1. Introduction: The Balance System Integration of Multiple Cues To facilitate orientation & navigation To maintain –upright posture –visual focus Through stimulation of –postural muscles –eye muscles

2. Balance Is… the ability to control the center of gravity over the base of support in any given sensory environment

3. Disorders of the Balance System Can Produce: “dizziness,” vertigo, lightheadedness, presyncope, nausea, unsteadiness, vexion, pulsion, ataxia, diplopia, oscillopsia,... With varying degrees of influence on functional health and lifestyle.

4. Disorders of Balance Benign Paroxysmal Positional Vertigo Meniere’s Disease Vestibular Neuronitis Autoimmune Inner Ear Disease Trauma Toxic Substances/Medications

5. Disorders of Balance Migraine Acoustic Neuroma Vascular Disorders Multiple Sclerosis Cervical Vertigo

6. The Audiologist’s Role: Detection Assessment Rehabilitation Referral

7. Case History Nature of the dizziness (true vertigo, imbalance, presyncope) Timing/Duration of Spells What triggers spells? Other otologic symptoms General Health issues Neurologic symptoms

8. Electronystagmography Recording eye movements (nystagmus) Using electrodes to measure the Corneo-retinal potential

9. Video-nystagmography

10. The ENG/VNG Battery Gaze Testing Visual Tracking/Oculomotor Testing Dix-Hallpike Maneuver Positional Testing Caloric Testing

11. The Dix- Hallpike Maneuver

12. Rotary Testing Rotary Chair Vestibular Autorotation Test (VAT)

13. VAT Results

14. Dynamic Posturography Analysis of Sway under conditions which remove or attenuate: Visual Cues and/or Proprioceptive Cues

15. CDP: Sensory Organization Test

16. Medical Management Vestibular Suppressants: benzodiazepenes, antihistimines, anticholinergics Steroids, Glucocorticoids Calcium channel blockers Beta blockers Diuretics Dietary changes

17. Surgical Management Endolymphatic Sac decompression/shunt Labyrinthectomy Gentamycin/Streptomycin Perfusion Vestibular nerve section Posterior Canal Occlusion Perilymph Fistula Exploration

18. Vestibular Rehabilitation Habituation Adaptation Substitution

19. BPPV Management Canalith Repositioning –Epley, –Semont Horizontal Canal Procedures –Barbecue Roll –Appiani –Casani

20. Brandt-Daroff

21. Cawthorne-Cooksey Exercises Regime of movements Graded in difficulty/challenge Eye Head Shoulder & Trunk Sit to Stand Walking up and down slope/steps (Lying in bed, sitting, then standing)