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Vestibular Balance

Understanding what controls balance, the symptoms of vestibular problems, assessment and the importance of tailored treatment.

Vestibular Balance Services – All About Balance

Why do we need balance?

Everyday tasks such as getting out of a chair, carrying shopping bags while walking or standing on tiptoes to reach an object all require good balance. Your brain uses information from your senses to keep you upright, maintains steady vision when you turn your head, and quickly corrects posture imbalances by adapting the body to changes as you move.

How does your body balance? 

Good balance is controlled by three systems:

  • What you are seeing
  • Postural information from your muscles and joints
  • Sensations from inner ear’s balance receptors, the vestibular system

What happens when these systems aren’t working? 

If you have a disorder in any of these three functions, your brain relies heavily on the other two sources of information to compensate. However, sometimes the brain is over-challenged, triggering the disorientating symptoms of imbalance. This experience can impact everyday life and affect your ability to perform daily activities such as chores, work or exercise.

What are the symptoms of balance and vestibular problems? 

Symptoms of balance and vestibular problems can include:

  • Feeling unsteady or imbalanced
  • Veering while walking
  • A false sense of spinning, swaying or motion (vertigo)
  • Light-headedness, floating, nausea or wooziness
  • Headaches
  • Concentration difficulties
  • Sleep problems
  • Jelly legs
  • Falls

What are the causes of dizziness and vertigo?

There are many reasons you may be suffering symptoms of imbalance, including medication side effects, Benign paroxysmal positional vertigo (BPPV), Vestibular migraine, Ménière’s disease and natural ageing. See our article on dizziness disorders here.

Why should you get balance symptoms assessed and treated?

If left undiagnosed and untreated, balance and vestibular symptoms can result in worsening unsteadiness, and an increased risk of falls and injury. It may also create anxiety over worsening symptoms and worries about potentially falling often mean loss of confidence, inactivity and reduced independence.

IMPORTANT: If you feel dizzy, unsteady, disorientated and/or lightheaded and experience any of these symptoms IN ADDITION, please attend the nearest A&E hospital or call the emergency services as soon as possible.

Vestibular Balance Assessment

The first step is seeking an assessment to determine the cause of your symptoms and then developing a  treatment and rehabilitation plan that can improve your balance. The goal would be to restore your quality of life.

Our expert Audiologists and Vestibular Physiotherapists specialise in the assessment and treatment of balance and vestibular problems. We have three types of assessment available:

  • Audio-Vestibular Assessment
  • Neuro-Vestibular Assessment
  • Balance and Falls Risk Assessment

If you are not sure what type of assessment you might need or where to start, we also offer a FREE Balance Health Check.

You can self-refer for an assessment if you have any concerns about your balance. We also accept referrals from a primary care doctor (GP), ENT doctor (ear, nose and throat) or neurologist.

Vestibular Balance Assessment

Audio-Vestibular Assessment

The Audio-Vestibular Assessment is recommended if you are experiencing ear or hearing problems as part of your dizziness/unsteadiness symptoms. Such as:

  • A feeling of pressure in your ear or ears
  • A sensation of tinnitus (ringing or whistling) when no external sound is present
  • Change in your hearing levels
  • A feeling of fullness in the ear or ears

We’ll discuss symptoms and explore your medical history to determine the extent of any unsteadiness or dizziness, then learn how this is impacting your lifestyle.

Our highly experienced audiologists will carry out a Full Diagnostic Hearing Assessment to accurately appraise the abilities of all components of your hearing pathway – from outer ear through middle ear and cochlear, and finally how your brain processes auditory information. This test is non-obtrusive, pain-free and performed in a large, sound-treated room.

We’ll also ask you to carry out body movement tests when you are seated, followed by some standing, so we can assess whether your balance is due to vestibular (inner ear) issues, the brain or joints, bones and muscles.

Finally, using our innovative vestibular testing technology, including Video Head Impulse Test (vHIT) and Videonystagmography (VNG), we will also test eye movement, head movement and coordination to further measure your inner ear functionality.

Where we suspect your dizziness/postural instability is due to the brain or nervous system, you may be referred for our Neuro-Vestibular Assessment, for further exploration and a treatment plan to improve your symptoms. We can also refer any causes for your imbalance that are beyond the scope of our clinical services to your doctor, for any further medical investigation where required.

Neuro-Vestibular Assessment

In our Neuro-Vestibular Assessment which is suitable when no hearing or ear-related symptoms are experienced, we investigate your vestibular functionality and balance system. Through this process, we can find where any balance difficulties may originate from, or determine if the dizziness or instability is brain-related.

