular nerve to the cerebellum
Vestibular nerve: Also known as the balance nerve, this is the nerve that send messages from the vestibular system to the cerebellum in the brain.
Visual system: The eyes, muscles and parts of the brain that work together to let us see.
Otoconia: Tiny crystals in the otolith organs in the vestibular system. They shift around with movement to stimulate tiny hairs, which transmit the message via the vestibular, or balance nerve to the cerebellum.
The inner ear is deep inside the ear, just under the brain. One part is called the vestibular system. It is the inner ear balance mechanism. It is designed to send information about the position of the head to the brain’s movement control centre, the cerebellum.
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The cerebellum is at the back of the head where it meets the spine. It receives messages about the body’s position from the inner ear, eyes, muscles and joints. It then sends messages to the muscles to make any adjustments to posture that are needed to maintain balance. It also coordinates the timing and force of muscle movements that are initiated by other parts of the brain.
The vestibular system in each inner ear is made up of three semi-circular canals and two pockets, called the otolith organs, which together provide constant feedback to the cerebellum about head movement.
Each semi-circular canal is positioned in a different direction, to detect a variety of movements such as nodding or rotating. Head movements cause fluid inside the canals to move and stimulates the internal sensor (cupula) that send messages via the vestibular nerve to the cerebellum.
The two otolith organs (called the saccule and utricle) send messages to the brain about body movement in a straight line (backwards and forwards or upwards and downwards) and also about where the head is in relation to gravity, such as tilting, leaning or lying down. These organs contain small crystals (otoconia) that are displaced during these movements to stimulate tiny hairs, which transmit the message via the vestibular, or balance nerve to the cerebellum.
The vestibular system works with the visual system (eyes and the muscles and parts of the brain that work together to let us see) to stop objects blurring when the head moves. It also helps us be aware of the position of things, for example, when walking, running or riding in a vehicle.
Sensors in the skin joints and muscles also provide information to the brain on movement, including the position of parts of the body in relation to each other and the position of the body in relation to the environment. Using this feedback, the brain sends messages to instruct muscles to move and make the adjustments to body position that will maintain balance and coordination.
Frequently asked questions
You will be supported by our team of specialists, including:
Audiologists: Allied health professionals who assess, prevent and manage hearing and balance disorders.
Ear, nose and throat (ENT) specialists: Medical doctors who specialises in conditions affecting the ears, nose and throat and related structures of the head and neck.
Otologists: A medical specialist focusing on issues related to the ear.
Your GP will need to send a referral to the Eye and Ear, requesting that you see a specialist doctor.
Once a referral is received, a specialist doctor will assess the referral and you will be contacted by the to make an appointment. If you need an interpreter and this is not mentioned in the letter, please call (03) 9929 8234 to book an interpreter for your appointment.
When you arrive you will meet our administrative staff who will check your details and help you complete the required paperwork.
You will then meet with a specialist, who will ask questions to fully understand your medical history and your symptoms. They will also conduct a medical examination.
The assessments will vary depending on your condition, but may include:
an eye movement assessment using video goggles
an assessment of the coordination of your arms and legs
a balance and walking assessment.
The specialist may send you for more tests, for example with a specialist balance audiologist. These tests may include:
Hearing test: The hearing organ (cochlea) and the balance organs are both located in the inner ear, and assessment of hearing function may be necessary to make an accurate diagnosis. In this test you will hear tones of different pitches and you will need to press a button for the sounds you can hear.
cVEMP: This test involves monitoring muscle activity in the neck while the head is raised off the pillow and clicking noises are played through headphones.
oVEMP: The activity of the eye muscles is monitored while the eyes are directed upwards and a tapper is placed on the forehead.
Calorics: Air is inserted into the inner ear and the resulting eye movements are recorded.
Rotational chair: A special chair is rotated back and forth while a camera records eye movements. The chair does not make any sudden movements and the speed is no faster than an office chair being turned.
Video head impulse test (vHIT): Quick but small head movements are performed from side to side and your eye movements are recorded.
A copy of your GP referral letter that includes:
information about your symptoms
a summary of recent test results
details of any treatments that have been carried out
a list of any existing or past medical conditions
an up-to-date list of your current (or recent) medication
your appointment letter
all your medications in their original containers
the written results of any tests if you have them, including blood test results, scans and audiology tests
your Medicare card
the names and addresses of any doctors you see, including GPs and specialists.
If it is your first appointment, you will be asked to complete this BDAS symptom questionnaire final draft . You can complete it at home and bring a printed copy with you, if you prefer.
Allow at least two hours for your visit. If additional testing is needed you will be at the hospital for longer.
Please arrive 15 minutes before your appointment, to complete the paperwork needed.
Once your condition has been identified, you will be given a treatment plan. This may include vestibular rehabilitation therapy.
This is an effective exercise based program that improves the symptoms of dizziness, vertigo and unsteadiness resulting from inner ear conditions. It can help you get back to normal everyday activities like balancing when showering, walking, playing sport, or doing housework. It can help to reduce fatigue and increase independence.
What to expect
The initial assessment will take about one hour.
This service is provided by specialist physiotherapists.
If appropriate, you will be given an exercise program that you can do at home. These exercises are individually tailored to your balance symptoms. Generally the program takes between 10-15 minutes to do and consists of balance and walking exercises to reduce the dizzy feelings you may get with particular movements. The daily program can be done up to three times per day for maximum benefit.
Follow up appointments are 30 minutes and will be organised as required.
The first follow up will usually be scheduled within one to two weeks and any further reviews (up to a maximum of six) are usually one month apart. These sessions are used to monitor your progress and carefully grade the exercise program.
The balance disorders clinic is located at:
Level 1
Blue Wing
32 Gisborne Street
East Melbourne.
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