We're here to help you with your Dizziness, Vertigo, & Imbalance Problem

Loren J Bartels MD FACS and Christopher J Danner MD FACS are specialists in dizziness and balance disorders. Both doctors are listed as Best Doctors of America®.

Vestibular Disorders

The Tampa Bay Hearing and Balance Center evaluates people with a variety of balance disorders. Dizziness is abnormal and usually treatable.The dizzy patient evaluation protocol at the Tampa Bay Hearing and Balance Center is organized into several segments. You may read more about the evaluation protocol at Tampa Bay Hearing and Balance Center further down this page and learn more about various disorders of the vestibular system in the menu to the left.

Appointments Available
Monday to Friday from 7:30 AM to 4:30 PM

Appointment Options & New Patient Registration

• Call us at (813) 844-HEAR (4327)
• NEW PATIENTS: Fill out our pre-registration form. Once registered follow our instructions for obtaining the medical history form from your new Patient Portal account.
• EXISTING PATIENTS: Request an appointment via your Patient Portal Account.
• If you would like Text Relay help please use i77.com

Obtaining Medical History Forms

Please call us at (813) 844-HEAR (4327) to obtain your patient portal PIN if you do not have one. You need a PIN number from us before you can access your online patient portal account. Once you have your PIN number log in to your Patient Portal account to complete the Medical Forms. The forms include a checklist of tasks to complete before your appointment, what to bring with you to your appointment, and detailed driving instructions.

Functional Hearing and Balance Assessment

A trained vestibular technician obtains a detailed history of the dizziness symptoms and performs a number of functional balance tests. Among the functional assessments are ability to stand eyes-open, eyes-closed, ability to walk, ability to maintain balance on cushions, ability to maintain balance with visual confusion, and gait testing. Other tests include ability to read an eye chart with head movement, ability to keep the eyes focused during rapid head turns, and symptoms of dizziness during lying-to-sitting and sitting-to-lying action. Other general measures are evaluated, as well. If hearing loss is present, a detailed hearing test is completed.

Physician Examination, Diagnosis, and Plan of Action

When the above information is available, the physician will review all data, obtain more detailed history, and complete the physical examination. The physician considers the possible diagnoses, explains them, and orders any additional tests that seem appropriate.

Diagnostic Testing

Among the additional tests that may be ordered are:

• Videonystagmography (VNG) attempts to determine if dizziness is due to inner ear or brain/other disease. The test checks how the eyes move as a reflex to balance system stimulation.
• Vestibular Autorotation testing (VAT) assesses the accuracy of eye movements during head rotation at various frequencies.
• Auditory Brainstem Responses (ABR) testing checks associated hearing pathways from the inner to the brain since, when the balance system is abnormal, the hearing may also be abnormal.
• Electrocochleography (EcoG) checks ratios of inner ear and hearing nerve output. The ratio is commonly too high in Ménière's disease, indicative of elevated inner ear fluid pressure.
• Other tests such as an MRI and a CT Scan may be ordered.

The brain's ability to maintain balance employs the inner ear, the eyes and a variety of muscle and joint sensors to inform the brain so that the body moves smoothly while in action. For it all to function well, circulation of blood to the brain must be sufficient and stable.

A person who has poor balance might have abnormalities in one or more of these systems. Balance, therefore, is supported by more than the inner ear. Several other organ systems, critical to good balance, might have to be assessed to properly diagnose a person's particular balance problems.

Balance Systems

The following is a brief explanation showing how these systems work together and influence one another:

Inner Ear Semicircular Canals

Each inner ear has five sensory organs. Three canals that sense changes in any direction of rotation and two sensors that detect changes in up-down, side-to-side, and front-to-back motion. Each ear has a duplicate set of these organs that are oriented to present mirror images of the opposite side. The resulting balance system provides an incredibly rich set of information tat keeps a person precisely oriented in space.

Eyes

The eye-brain relationship has two systems that affect balance. The first, the pursuit system, keeps objects precisely focused on the central visual receptors in the eyes. The second, the saccadic system, finds objects in peripheral vision and moves the eyes with exceptional speed and precision to bring the object into the central visual field. Eye problems such as cataracts, eye muscle imbalance and altered eye position can affect precise movement and positioning of the eyes.

Muscles and Joints

The muscles, tendons and joints detect position and tension with special position and pressure receptors.

Brain

The brain combines the information from the inner ears, eyes, muscles and joints in several ways. Decisions are made subconsciously that adjust eye position to keep the environment in stable focus. In other words, the environment does not normally jump or shift during running, walking or riding. Automatic brain signals adjust muscle activity to maintain balance. For common activities, the brain recognizes patterns of movement and anticipates the next actions. Muscles, eyes and thought patterns adjust automatically for expected additional sensory information.

Circulation

The blood's circulatory system has several features that are critical to balance. When shifting body position from either lying or sitting to standing, the muscles in the walls of blood vessels in the legs and the abdomen contract to prevent pooling of blood in those lower areas of the body. A regular heart beat provides uninterrupted circulation of blood to the brain. In the neck and the base of the brain, blood vessel walls free of obstructions maintain low resistance to circulating blood. These multiple mechanisms insure that the head and brain receive an adequate supply of blood.

Functional Assessment

Your first visit at Tampa Bay Hearing and Balance Center as a patient having dizziness will involve an extensive interview and physical performance test evaluating your present use of the major balance systems.

Our Balance System Tested in Six Ways: Clinical examination of sensory integration involves six tests. Three assess the ability to stand on a floor with feet together, eyes open and closed, and the ability to maintain balance with a visual conflict dome on the head. The final three tests are the same as the first three but are performed on a thick cushion. The six tests asses the patient's ability to use all parts of the balance system together.

Oculomotor Function: The oculomotor function tests assess the vestibulo-ocular reflex actions of the eyes to move accurately in several situations:

• Oculocephalic reflex test measures the response of the eyes to quick head movement
• Vestibulo-ocular reflex cancellation looks for eye responses when both the head and a fixed object rotate together
• Otolithic reflex seeks subtle eye shifts with linear, non rotational head movements

Position Tests: Position tests take the patient through several maneuvers to determine whether they provoke dizziness or imbalance. Position testing looks more vigorously for responses to more rapid position changes. Sometimes, the use of special goggles, called Frenzel's lenses, helps the examiner evaluate responses.

Station and Gait Tests: Station and gait tests produce critical information about stability and action. Station testing can evaluate stability with eyes open and closed, feet in normal positions, feet spread apart and one foot directly in front of the other. Stability with a gentle push in any of several directions, can assess ability to correct for unexpected situations. Gait testing looks for unexpected situations. Gait testing looks for instability while walking normally, swinging the head up and down and side to side. For some, gait testing is repeated with the eyes closed in a controlled manner.

General Sensory & Motor Testing: General sensory and motor testing allows the examiner to observe comparative strength of arms, legs, and hips; soft touch and limb position senses; and the accuracy and smoothness of movements.

Balance Therapies

At Tampa Bay Hearing & Balance Center the following treatments are available for certain balance conditions:

• Canalith repositioning procedure (stones or "crystals" in the semicircular ear canal)
• Home exercise program (performed daily)
• Adaptation therapy (motion sensitivity)
• Gait and safety training (reduces fall risk)
• Physical Therapy Referral Services