How are Vestibular Disorders Diagnosed?

Doctors use information from a person’s medical history and findings from a physical examination as a basis for ordering diagnostic tests to assess the vestibular system function to rule out alternative causes of symptoms.


The vestibular and visual systems are connected to each other and to the muscles in the eyes and neck that help maintain good balance.  Head movements or other stimulation of the inner ear sends signals through the nervous system to control eye muscle movements.  This forms a reflex pathway called the vestibule-ocular reflex, or VOR.  This system is designed to generate eye movements that maintain clear vision when the head is in motion.  Many vestibular tests use equipment to monitor the eyes for normal and abnormal movements when the vestibular system is stimulated.

  • Electro/Video-Nystagmography (ENG or VNG)


  • Rotation Tests


  • Video Head Impulse Testing (VHIT)


  • Vestibular Evoked Myogenic Potential (VEMP)


  • Computerized Dynamic Postugraphy (CDP)



Audiometry measures hearing function.  Hearing evaluations are an important part of vestibular diagnostics, because the inner ear contains both hearing and balance organs.

  • Pure Tone Audiogram
  • Speech Audiogram
  • Immitance testing (Tympanogram and Acoustic Reflexes)
  • Oto-Acoustic Emissions (OAE)
  • Electrocochleography (ECOG)
  • Auditory Brainstem Response Test (ABR)



An MRI of the brain can reveal the presence of tumours, stroke damage, and other soft-tissue abnormalities that might cause dizziness or vertigo. MRIs of structures in and around the inner ear can be helpful in the diagnosis of some vestibular disorders.



A CT scan is an X-ray technique that is best for studying bony structures.  The inner ear is inside of the skull’s temporal bone on each side.  These scans are often used to look for abnormalities around the inner ear, such as fractures or areas with thinning bone.


  • An Audiologist for hearing and balance related testing.
  • Physio Therapist for gait or balance related testing.
  • A Radiologist for imaging testing.


What are the Symptoms of a Vestibular Disorder?


  1. Vertigo and Dizziness
  • Spinning sensation, an illusion of movement of self or the world (vertigo)
  • Lightheaded, floating, or rocking sensation (dizziness).
  1. Balance and Spatial Orientation
  • Imbalance, stumbling, difficulty walking straight or turning a corner.
  • Clumsiness or difficulty with coordination.
  • Difficulty maintaining straight posture.
  • Tendency to touch or hold onto something.
  • Difficulty finding stability in crowds or in large open spaces.
  1. Vision
  • Trouble focusing or tracking objects with the eyes
  • Discomfort from busy visual environments such as traffic, crowds, stores and patterns.
  • Sensitivity to light, glare and moving flickering lights
  • Sensitivity to certain types of computer monitors and digital televisions.
  • Poor depth perception.
  • Increased night blindness, difficulty walking in the dark.
  1. Hearing changes
  • Hearing loss, distorted or fluctuating hearing.
  • Tinnitus (ringing, buzzing or other noises in the ear).
  • Sensitivity to loud noises or environments.
  • Sudden loud noises may increase symptoms of vertigo, dizziness, or imbalance.
  1. Cognitive
  • Difficulty concentrating and paying attention, easily distracted.
  • Forgetfulness and short-term memory lapses.
  • Confusion, disorientation, difficulty comprehending directions or instructions.
  • Mental and physical fatigue


Causes of Dizziness

  • Dizziness, vertigo and disequilibrium are common symptoms reported by adults.
  • They are all symptoms that can result from a PERIPHERAL VESTIBULAR DISORDER (a dysfunction of the balance organs of the inner ear) or CENTRAL VESTIBULAR DISORDER (a dysfunction of one or more parts of the central nervous system that help process balance and special information).

