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Vestibular & Balance Service

Seeking Balance: Navigating the Vestibular System, Recognising Symptoms and the Power of Tailored Treatment

Vestibular and Balance Services – All About Balance

angli-EAR Hearing is one of the only multidisciplinary clinics outside London to offer both assessment and rehabilitation for vestibular and balance problems.

Why do we need balance?

Everyday tasks such as getting out of a chair, carrying shopping bags whilst walking, or standing on tiptoes to reach an object, all require good balance.

Your brain uses information from the vestibular, visual, and proprioceptive systems, to keep you upright, maintain steady vision when you turn your head, and quickly react if there is a sudden risk of falling.

If you have an issue with one of these systems, it can cause problems with your balance, which may impact your everyday life and ability to do tasks about the house, work, or exercise.

What is the vestibular system?

The vestibular system is a special sensory system that plays an important role in maintaining your balance, orientation, and coordination of movement.

It involves the inner ear and a complex network of structures that work together to tell your brain where your body is in space.

Although amazing and efficient when it is working, disorders involving the vestibular system can cause vertigo, dizziness, and balance issues.

What are some of the symptoms of vestibular and balance disorders?

There are many different symptoms which can occur when a person is suffering from a vestibular or balance disorder. Common symptoms include:

  • Vertigo (e.g., “spinning of the room”)
  • Dizziness (“feeling giddy, foggy, fuzzy, woozy”)
  • Lightheadedness
  • Unsteadiness, imbalance and falls
  • Nausea and Vomiting
  • Visual problems
  • Auditory problems
  • Headache and Migraine
  • Neck and back problems
  • Psychological distress


What are some of the more common vestibular and balance disorders?

There are many different conditions which can cause problems with vertigo, dizziness, and imbalance. The more common vestibular conditions include:

  • Benign Paroxysmal Positional Vertigo (BPPV)
  • Vestibular Neuritis/Labyrinthitis
  • Meniere’s Disease
  • Vestibular Migraine
  • Persistent Postural and Perceptual Dizziness (PPPD)
  • Concussion/Traumatic Brain Injury
  • Age-related vestibular loss and balance problems


Why should you have your vestibular or balance problem assessed?

Although the symptoms of vestibular and balance disorders can be frightening many of the conditions can be effectively managed following a thorough assessment and accurate diagnosis.

Thankfully many symptoms can also be reduced, or resolve completely, with an appropriate treatment plan.

Unfortunately, if vestibular or balance disorders are left undiagnosed and untreated, they can result in a worsening of symptoms, which can lead to increased unsteadiness, a higher risk of falls, reduced confidence, and often a more significant impact on your quality of life.

Vestibular Balance Assessment

Vestibular and Balance Assessment

At angli-EAR Hearing your physiotherapist will perform a thorough targeted examination of your vestibular system to gain a better understanding of your history and presenting symptoms.

After discussing your history and symptoms, your physiotherapist will run through several tests involving eye and head movements, as well as balance and walking.

Additionally, your physiotherapist will perform a number of positional tests, to assess whether you have any positional vertigo.

To enhance the effectiveness of the assessment your physiotherapist will use specialised equipment, including infra-red video goggles – which are essential for a thorough and accurate assessment.

From all the information gathered, your physiotherapist will have gained valuable information about the function of your vestibular system and will be able to discuss these findings with you and answer any questions.


Tailored Treatment and Vestibular Rehabilitation

Following a thorough assessment, you will be provided with a tailored treatment plan. This will include information about the findings from your assessment, education, and effective strategies for ongoing management.

For those individuals with BPPV, you will be treated using the most appropriate repositioning manoeuvres, whilst most other individuals will be given a customised home exercise program.

As part of your treatment plan, your physiotherapist will also discuss with you when would be a suitable time for you to return for a review and reassessment.

We understand the challenges that come with navigating a vestibular or balance problem and are here to provide ongoing support. We want to assist you to live the life you want and to not have to constantly worry about your vertigo, dizziness, or balance problem.

Seeking an assessment from angli-EAR Hearing will assist you in determining the cause of your symptoms and identifying the best pathway forwards regarding self-management and restoring your quality of life.

Vestibular and Balance Appointments:

  • Initial Vestibular and Balance Appointment: 60 minutes / £120
  • Follow-up Vestibular and Balance Appointment: 30 minutes / £60
  • Vestibular and Balance Health Check: 15 minutes / FREE

Our expertise

Our lead Physiotherapist James Saladine, is a highly experienced clinician and educator in the area of vestibular rehabilitation. Prior to joining angli-EAR Hearing he worked in a bustling vestibular rehabilitation practice, as well as taught vestibular rehabilitation to undergraduate physiotherapy students at one of the local universities, in Brisbane Australia.

