There are several different types and combinations of vestibular (balance and/or dizziness) disorders. “Vertigo” is not a disorder or a diagnosis, but rather a symptom or description of the symptom or sensation a patient feels. All vestibular disorders can be classified as “central” or “peripheral” vestibular disorders. Central disorders involve the brain, brainstem and/or neurological pathways and is usually treated or managed by a neurologist, ENT and/or neurosurgeon. 

The six most common peripheral vestibular disorders are:

  1. Acute unilateral vestibulopathy,
  2. Bilateral vestibulopathy,
  3. Vestibular paroxysmia,
  4. Meniere’s disease,
  5. Benign paroxysmal positional vertigo (BPPV)
  6. Superior Canal Dehiscence Syndrome (SCDS).

All these peripheral vestibular disorders can be classified in one of three categories, namely:

  1. Bilateral vestibulopathy (BVP)
  2. Acute unilateral vestibulopathy (AUVP)
  3. Inadequate paroxysmal stimulation or inhibition of the peripheral vestibular system.  

Bilateral vestibulopathy (BVP)

The main symptoms of BVP is postural imbalance, instability of gait and blurred vision or inability to focus the eyes on objects while walking or quick head movements. The symptoms worsen in the dark on when walking on uneven surfaces and there are no symptoms when sitting or laying down. 

In older adults, Presbyvestbulopathy can occur where the symptoms are the same as with BVP, but these patients have chronic vestibular syndrome (lasting at least 3 months), postural imbalance or unsteadiness, abnormal gait, chronic dizziness and/or recurrent falls. 

Acute unilateral vestibulopathy (AUVP)

For AUVP the main symptoms are acute, longer lasting spinning vertigo, blurred vision or inability to focus eyes on objects while walking or with quick head movements, tendency to fall in a certain direction and nausea.

Inadequate paroxysmal stimulation or inhibition of the peripheral vestibular system.  

The main symptoms to look for here is to attacks of spinning or non-spinning vertigo or postural imbalance. 

Balance / dizziness testing

Balance disorders and/or dizziness is evaluated by using specialized equipment and tests that not all audiologists have in their practices. A comprehensive balance/dizziness evaluation can take up to 2 hours and several evaluations are done during this time. The audiologist assesses the vestibular components of the ear as well as their functioning and ability to send the right information to the brain.

A comprehensive balance/dizziness test battery consists of the following tests and all of these test results is combined to determine the diagnose and further treatment options.