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  • DIZZINESS = is a sensation of light-headedness, faintness, or unsteadiness.
  • VERTIGO= has a rotational, spinning component, and is the perception of movement, either of the self or surrounding objects.
  • DISEQUILIBRUIM= simply means unsteadiness, imbalance, or loss of equilibrium that is often accompanied by spatial disorientation.
  • The body maintains balance with sensory information from 3 systems:


  1. Vision
  2. Proprioception (touch sensors in feet, trunk, and spine)
  3. Vestibular system (inner ear)

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Vestibular dysfunction is most commonly caused by head injury, aging, and viral infection.  Other illnesses, as well as genetic and environmental factors, may also cause or contribute to vestibular disorders.

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Causes of dizziness related to vestibular system dysfunction are listed below:

  • Acoustic Neuroma: benign tumour growing on the vestibule-cochlear nerve.
  • Autoimmune inner ear disease: occurs when the defence capabilities of a mal-functioning immune system harm the cells of the body that affects the ear. Specific diagnoses include Cogan’s syndrome, Wegener’s granulomatosis, systemic lupus, Sjogren’s syndrome, and rheumatoid arthritis, among others.
  • Benign paroxysmal positional vertigo (BPPV): is a condition resulting from loose otoconia (small crystals of calcium carbonate) that collect within a part of the inner ear.
  • Cervicogenic dizziness: is a clinical syndrome of disequilibrium and disorientation in patients with neck problems that include cervical trauma, cervical arthritis, and others.
  • Cholesteatoma: is a skin growth that occurs in the middle ear behind the eardrum.
  • Enlarged vestibular aqueduct: houses the fluid-filled endolymphatic duct, which is connected to the endolymphatic sac. The function of the duct and the sac are affected when the aqueduct is larger than normal.
  • Labyrinthitis and vestibular neuritis: are inflammations caused by a viral infection that can result in damage to hearing and vestibular function (labyrinthitis) or damage to vestibular function only (vestibular neuritis).
  • Mal de débarquement: is a sensation of rocking or movement that persists after a sea cruise or other form of travel.
  • Méniere’s disease: or primary endolymphatic hydrops, involves abnormalities in quantity, composition, or pressure of the endolymph (one of the fluids within the inner ear). It is a progressive condition.
  • Migraine associated vertigo (MAV): is typical characterized by head pain with symptoms associated with vestibular impairment such as dizziness, motion intolerance, spontaneous vertigo, sensitivity to light and sound, tinnitus, imbalance and spatial disorientation.
  • Otitis media: is a bacterial infection of the middle ear and Meningitis is a bacterial infection of the brain covering that may spread to the inner ear.
  • Otosclerosis: is an abnormal growth of bone of the middle ear that prevents structures within the middle inner ear from working properly.
  • Ototoxicity: is caused by exposure to certain drugs or chemicals that damage the inner-ear nerve hair cells or the vestibule-cochlear nerve.
  • Perilymph fistula: caused by injury, is a tear or defect in the oval or round window, which is small, thin membranes that separate the middle ear from the fluid-filled inner ear.
  • Superior semi-circular canal dehiscence: is an opening in the bone overlying the uppermost semi-circular canal within the inner ear.
  • Secondary endolymphatic hydrops: involves abnormalities in quantity, composition, or pressure of the endolymph. Vascular compression of the vestibular nerve is an irritation of the vestibular portion of the vestibule-cochlear nerve by a blood vessel. 

Hair cells in Cochlea

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Book an appointment by contacting either of our two Pretoria-based Audiology practices today for hearing problems.

Noise-induced Hearing Loss

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  • Sounds can be harmful when they are too loud, even for a brief time, or even when they are both loud and long lasting.
  • These loud sounds can damage sensitive structures in the inner ear and cause noise-induced hearing loss (NIHL).
  • NIHL can be immediate or it can take a long time to be noticeable. It can be temporary or permanent; can affect one ear or both ears.


  • Wear noise protectors
  • If you can’t reduce the noise or protect yourself from it, move away from the noise.
  • If you are exposed to loud sounds, get your hearing tested regularly.