We’ll conduct a hearing screening test and physical performance-based tests designed to evaluate balance, gait and posture, as well as head and eye coordination. We also test for any neurological disorders, to exclude any brain-related causes for your symptoms.

Where we suspect your dizziness/instability may in fact be due to an audiological disorder, we’ll refer you to our Audio-Vestibular Assessment, for a Full Diagnostic Assessment of your hearing and tests with our audiologists using specialised vestibular technology. This will measure your eye tracking and head movement coordination for any inner ear problems.

Balance and Falls Risk Assessment

If dizziness isn’t one of your symptoms, but you feel unsteady, unsure about your footing, clumsy or concerned about your balance and risk of falling, or had a previous fall and want to prevent it from happening again, we recommend our Balance and Falls Risk Assessment.

This evaluates your balance, mobility and strength, and will identify if you may be at risk of falls.

While imbalance and unsteadiness increase with age, certain medications or inner ear issues, you do not need to already experience unsteadiness for this risk to be assessed. Our Falls Assessment Risk will check whether your balance and gait are within normal range for your age/build and help reduce the possibility of future falls.

Through identifying this risk factor and its causes, our expert Vestibular Physiotherapists can create personalised therapy plans to help improve your balance and decrease your fall risk. We can also make recommendations on how to manage factors in your home, at work or outside that may contribute to an increased fall risk.

Vestibular Balance Assessment Prices:

  • Balance Health Check (15 minutes): FREE
  • Neuro-Vestibular Assessment (1 hour): £120
  • Audio-Vestibular Assessment (1.5 hours): £200
  • Balance and Falls Assessment (1 hour): £120


Vestibular Balance Management

You may only need a one-off assessment to diagnose a condition causing your symptoms, or you could require a follow-up assessment. The number of sessions you will need depends upon your circumstances. This information will be communicated to you by your Audiologist and Vestibular Physiotherapist.

What’s next?

You may be recommended for our leading Vestibular Rehabilitation Therapy (VRT). After assessment, your Audiologist and Vestibular Physiotherapist will discuss your Personalised Home Exercise Programme with you. They will help set your short- and long-term goals through a series of exercises to do at home. Follow-up appointments will be required and the therapist will advise on how often they need to see you in the clinic.

Vestibular Rehabilitation Therapy

Vestibular Rehabilitation Therapy

Our Vestibular Rehabilitation Therapy consists of physiotherapy exercises for your neck, eyes and body that train your brain to use the information from all three sources, improving your balance system and reducing symptoms of dizziness or vertigo. It also works to enhance your confidence in movement, restore your physical activity levels and quality of life, and prevent falls caused through instability.

At angli-EAR Hearing, our physiotherapy rehabilitation plans are personalised for your specific condition, as well as your needs and goals – these are not simply generic exercises. We take a holistic approach with our therapies and your rehabilitation plan may include:

● Physical exercises for at home to improve your standing balance and walking

● Eye and head movement, and coordination exercises

● A management plan of techniques to assist with aspects of daily living and boost your confidence

● Advice on the prevention or reduction of falls

During follow-up visits, our specialist Vestibular Physiotherapist may decide to reassess your symptoms and review the home exercise programme. They will aim to progress your exercises gradually as symptoms improve. The frequency of visits can vary, and duration of rehabilitation may last from as little as a few weeks to several months. Our Vestibular Physiotherapist will discuss this with you and offer appointments lasting between 30 and 60 minutes, depending on your needs.

Vestibular Rehabilitation costs:

  • 30 mins (£80)
  • 45 mins (£120)
  • 60 mins (£160)

Our expertise

All our Audiologists and Vestibular Physiotherapists are highly experienced in delivering diagnostic hearing and balance programmes. Our Audiologists are MSc Audiology qualified,

in addition to certification in International Vestibular Rehabilitation and professional vestibular training. We also hold membership of the Health and Care Professions Council, British Academy of Audiology, Association of Independent Hearing Healthcare Professionals and the British Society of Hearing Aid Audiologists.

Our Vestibular Physiotherapist is MSc in Advanced Neuromusculoskeletal Physiotherapy, qualified and registered with the Chartered Society of Physiotherapy, Member of the International Society of Posture and Gait Research Associations in the UK, Musculoskeletal Association of Chartered Physiotherapists, Association of Chartered Physiotherapists Interested in Vestibular Rehabilitation, Association of Pelvic, Obstetric and Gynaecological Physiotherapy, and the Association of Chartered Physiotherapists Interested in Neurology.

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