Balance Disorders

Advanced Hearing & Balance Center is a world-class balance center with an all-inclusive setting designed to restore balance and quality hearing back to your life. We offer innovative solutions for all ages, including pediatric patients. Our patients are often referred by their primary care doctor (general, internal & family medicine), neurologist, otolaryngologist (ENT), and pediatrician. We welcome patient and self-referrals as well.

Serving the DFW Area for over 25 years!

Balance, Dizziness and Vertigo (Vestibular Disorders)

We believe it’s possible to eliminate the many frustrations that come with seeing doctor after doctor – with no real relief.  Our audiologists take an integrated approach to your care – providing accurate diagnosis and treatment to eliminate the time-consuming challenges that come from traveling from specialist to specialist, or to different therapies.  We evaluate and confirm the inner ear involvement, then provide solution and treatment options that are realistic, enjoyable, and feasible.  Our unwavering commitment to our patients sets us apart in the medical community.

Our practice is built on the distinction of trust. We hope you’ll feel empowered and confident in your care at every step. We also believe in patient education. Our support and clinical staff are happy to provide care, resources and consultations that lead you to renewed emotional and physical well-being.
Balance, Dizziness & Vertigo
Balance requires the interaction between many different organs and systems in the body.  The brain is the central processing center for all balance information coming from the senses and for all information going out to the muscles of balance.  Input comes from three main areas: vision, touch (feet and joints), and the balance portion of the inner ear.  

Balance is maintained by the interactions in the brain of nerve impulses from the inner ear, the eye, the neck muscles, and the muscles and joints of the limbs. A disturbance in any of these areas may result in the subjective sensation of dizziness or unsteadiness. General disturbances of body function may lead to dizziness by interfering with coordination of the impulses of the brain.

Feelings of dizziness (abnormal sensation of motion) can mean many different things and are often linked to problems affecting the equilibrium system. Dizziness can be caused by numerous disturbances to any of the different parts of the body.  Common causes for dizziness and imbalance are:
  • Benign Paroxysmal Positional Vertigo (BPPV)
  • Loss of balance and unsteadiness
  • Migraine
  • Vestibular Neuronitis / Neuritis
Reduce or eliminate challenges so you can live dizzy-free.  As one of the country’s most inclusive dizziness and balance facilities, our specialties include:
  • The distinction as one of few facilities of its kind to offer comprehensive diagnostic and therapeutic resources, with specialty in difficult-to-diagnose cases
  • Comprehensive balance testing of all 6 vestibular canals and all 10 end organs of the inner ear vestibular systemPersonalized results evaluation
  • Customized dizziness and balance treatment programs
Our full-service practice also provides audiological evaluation services and hearing loss solutions for adults, teens and children.

Symptoms and Complaints

Meniere’s Disease

Meniere’s disease is often responsible for episodes of vertigo that heighten in severity over a period of minutes, but last for several hours with a gradual improvement during another period of several hours.  Vestibular neuronitis and episodes of labyrinthitis typically present with fairly abrupt onset vertigo (over a period of hours) with resolution of the acute phase over the next several days.  Traumatic injuries or vascular infarction of the labyrinth cause a sudden onset of symptoms with a slow recovery from the acute phase over a period of days to weeks, often with residual effects over a period of 12 to 18 months.

Head Impact Injuries

The Center for Disease Control (CDC), estimates that each year over 20 million children and adults will suffer from concussions, mild traumatic brain injuries (TBI), or head trauma as a result of sports injury, falls, motor vehicle accidents and blunt force trauma. Head impact injuries cause disruption of participation in sports, work, and recreational or just everyday activities. Symptoms associated with head impact trauma may include: dizziness, nausea, blurred or double vision, imbalance, hypersensitivity to light, and cognitive impairment.

The AHBC clinic serves as a resource for referring physicians, specialists, athletic trainers, school and professional sports teams. Through a comprehensive evaluation process, AHBC will provide information regarding the patient’s status, progress, and ability to resume work or play. The evaluation protocols represent the most advanced evidence based studies available from any institution.

Types of Dizziness

Visual DizzinessEye muscle imbalance and poor vision can make one’s balance worse. The brain relies on information from the eyes to help with balance. Car sickness or sea sickness are types of visual dizziness because the eyes are constantly adjusting to a moving visual field and confuses the balance part of the brain. This can lead to dizziness, nausea and vomiting.