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  • People of all ages who have been exposed to loud noise (85 dB or above) can develop NIHL.
  • The loud noise can be a one-time exposure to an intense sound, such as an explosion, or by continuous exposure to loud sounds over an extended period of time, such as noise generated in a work place. For example road workers working with jack hammers.



  • Most NIHL is caused by the damage and eventual death of hair cells in the cochlea.
  • Human hair cells don’t grow back.


Book an appointment by contacting either of our two Pretoria-based Audiology practices today for hearing problems.

Some Medication can Damage Hearing – Ototoxicity

Medication that can damage hearing - Ototoxicity - audiologist in pretoria

What is Ototoxicity?


Certain medications can damage the ear, resulting in hearing loss, ringing in ear, or balance disorders.  These drugs are considered Ototoxic.

Factors affecting Ototoxicity include:


  • Co-administration with other drugs having ototoxic potential
  • Dose
  • Duration of therapy
  • Concurrent renal failure
  • Infusion rate
  • Lifetime dose
  • Genetic susceptibility


Some Drugs that Cause Ototoxicity include:                                                       

  • Antibiotics
  • Aminoglycosides
  • Vancomycin
  • Chemotherapeutic drugs
  • Platinum containing drugs eg. Cisplatin
  • Diuretics
  • Ethacrynic acid
  • Flurosemide
  • Malaria medicine
  • Quinine
  • Salicylates


  • Ototoxic antibiotics should be avoided during pregnancy.
  • Elderly and people with pre-existing hearing loss should not be treated with ototoxic drugs if other effective drugs are available.
  • The lowest effective dosage of ototoxic drug should be used and levels should be closely monitored.
  • The risk of ototoxicity increases with the use of multiple drugs with ototoxic potential.
  • If possible before treatment with an ototoxic drug, hearing should be tested and then monitored during treatment.


5 Signs you’re going deaf

Hard of hearing or think you’re going deaf? Here’s how to spot the signs and how to look after your hearing.

  • You’re asking people to repeat themselves or using “what?” or “huh?” frequently.
  • You increase the TV or music volume to unreasonably loud levels or sit close to the TV when the volume is adequate for others.
  • You intently watch the faces of speakers or can’t locate the source of a sound accurately.
  • You have difficulty understanding what is said in noisy places such as in pubs or restaurants, even though other people manage to have conversations. You may also actively shy away from participating in conversations.
  • You don’t respond to voices over the telephone or switch ears continually when using the phone.




How to look after your hearing

The ear is a very fragile structure and while it’s not always possible to prevent hearing loss from developing as a result of age, illness or a genetic hearing impairment, it’s predicted that around half of hearing loss cases could be prevented by following a few simple steps:

  • Use ear protection if you work in a noisy environment where it’s too loud to hold a normal speaking-volume conversation.
  • Wear earplugs at loud concerts or night clubs – you should never be left with a ringing in your ears after listening to music.
  • Wear ear protection when shooting/hunting.
  • Don’t insert objects such as fingers, cotton buds, cotton wool or tissue into your ears.
  • Monitor volume levels on your TV, home stereo or car system.
  • Get your hearing checked regularly, especially if you have a family history of hearing loss.
INTERESTING FACT: The majority of individuals suffering from hearing loss are under the age of 65.



5 Tekens van gehoorverlies

Is jy hardhorend of is jy besig om doof te word?  Hier is hoe jy die tekens van gehoorverlies kan identifiseer, asook riglyne oor hoe om jou gehoor te beskerm.

  • Vra jy gereeld vir mense om hulself te herhaal of reageer jy deur die volgende te sê: “wat?”, “ekskuus?”, “sê weer.”
  • Sit jy die TV of radio/musiek se volume uitermatig hoog, of sit jy naby die TV wanneer die volume aanvaarbaar is vir ander.
  • Jy liplees, hou die spreker se gesig fyn dop en sukkel om te lokaliseer waar klank vandaan kom.
  • Jy sukkel om spraak te verstaan in ‘n raserige omgewing soos restaurante. Jy onttrek jouself van gesprekke.
  • Jy sukkel om sekere stemme oor die telefoon te hoor en ruil dikwels ore terwyl jy op die telefoon praat.


