We start with VNG as standard to check for normal eye movement. Vertical measurements are always done and abnormal responses are repeated to check consistency.

Our VNG battery:

• Spontaneous Nystagmus

• Gaze

• Smooth Pursuit

• Smooth Pursuit Neck Torsion (if indicated)

• Saccadometry

• Optokinetic Nystagmus (if indicated)

• Ocular Counter Roll (OCR)

• Dynamic Visual Acuity (if indicated)

• Skull Vibration-Induced Nystagmus Test (SVINT)

• Head Shaking Induced Nystagmus

• Positional Testing

If you would like a specific test carried out please let us know: info@northernbalanceclinic.com

We assess the function of all six semicircular canals. VOR gain and the presence of any catch-up saccades are reported for each canal. Where appropriate, we can also advise on the clinical significance of abnormal findings within the broader context of the case. (Example: dispersed catch-up saccades on posterior canal vHIT may represent a normal age-related finding in older adults).

We assess saccular and utricular function using cervical VEMP (cVEMP) and ocular VEMP (oVEMP) testing. As standard, responses are measured at a range of sound intensities to assess response growth and threshold characteristics. In cases of suspected endolymphatic hydrops, we also test responses at different stimulus frequencies to assess VEMP frequency tuning.

Using the Bertec Portable Essential, we perform a modified Clinical Test of Sensory Interaction on Balance (mCTSIB) to objectively assess postural stability and the patient’s use of visual, vestibular and somatosensory information. This can help identify patterns of sensory dependence, impaired sensory integration and the conditions under which postural stability deteriorates.

Our Audiological test battery:

• Pure-tone audiometry, including extended high-frequency testing up to 16 kHz

• Tympanometry, including eustachian tube function testing even if there’s a perforation. We can also test for patulous eustachian tube.

• Acoustic reflex threshold testing

• Otoacoustic emissions (TEOAE and DPOAE)

• Uncomfortable Loudness Levels (ULLs)

• Speech testing (AB Words or BKB sentences)

• Speech-in-noise testing (Quick SIN)

• High resolution otoedoscopy photographs of the tympanic membrane and mastoid cavities.

• Swabs for refractory otitis externa and suppurative otitis media.

Our evoked potentials test battery:

• ABR (Auditory Brainstem Response) on paediatrics and adults.

• CERA (Cortical Evoked Response Audiometry).

• Neuro-ABR (Neurodiagnostic ABR evaluates waveform morphology, absolute and interpeak latencies, and amplitude, with particular attention to Waves I, III and V.)

• Electrocochleography (ECochG or ECoG); we normally use VEMP frequency tuning for suspected Ménière's disease / endolymphatic hydrops, however ECoG can be a useful cross check if the diagnosis is uncertain.