Dizziness & balance disorders
In medicine, dizziness is understood to be a disturbance of the sense of balance, the feeling of turning or swaying, the feeling of not being able to move safely in space, or even the feeling of threatening unconsciousness. Vertigo is one of the most common complaints in Germany. About every 10th patient who visits his or her doctor complains about the feeling of losing orientation in space. For the person affected, this is a very unpleasant sensation, sometimes perceived as threatening, which can go so far that even the simplest everyday activities can no longer be performed. Often it is not easy to find the cause, as there are many different reasons for dizziness. In order to understand them better, it is necessary to take a closer look at how the sense of balance functions. The vestibular system obtains its information from three different systems: the two organs of equilibrium, which are located in the inner ear, the eyes, through which we perceive visual impressions, and the sensors in our joints and muscles, which provide information about posture and movement. If a malfunction occurs in one of the three systems, a conflict of perception arises and the person affected feels dizzy. All incoming information is processed in the brain, so that diseases in this area can also lead to dizziness. Other factors that can influence the vestibular system are medication, cardiovascular diseases and mental illness.
The dizziness consultation
During the initial presentation in the dizziness consultation, we perform a comprehensive diagnosis. Our primary goal in the vertigo outpatient clinic is to identify the cause of the vertigo and to find a suitable therapy. The anamnesis is of central importance in the diagnosis. For this purpose, a detailed conversation between doctor and patient is conducted to establish the exact history of the illness and any pre-existing and underlying diseases. This is followed by a detailed anamnesis on possible triggers of dizziness, the exact symptoms, how long they last and what accompanying symptoms there are. An important role in the diagnosis is also played by whether the patient is taking medication and, if so, which. The next step on the way to a diagnosis is a thorough physical examination of the patient. First of all, the ear, nose and throat area, eye movements using so-called Frenzel glasses and an orienting balance test are examined. This is followed by the apparatus-based examinations, which are intended to provide more precise information about the organs of equilibrium and also the hearing ability than the other part of the inner ear. Of central importance are the tests on the function of the organ of equilibrium, the so-called vestibularis tests. With their help it can be clarified whether the dizziness is caused by disturbances of the organ of equilibrium. Finally, the findings are discussed in a concluding conversation and a therapy is suggested, which in most cases can be started immediately. If we suspect a cause in another specialist area, we help to establish contact with other specialist colleagues.
We test the spontaneous nystagmus including fixation suppression, the optokinetic reactions, positioning nystagmus, the gaze sequence, the rotational nystagmus (eye tremor) and the caloric nystagmus. The latter can be provoked with both water and air.
Vestibular evoked myogenic potentials (VEMP)
By examining the vestibular evoked myogenic potentials we can make statements about the sacculus function and thus diagnose less frequent causes of dizziness.
Video-based Head Pulse Test (vHIT)
The Head Pulse Test is a quick and clear side-specific examination of the vestibulo-ocular reflex. It can provide valuable information for the qualitative estimation of the arch duct function. The test is performed by passive head movements with low amplitude and high acceleration in lateral direction. Patients with a vertibular disorder exhibit corrective saccadic eye movement during or after the head impulse.
With the posturography platform we measure the body sway movements with open and closed eyes.
With the Swaystar© we have a portable system at our disposal, which measures body sway similar to posturography. Since the device is attached directly to the patient's back, a wide range of tests can be carried out, with the focus on recording fluctuations in more complex movements and gait sequences. In this way, important additional information can be obtained, e.g. on the risk of falls of older patients or on the extent of the psychological component of vertigo. The Swaystar© device also serves as an effective therapy for vertigo.
The inner ear consists of the organ of equilibrium and the hearing organ, which is why we perform hearing tests on each patient in addition to the actual examination of the organs of equilibrium. These may include: the tuning fork test, the tone threshold audiogram, the speech audiogram, impedance tests, supra-threshold hearing tests, the derivation of otoacoustic emissions and the derivation of brainstem potentials.
- Ambulatory and stationary vestibular habituation training
- Infusion Therapies
- Rescue maneuvers and storage training
- Timpani tube insert
- Intratympanal injections of cortisone
- Intratympanal injections of gentamycin
- Intratympanal labyrinth anaesthesia
- Referral from your family doctor, ENT physician, neurologist or ophthalmologist
- Health insurance card
- All previous findings, e.g. MRT images on data carriers and doctor's letters
- List of medications you take regularly
Please come to our ENT clinic about 15 minutes before your appointment to register. You should plan 3 - 4 hours for your visit to the vertigo clinic, as we endeavor to provide a complete clarification and consultation. We ask you not to wear eye make-up on the appointment, as this may limit the results of the examination.