Riglyne oor hoe om jou gehoor te beskerm

Die oor is ‘n delikate struktuur en dis nie altyd moontlik om ‘n gehoorverlies as resultaat van ouderdom, siekte of genetiese oorsake te voorkom nie.  Daar word wel voorspel dat minstens die helfte van gehoorverlies gevalle voorkom kon word deur die volgende stappe te volg:

  • Maak gebruik van gehoorbeskermers indien jy in ‘n raserige omgewing werk, waar die geraas so hard is dat dit moeilik is om ‘n gesprek te voer.
  • Dra gehoorbeskermers of oorpluisies tydens musiekvertonings waar die klank baie hard is. Jy moet nooit ‘n gesing/gesuis in jou ore hê na jy na musiek geluister het of blootgestel was aan harde klanke nie.
  • Dra gehoorbeskerming as jy jag of skiet.
  • Moet nooit enige voorwerpe soos vingers, oorstokkies of watte in jou ore druk nie.
  • Monitor die vlak van die TV of radio se volume.
  • Laat jou gehoor op ‘n gereelde basis toets, veral as jy ‘n familiegeskiedenis van gehoorverlies het.




INTERESSANTE FEIT: Die meeste mense wat ‘n gehoorverlies het is onder die ouderdom van 65.





Middeloorinfeksie (Otitis Media)

Hearing Hub Audiologist in Pretoria

Middeloorinfeksie (Otitis Media) – Oudioloë in Pretoria

Seer ore, rooi ore, nat ore – klink dit bekend?

Middeloorinfeksie kom algemeen voor by kinders.  `n Middeloorinfeksie is vloeistof wat opbou in die middeloorsisteem en ontsteek raak.  `n Middeloorinfeksie word ook algemeen aangetref na of tydens `n verkoue.

Vir kinders is dit van kritiese belang om alle spraakklanke korrek te kan hoor vir die aanleer van korrekte taal- en spraakvaardighede.  Kinders moet soveel as moontlik ouditiewe stimulasie ontvang en met `n middeloorinfeksie is daar `n tydelike gehoorverlies teenwoordig wat dus veroorsaak dat hulle uitmis op sekere sagte klanke.  Dit kan lei tot verdere leer- en konsentrasieprobleme, asook lees- en spelprobleme.

Dit is dus van uiterse belang om te verseker dat daar nie `n middeloorinfeksie teenwoordig is nie.

Kom gerus vir `n gehoortoets as u bekommerd is oor u kind se gehoor.

Vloeistof bou op in die middeloorsisteem (die groen gedeelte)



Is een of twee apparate nodig?


Phonak Hearing Aids

Is een of twee apparate nodig?

Ons het twee ore gekry om mee te hoor.Dieselfde geld vir die pas van gehoorapparate. In meeste gevalle is dit noodsaaklik om twee apparate te pas. Indien daar `n gehoorverlies in beide ore is, gaan een apparaat nooit dieselfde effek hê as wat twee apparate het nie. Dit beteken dus ook dat die gehoorverbetering nie so goed is nie en die persoon steeds gaan sukkel om te hoor.

Daar is ook `n afname in gehoor in die oor wat nie gepas word nie. Die brein vereis ouditiewe stimulasie vanaf beide ore om die inligting korrek te prosesseer. Die ore werk dus as `n eenheid op dieselfde manier as wat die brein met sy twee dele werk.Tegnologie in vandag se apparate is uitstekend ten einde gehoorprobleme grootliks op te los.

Om meer uit te vind oor gehoorapparate, moenie huiwer om ons te kontak nie.