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Balance Disorders

Feeling dizzy? Head spinning?

Are you scared to turn your head or leave the house?

Is poor balance stealing your quality of life?

Dizziness is the number one complaint of persons over the age of 70 years.  Of all balance dysfunction cases, 85% may be inner ear related.  The inner ear hosts not only the hearing organ, but also the balance organ.  That is why audiologists are involved in balance evaluations.  Poor balance puts patients at risk for falling.  Falls are currently the leading cause of accidental deaths in persons over the age of 65 years.  Many falls can be prevented if the causes of imbalance are investigated and treated properly.

Balance is a specialised field of audiology and requires additional training and accreditation.  Audiologists working with balance disorders evaluate the balance system to identify where the dysfunction occurs.  The balance system is a most complex network involving the inner ear, brain and visual and somatosensory systems to maintain balance and a sense of orientation.  As we move frequently and things also move around us, it becomes a complicated task to maintain exact and accurate orientation of our whereabouts.  It is easily disrupted by even minor changes in any of the involved systems and can lead to imbalance, vertigo or dizziness.  In vestibular testing, a thorough case history together with careful evaluations of the different structures can help us to identify the origin of the problem.  From there we can manage the situation.  Depending on what we find, we may refer to other healthcare professionals, such as ENT specialists, Neurologists, Physio therapists etc.  Often, we can offer and start treatment ourselves, such as Vestibular Rehabilitation Therapy (VRT) or Canalith Repositioning Maneuvers (CRM).  CRM is done when a patient has BPPV, a condition where the “crystals” in the balance organ are dislocated.  VRT is therapy done to help the balance system with compensation.  VRT improves or restores balance function and coordination of head and eye movement.  It also reduces the hallucinations of motion.


Uitstekende en baie professionele diens.

Ek het maande lank met akute vertigo (BPPV) gesukkel en is toe verwys na Hannelie Kroon.  Behalwe vir haar diens wat uitstekend en baie professioneel was, is sy ‘n vriendelike en hulpvaardige persoon.  Alhoewel sy gesê het dat ek waarskynlik 2 behandelings sal benodig, was ek 2 dae ná my eerste eerste behandeling weer 100% reg.  Ek kan haar beslis aanbeveel en sal enige tyd weer van haar dienste gebruik maak.

Anette Moolman

You will always be my hero.

Nandel Gouws you are an amazing person who saved my life literally.  I was treated for eight months for Vertigo and Tinnitus.  My sister Pat went hunting for a solution and found you.  Thank you to your kind receptionist Emmie, who dealt with the initial contact excellently.  I was super excited as I had already been off work for a month – I fainted with no warning and could not sit up at occasions as I was nauseas and my head spinning.  Nandel was extremely professional but I felt as if I was at home.  She was extremely kind and made me feel right at home.  Nothing was rushed, everything was explained in detail of what was being done with all the tests.  It was very interesting and at the end of the appointment Nandel referred me to an ENT.  

I eventually was diagnosed with Arnold Chiari.  Thank you forever Nandel  – without your referral I most probably would still have been on medication that just did not help. It has been three weeks since my operation and I already feel amazing and very lucky to have crossed paths with such an amazing person.  You will always be my hero.


Frequently asked Questions

I was told I have “vertigo”. What does that mean?

Vertigo is a sensation of spinning. It is not a condition, but rather a symptom of a dysfunction. The dysfunction can occur at various levels of the vestibular system, but is typically seen in cases where asymmetrical function between the two different balance organs in the inner ears exist. For instance: If one balance organ is dysfunctional and the other is healthy, the brain receives mixed messages from the two balance organs, causing it to be confused about the body’s orientation. Because the brain can’t orientate himself at that moment, a sensation of spinning will occur. Many conditions can cause vertigo. The balance evaluation is aimed at finding the cause of the vertigo in order to plan the correct treatment.

What does it mean if “the crystals in my ear are loose”?

This is typically how Benign Paroxysmal Positional Vertigo (BPPV) is explained to patients. BPPV refers to a condition where otoconia (the “crystals”) in the balance organ have dislocated to a different area. It results in short bursts of vertigo triggered by head movement. BPPV is the most common cause of vertigo. BPPV cannot be treated with medication. The good news is that it is highly responsive to gravitational treatment maneuvers, as explained in the next section.

What is a “repositioning maneuver”?

Canalith respositioning refers to head maneuvers that are performed to move the displaced “crystals” back into place. The doctor or audiologist moves the patient’s head and body in particular ways, using gravity to shift the crystals. It takes only a few minutes and is highly effective in treating BPPV. Most patients will be clear of vertigo after 1-2 sessions. There are different kind of maneuvers. The type of maneuver that is performed will depend on the location of the crystals, as well as other physical considerations such as neck or back problems.

The doctor says it’s not a middle ear infection, but possibly an inner ear infection – what is the difference?

A middle ear infection occurs in the middle ear behind the ear drum. It is especially common in children and is easily treated by the ENT specialist. An inner ear infection refers to a viral infection in the cochlea (hearing organ) and/or the vestibular nerve of the balance organ. This often results in severe vertigo, sometimes accompanied by sudden hearing loss. The management of these conditions are more complicated. Vestibular rehabilitation therapy is often indicated to help the inner ear to compensate for the loss.

How does therapy work to improve balance?

Vestibular Rehabilitation Therapy (VRT) improves or restores the coordination of head and eye movement. People with vestibular dysfunction will experience a false sense of movement and the brain needs to be trained to change this perception. VRT cannot heal the damaged ear physically, but it works as “brain therapy” to compensate for the damage. Physical exercises using head, eye and body movements are gradually increased in complexity to get used those movements again without experiencing dizziness. Apart from doing these exercises, we use Cognitive Behavioural Therapy techniques to show the patients that they can cope in different situations. The overall goal is to improve the patient’s quality of life and participation in activities.

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