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Living Well

Feeling Off Balance? Assessment May Help

Last updated: Jul 11, 2016

VertigoDoes it sometimes feel to you like the world is spinning, or do you get light-headed when you stand up? You could have a balance problem.

Often called vertigo, balance problems are widespread, with an estimated 40 percent of the population experiencing dizziness or balance problems at some point. The condition can make daily functioning, including employment, a challenge. Symptoms tend to increase with age, and are a major factor in falls in older adults.

Treatments Are Available

Effective treatments are available, but the first step is a thorough balance assessment. 

Summit Medical Group audiologist, Dr. Smita Hiremath, CCC/A puts patients through their paces to assess the functionality of balance/vestibular organs because a deficit in these areas may be causing symptoms. The assessments are conducted in SMG’s Westfield, Berkeley Heights, and Florham Park offices.

“There is no typical patient,” says Dr. Hiremath, noting that she has tested 11-year-olds and 89-year-olds. “It can happen to any age group.” Patients describe themselves as feeling “off-balance or dizzy,” or tell me ‘when I walk, I feel like I’m steering to one side,’ ” Dr. Hiremath notes.

“They often say, ‘I hope you can find something, because this has been going on for some time,’ ” Dr. Hiremath explains. The condition can go away for years and may return for no apparent reason.

Dizziness Can Occur Suddenly

In the most extreme cases, a patient is referred by an emergency department physician. “Sometimes, people are incapacitated by sudden vertigo,” Dr. Hiremath notes. Vertigo can feel like the person is spinning or the world around the person is spinning. 

People with dizziness and balance issues are more prone to falls, injuries, fatigue, confusion, and headaches, among other problems.

The balance assessment requires some special preparation. Medications that might interfere with the test must be stopped 48 hours before the test, and no alcohol can be used during this time.

Medicines likely to be barred include over-the-counter cold medication, opioids, and meclizine. Patients also cannot eat for four hours prior to the test to avoid feeling woozy and nauseated during the testing.

A buildup of earwax can give invalid test results, so excess earwax should be removed by a health care provider before the test.

Patient’s Symptoms Explained

The most important part of the test is the case history, which includes a detailed account of symptoms, such as when they start and anything that seems to exacerbate or relieve them. A medical history includes any major illnesses, accidents, and injuries.

Next, the assessment moves on to a complete hearing test. Some people object to the hearing test, saying that their hearing is fine, “but there is a close relationship between hearing and balance,” says Dr. Hiremath. The hearing test can provide information about the health and integrity of the external, middle, and inner ear before the balance testing and show if there is any asymmetry in hearing in both ears, which can indicate a possible retro cochlear pathology.

The next part of the wide-ranging, 60-minute test can be a little tedious and disorienting, so Dr. Hiremath explains each step before it begins. Patients are welcome to bring a spouse, friend, or family member along for extra support, if desired. The assessment includes:

  • Video goggles are equipped with a camera to record involuntary eye movements called nystagmus.
  • Monitoring of the patient’s eye movements during positional and positioning maneuvers that gives valuable information about the “otoconia” commonly known as “crystals” in the fluid of inner ear’s semicircular canals, a crucial factor in balance. By moving the patient into different positions, Dr. Hiremath is able to see which type of vertigo the person has. 
  • “Irrigating” each ear with cool, then warm air known as “Caloric Testing”, confirms vestibular system of each ear is working and responding to the stimulation.

Ruling out Problems Is Crucial

Dr. Hiremath encourages people who are struggling with vertigo or dizziness to come in for an assessment. These symptoms can have an array of causes, including high blood pressure. “It could be anything. They need a full workup,” if they experience vertigo symptoms, she advises. “We look comprehensively at the whole patient so they can be helped,” Dr. Hiremath explains.

Some people try to treat themselves by following exercises online that are designed to eliminate dizziness, but Dr. Hiremath has found that is usually not very helpful. The problem is that the exercises are designed to help a specific problem. Unless a doctor diagnoses which semicircular canal is affected, the exercises may make little or no difference.

Once the balance assessment determines the possible cause of dizziness, a multidisciplinary treatment plan may involve various specialists.

Summit Medical Group has team members from different specialties under one roof, including RNs, otologists, neurologists, physical therapists, occupational therapists, and audiologists, who work together and share information regarding the contributing factors that influence each patient’s balance problem. From the initial doctor’s visit to treatment planning, this well-coordinated effort creates a better patient experience.


  1. Balance System Disorders. American Speech-Language-Hearing Association.
  2. National Institute on Deafness and Other Communication Disorders. (2014). NIDCD Fact sheet: Balance disorders [NIH Pub. No. 09-4374]. 
  3. Vertigo-associated disorders. Medline Plus. U.S. National Library of Medicine.