James holds a Bachelors degree in Exercise and Movement Science, and two Masters degrees; one in Physiotherapy and the other in Neurological Rehabilitation. He has also completed multiple post-graduate introductory and advanced vestibular rehabilitation courses. Including the renowned Competency-Based Vestibular Rehabilitation Course by the Herdman Faculty from the USA. He enjoys staying up to date with the latest in research and evidence-based practice, and regularly attends local and international conferences.

James is registered with the Health and Care Professions Council (HCPC) as well as the Chartered Society of Physiotherapy (CHP). He is also a member of numerous vestibular rehabilitation special interest groups.

We are CQC-registered (Care Quality Commission) and our professional team have been thoroughly examined and assessed, to ensure they are working to the highest possible clinical standards.

Frequently Asked Questions

Vestibular & Balance FAQs

Do I need a referral to access the Vestibular and Balance Service?

No, you do not need a referral to access the Vestibular and Balance Service.

If you do have a referral letter or any other correspondence/reports from relevant investigations, from visits with your GP or any other specialists, please bring it along to your appointment as it can provide valuable insight regarding your presenting condition.

Is there anything I need to do in preparation for the appointment?

Prior to your Initial Vestibular and Balance Appointment you will be emailed our pre-assessment patient intake form as well as a couple of additional forms (including a questionnaire) for you to complete.

Once completed please return these forms to the clinic as soon as possible. If you are unable to complete these forms prior to your appointment, please arrive 15 minutes prior to your appointment to complete the forms within the clinic.

What should I wear to my appointment?

For your appointment, please wear comfortable clothes and footwear.

Do you have Infrared Video Goggles?

Yes, we have access to Infrared Video Goggles for vestibular and balance assessment as well as other specialised equipment.

This equipment is essential for completing a comprehensive assessment of your Vestibular System and identifying the cause or your presenting symptoms.

Will I be able to drive home from the appointment?

In general, if you are able to drive to your appointment you should be able to drive home following.

If your symptoms are highly irritable or you are concerned about driving, we would recommend having a family member or friend drive you instead.

What is the duration and cost of your Vestibular and Balance Appointments?

Vestibular Balance Assessment and Rehabilitation Prices

  • Vestibular & Balance Health Check (15 minutes): FREE
  • Initial Vestibular and Balance Assessment (60 minutes): £120
  • Follow-up Vestibular and Balance Rehabilitation (30 mins): £60

Read more on our Vestibular and Balance Appointments here.

Will I be given exercises to do at home?

This will depend on your diagnosis, findings from assessment, and individual goals.

For many conditions, you will be given a vestibular rehabilitation home exercise program which will involve several exercises for you to complete at home.

These exercises will be individually tailored to your presenting problem, the findings from your assessment, and your goals.

Generally vestibular rehabilitation exercises are fairly simple and require little time, however it is important that you do them multiple times a day and follow the instructions given to you by your physiotherapist.

If you have any questions or concerns regarding your exercises, it is important that you contact angli-EAR Hearing to have a discussion with your physiotherapist. We are happy to hear from you and are here to provide ongoing support as needed.

How many appointments will I need?

This really depends on the complexity of your presentation and your individual goals.

There is one condition which can often be effectively treated within one or two appointments, and you will be assessed for this during your Initial Vestibular and Balance Appointment.

For most other conditions you will be given a vestibular rehabilitation home exercise program and will ideally be reviewed every 2-4 weeks.

Often it can take a matter of months (often 2-3 but sometimes up to 6) before significant improvements are noted, however this does vary between individuals.

I am unsure whether this is the right service for me?

If you are unsure whether our Vestibular and Balance Service is suitable for you, or whether you would be a good candidate for vestibular rehabilitation, please contact the clinic or book yourself in for a FREE 15 minute Vestibular and Balance Health Check with our Vestibular Physiotherapist.

We are more than happy to discuss our service and assist you in trying to find the best solution to your problem.


I need to cancel or change my appointment, will there be a cost to do so?

We are happy to assist you in cancelling or altering the time of your appointment.

We only charge a fee if you do not attend your appointment without notifying the clinic or if you cancel your appointment outside of the cancellation period as agreed at the time of booking your appointment.