Inner Ear Dizziness
Half of the inner ear is used for hearing (the cochlea) and the other half is used for balance (the labyrinth). If the labyrinth or the nerve that connects it to the brain is malfunctioning, dizziness can result. Many types of maladies occur in the inner ear to cause dizziness, including Meniere’s syndrome, labyrinthitis, positional vertigo, and vestibular neuritis, migraine and tumors of the inner ear nerves. These usually cause imbalance, vertigo (spinning), and nausea. It can also be accompanied by tinnitus and hearing loss, if the nearby cochlea is also affected. These diseases will be further explained.

Central Dizziness
Central dizziness is caused by problems in the balance portion of the brain. Anytime this portion of the brain is not working properly, dizziness can occur. Symptoms usually include lightheadedness, disorientation, imbalance, and sometimes even blacking out. Causes of central dizziness include low blood sugar, low blood pressure to the brain, strokes, multiple sclerosis, migraine headaches, head injury, tumors, and the aging process, among others. Treating these types of dizziness usually involves treating the problem which is causing the brain to malfunction.

Muscle-Joint Dizziness
This type of dizziness is uncommon. If the muscles, joints or touch sensors of the limbs are not working well, it becomes difficult for the body to react to motion, and makes it difficult to remain upright. Causes of muscle-joint dizziness include muscular dystrophy; severe diabetes, arthritis, joint replacements, and injuries. Symptoms are usually imbalance and unsteadiness.

Diagnostic Tests

Dizziness can be caused by numerous disturbances to any of many different parts of the body. Based upon your history and physical findings your physician may require further tests to complete a full evaluation. The tests necessary are determined at the time of examination and may include hearing and balance tests, imaging (CT or MRI scans), blood tests, and ultrasound tests. A general physical exam and neurological tests may also be needed.

The most common test for dizziness is the videonystagmogram (VNG). In these tests, the strength of the inner ear is tested, as well as the coordination of eye movements. They involve watching the eye movements after placing warm or cool air into the ear canal. This usually causes a normal sensation of brief dizziness. It is important not to be taking any medications which can affect the test such as Valium, Antivert, alcohol and others. When scheduling this test make sure to ask if your medications will impact the outcome of the tests.

Other tests that are done for dizziness are the electrocochleography (ECoG) and Vestibular evoked myogenic potentials (VEMP).  These painless tests may be useful in determining the cause of dizziness in complex cases.  The object of this evaluation is to be certain that there is no serious or life-threatening disease and to pinpoint the exact site of the problem.  This lays the groundwork for effective medical or surgical treatment.  Diagnosis can often be difficult.  Frequently, multiple tests must be conducted.  Patience and understanding is necessary on the part of the doctor and patient alike.  Prior to your appointment, we will give all patients detailed information so you can better prepare for this testing and prevent further delay in an accurate diagnosis.

Evaluating and Treating Equilibrium DisordersProblems with the equilibrium system can result in dizziness, vertigo, and imbalance. The equilibrium system is very complex and cannot be directly observed. To truly understand a patient’s equilibrium, a number of sophisticated tests must be performed, correlated, and compared.

Balance disorders are often accompanied by changes in hearing and/or ear function. These changes can be acute and hardly noticeable by the patient. Vestibular testing will include comprehensive testing of your outer, middle, and inner ears. These tests include audiologic, tympanometry, immittance, and distortion product otoacoustic emission tests.

A number of complex pathways control our equilibrium.  A comprehensive vestibular evaluation will include sophisticated measures of these pathways and your central nervous system.

These tests are:
  • Sensory Organization Performance (SOP)
  • Videonystagmography (VNG) with Air Calorics
  • Rotary Chair
  • Video Head Impulse Test (vHIT)
  • Vestibular Evoked Myogenic Potential (C-VEMP & O-VEMP)
  • Electrocochleography (ECoG)
  • Posturography (CDP)
  • Auditory Brainstem Response (ABR)
  • Dynamic Visual Acuity
  • Electro-oculography
Tests used to evaluate dizziness and imbalanceAudiometry: Evaluates the hearing portion of a patient’s ear. This allows us to define cause, type and degree of hearing loss. This testing is important for dizzy and off-balance patients because small unnoticed hearing changes can indicate inner ear damage or other medical problems.

Distortion Product Otoacoustic Emissions: This test helps us evaluate the function of the inner ear. This test also helps us further differentiate where an individual’s hearing loss is coming from. This is important for patients who have equilibrium disorders, as it further defines the location of an inner ear problem.

Neurodiagnostic Auditory Brainstem Response (ABR): This test helps us evaluate the neural integrity of the nerve going to the hearing part of the inner ear. This test is often used to further explain why a person might have unilateral symptoms or test findings. This test helps us evaluate the nerve quality and function of the inner ear hearing nerve.

