What to expect at your next appointment

Our services focus on the assessment of the function of your inner ear balance organs and hearing to see how they contribute to your symptoms of imbalance and dizziness. We use these assessments to work out the best course of action to help treat and manage your symptoms in conjunction with your Doctor and other relevant health professionals.

Our services are useful to aid in the diagnosis of your balance/dizziness condition and/or to understand how the inner ear is contributing to your symptoms.

Therefore, our services may be useful for any of the following scenarios:

• You have never had a diagnosis or treatment for your balance/dizziness. This includes if you have been told you have 'vertigo', but not a name of the disease that caused your vertigo. This includes if you have not been given options for treatment pathways.
• You have had a diagnosis for your dizziness/balance problems in the past but your symptoms have now changed or are more frequent or severe than before.
• You are still symptomatic and have never seen a specialist or someone who deals specifically with people who are dizzy.
• You would like to begin a pathway for a second opinion.

If you are dizzy for the first time and you don't know what it is, please call the ambulance or go to the emergency department of your local hospital.
If you have a flare up for a known vestibular condition please call the ambulance or visit your doctor who is helping you manage the condition.
The exception to this is if you have been diagnosed with BPPV and your symptoms have not changed. A shorter (30 min) appointment can be arranged for particle repositioning manoeuvres. We will try to get you in at the end of the day as soon as possible.

A referral from a medical practitioner (GP or a specialist) is required in order to bulk bill services under Medicare with no out of pocket expense to you. However, we can also see you without a referral but it will incur an out of pocket expense to be paid on the day of assessment.

Please ask your GP to refer you for Vestibular (Balance) Assessment at Dizzyology. Our service is provided by vestibular audiologists on behalf of Dr John Waterston (who is a Neurologist/Neuro-otologist).

Dr John Waterston does not consult directly with patients at Dizzyology. You will need to organize a referral from your GP to see him separately at Malvern Neurology. Link: https://www.malvernneurology.com.au/

If you have a Medicare card and can get a referral from a GP or specialist, the appointment is bulk billed under Medicare, meaning there is no out of pocket fee to you. We can also see Workcover or TAC patients with a doctors referral and prior approval from TAC or Workcover. If you are to be seen privately (i.e. you do not have a Medicare card &/or referral) then the fee will be determined by the number and type of assessments we undertake on the day and could range from $110-$850. Patients who would like their assessment covered under Health or travel insurance please call us to understand the cost you might expect for your assessment/appointment and to check with your insurance agency to ensure our services are covered under your policy.

Usually, the appointment is scheduled for two hours. While the test time may be shorter depending on your symptoms and test results, you should plan on being at the testing facility for the entire time.

Free on site parking is available. Please park in the parking bays labelled "Dizzyology".

The standard two-hour assessment is well tolerated and doesn't usually provoke dizziness. Two tests that could provoke some symptoms involve turning your head from side to side quickly, and another test involves lying you down with your head to one side. If these types of movements make you dizzy then these movements could provoke dizziness during the appointment. However, the dizziness is usually momentary, and we can adapt or stop any testing at your request.

Other non-routine tests such as the caloric test can also cause dizziness but this is not performed on every patient. If this test has been requested by your doctor we will advise you of what to expect.

If in doubt, please have someone accompany or drive you to your appointment.

A vestibular test battery includes several different tests that will tell your healthcare provider how well the vestibular portion of your inner ear system is working. Your Doctor may order a vestibular test battery if you have symptoms of dizziness, vertigo or feeling off balance. The tests will show if these symptoms are due to an inner ear problem or a neurological (brain) problem and will help your doctor develop the best treatment plan.

The testing is performed by an audiologist (a hearing and balance specialist). During testing, the audiologist will look for the presence of nystagmus (involuntary eye movements) that may be due to vestibular or neurological problems.

The audiologist may perform any of the following tests during your appointment:

• Videonystagmography (VNG): Provides information about how certain parts of the inner ear system and eye reflexes are functioning. This test will require you to wear goggles around your eyes in order to monitor eye movement. You'll perform tasks such as following a target in various directions and moving your head and body into different positions. The other part of this test, which is not always performed is the caloric test. In this test your eye movement responses will be recorded when warm and cool water are put into your ear canal.
• Video head impulse test (VHIT): Provides information on the parts of your inner ear balance system (three semicircular canals) that help detect head movements. For this test, you'll wear goggles to record eye movement while you are told to stare at a target. The clinician will move your head to the right and left or up and down in order to see how well the semicircular canals are working.
• Vestibular evoked myogenic potentials (VEMP): Provides information about how parts of the inner ear balance system (saccule and / or utricle) are functioning. For this test, you'll be reclined on a bed and asked to raise your head off the pillow or stare at a target while you listen to a series of tones.
• Audiometry: This is a test of your hearing. You will be asked to listen to a series of tones and press a button when you hear it. As the hearing organ is connected to the balance organs and some vestibular disorders affect your hearing, we routinely assess your hearing to understand the pattern of your results to aid diagnosis.
• Functional balance: We will ask you to perform some balance tasks such as standing still with eyes open and closed, walking down a hallway with or without head turns.
• Particle Repositioning treatments: Should your test results indicate the presence of a common condition called BPPV, then the audiologist may proceed with treatment. This involves placing your head/body in different positions to reposition tiny crystals called otoconia out of the wrong part of the balance organ to prevent any positionally triggered symptoms.
• Information and counselling: depending on the outcome of your results, the audiologist may provide you with some information about your diagnosis and follow-up recommendations which could include balance physiotherapy, seeing another type of doctor, lifestyle modifications, emotional counselling.

A normal test means there were no signs of vestibular dysfunction as a cause for your reported symptoms.
An abnormal test may mean that there are signs of vestibular (inner ear) and/or neurologic problems contributing to your symptoms.

The healthcare provider who referred you for testing may order more tests to get a better understanding of your symptoms, or you may be referred to see another specialist based on the results of the vestibular test battery.

The audiologist will review the results of the appointment and provide a verbal summary of the results along with any recommendations on the day. In addition, the results will be written up in a report after the appointment and will be sent to the referring doctor. A copy may also be sent to you if requested.

Sometimes additional time is needed to review the test results. If this happens, your audiologist may schedule a later discussion with you and/or prepare this information to be included in the written report.