Vestibular problems may affect individuals throughout the life cycle and may occur in infants as well as elderly individuals. Vestibular disorders may be due to syndromes, disease, toxins, or trauma. They may occur suddenly or develop slowly. Disorders of the vestibular system and its interconnections with the brain may cause a variety of serious problems, including falls, imbalance, dizziness, spatial disorientation, and blurring of vision. This position statement discusses the audiologist’s role in the diagnosis and treatment of vestibular disorders.
Education and Training
Audiologists should complete coursework and clinical training in their graduate programs sufficient to allow them to perform and interpret diagnostic vestibular function tests and participate in the treatment of patients.
Patient Care and Safety
In order to enhance patient outcomes by identifying and addressing safety issues, audiologists are encouraged to develop strategies for unanticipated outcomes with their patients. Communicating risks before and after evaluation and treatment procedures can minimize aggravation for both patients and clinicians.
Prior to undertaking the evaluation, it is important for audiologists to obtain a comprehensive medical and family history as well as a list of all medications the patient is taking that could influence test results. Case history should include, but not be limited to, nature and onset of symptoms, duration and frequency of episodes or symptoms, and associated symptoms (e.g., visual changes) provoking or exacerbating conditions.
Evaluations may incorporate clinical and electrophysiological tests of vestibular and extravestibular (vision and somatosensory) systems. Tests may include, but are not limited to, videoculography, electronystagmography, videonystagmography, tests of dynamic visual acuity, tests of active and passive rotation, tests of postural stability, and vestibular evoked myogenic potentials.
The treatment, which has become a standard of care, uses specific exercises to reduce vertigo and to improve gaze and postural stability in individuals with vestibular disorders by facilitating central neural compensation.
Vestibular treatment and therapy protocols may include, but not be limited to, canalith repositioning and liberatory maneuvers for the treatment of benign paroxysmal positioning vertigo; adaptation, habituation, and substitution protocols; gaze stabilization exercises to strengthen and set gain of the vestibulo-ocular reflex; static and dynamic balance activities.
The assessment of treatment outcomes is considered to be an essential part of clinical practice. The assessment of treatment outcomes begins prior to management of dizziness and unsteadiness and represents a baseline measurement.
An interdisciplinary approach to the management of dizzy and unsteady patients may include involvement of primary care and medical subspecialties as well as allied health disciplines including physical and occupational therapy for patients with medical, biomechanical, neuromuscular, and orthopedic comorbidities.
Professional Referrals and Consultations
Audiologists should recognize that patients might present with physical impairment or medical and psychological conditions that may not contribute to their symptoms. Practitioners are encouraged to have available a network of referral and consulting specialists for patients whose problems are not vestibular and who require additional medical, psychological, or therapeutic expertise.
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