Dynamic Visual Acuity Test: This test is fairly similar to the VAT, but the test protocol is slightly modified. It may be easier for some patients to perform.

Electrocochleography (ECoG): This technique records electricity generated in the inner ear and auditory nerve. The test helps rule out an abnormal accumulation of fluid within the inner ear that may be causing acute attacks of true room spinning vertigo.

Electro-oculography: This testing evaluates very specific eye movements that are coordinated by the equilibrium centers of the brain. Damage to these brain areas can cause dizziness.

Rotary Chair: This advanced test utilizes a computer-controlled motorized chair to stimulate the ear at different speeds. A patient's eye movements are also recorded with video goggles. This test allows us to assess the overall health of the inner ears and how the brain is adapting to a vestibular disorder.

Sensory Organization Test: This test helps us identify balance problems. With careful evaluation, it allows your audiologist to determine the cause of your imbalance and identify a potential fall risk.

Tympanometry / Immittance testing: Helps us rule out fluid in the middle part of the ear, which can impact other vestibular test results. This test also allows us to evaluate nerve responses.

Vestibular Evoked Myogenic Potential (VEMP): This neurological test helps to evaluate a very specific portion of the nerve that goes to the equilibrium part of the inner ear. There are two portions of the equilibrium nerve, and this test evaluates the bottom part of the nerve.

Computerized Dynamic Posturography (CDP): Tests postural stability or the ability to maintain upright posture in different environmental conditions.  Maintenance of postural stability depends on sensory information from the body’s muscles/joints, eyes, and inner ears.  CDP investigates the relationship among these three sensory systems and records the balance and posture adjustments made when different challenges are presented.

Video/Electro-nystagmography (VNG/ENG): This test is composed of a number of subtests. For this testing, a patient wears video goggles or electrodes. These allow us to watch for small eye movement abnormalities, which can indicate an inner ear problem. There are also sub-tests that can help us identify positional vertigo and/or permanent ear damage. This testing also looks at the top portion of the nerve going to the equilibrium part of the inner ear.

Self quiz for dizziness and balance problems

90 million Americans will experience dizziness or balance problems at some time in their lives. Listed below are common complaints or problems reported by patients.

Have you ever felt...

A feeling of motion, spinning, or falling when moving your head quickly, or changing your position, e.g. getting in and out of bed?

  • Yes
  • No

Uncomfortable trying to get around in the dark?

  • Yes
  • No

Walking down grocery store aisles or through the mall is upsetting?

  • Yes
  • No

Your feet just won't go where you want them to?

  • Yes
  • No

A sense of unsteadiness? A feeling you are not surefooted?

  • Yes
  • No

A fear of falling or stumbling?

  • Yes
  • No

Looking at moving objects such as escalators or looking out the side window of a car makes you queasy?

  • Yes
  • No

Difficulty keeping your balance as you walk on different surfaces, e.g. tile to carpet?

  • Yes
  • No

A feeling like you are drifting or being pulled to one side when walking?

  • Yes
  • No

No one really understands how frustrating all this is?

  • Yes
  • No

If you answered YES to one or more of these questions, you may have an equilibrium disorder. The good news is that 90% of the time, these disorders can be successfully treated once they have been properly diagnosed. Schedule an appointment today for a vestibular and equilibrium evaluation with one of our audiologists.

For Health Professionals

How to Refer to UsAt Advanced Hearing & Balance Center, we work with a large network of referring physicians and primary care providers in the greater Dallas/Fort Worth and suburb communities. Currently, Medicare beneficiaries must obtain a physician referral prior to seeing an audiologist in order to have those services reimbursed by Medicare. To assist with your referral, please contact us for a Patient Referral Form and fax to the appropriate office.

Patient Referral Form
Fax Orders For Your Patients
ALL ORDERS should be faxed to (972)733-3852.

To request more information, please call (972)733-3344.

Convenient Office LocationsPlano – Lakes on Tennyson
5048 Tennyson Parkway, Ste. 250
Plano, TX 75024

Grapevine – Carpenter Business Center
1340 S. Main Street, Ste. 190
Grapevine, TX 76051

Consulting Audiology ServicesWe provide forensic and legal consultation regarding hearing loss, tinnitus, and vestibular disorders, as well as audiological worker's compensation examinations. Professional services in consultation with legal counsel are provided at hourly rates. Examination and reporting fees vary upon the specific needs of the case. For more information, contact Marilyn Hinrichs, Au.D., President, Advanced Hearing & Balance Center at (972)733-3344.

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