University Otolaryngology

                                                                                                                              Head & Neck Surgery, Inc.

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  • Brian E. Duff, MD
  • Sharon E. Gibson, MD
  • Charles M. Ruhl, MD
  • Jan Groblewski, MD
  • Jules M. Friedman, MD

 

Dizziness or imbalance is the second most common reason for visits to the doctors office, second to back problems. 
 
Everyone experiences dizziness differently.  For many, dizziness is experienced as a sensation of lightheadedness or faintness.  Many experience dizziness as the sensation of motion in the absence of movement.  Others report a sensation of spinning in which they are moving or their environment is spinning around them (vertigo).  Describing exactly what you experience when you feel dizzy will aid your physician in determining its cause.
 
Nausea and anxiety may accompany dizziness.  Dizziness can occur along side other symptoms such as pressure or fullness in the head or ears and ringing in the ears (tinnitus).  It is important to report these symptoms to your doctor.  Also the experience of dizziness may affect your ability to maintain balance and perform activities of daily living. 
 
Dizziness is a symptom of a variety of medical conditions.  Underlying causes can be found in the central nervous system and can result from injury or disease.  Dizziness can be experienced as a medication-related side effect.  Cardiovascular problems such as poor circulation, as well as various viral and bacterial infections, have also been linked to dizziness. Most commonly, the experience of vertigo is related to the balance (vestibular) system of your inner ear. 
 
The more specific you can be about when your dizziness began and when it is likely to occur, the more information your physician will have to assist in the diagnosis process.  Sometimes a specific cause of dizziness cannot be identified.  In these cases, the physician is able to rule out serious illness.  The diagnostic process is complex and often requires several tests.  Electronystagmography (ENG), equilibrium platform testing, vestibular function testing (rotary chair) & visual-vestibular integration testing compose our vestibular assessment battery.  ENG testing is performed by an audiologist and is available in all four of our locations.  The remaining tests are available at the Lincoln office only.  The following testing instructions apply to all tests:  
 

Dr. Jules Friedman specializes in Otoneurology and heads the Vestibular Clinic at University Otolaryngology, located in Providence's east side (lower level) and our new handicapped accessible office in East Greenwich. 
 
Office hours vary by location.  Margaret is in the office Monday through Friday 9:00 a.m. to 5:00 p.m. to answer your questions. 
Please call (401)453-5152 if you need further information or would like to book an appointment. 

Center for Vestibular & Balance Disorders/ Vestibular Rehabilitation

Electronystagmography/Videonystagmography (ENG/VNG)
This three-part test assesses your balance system under varying conditions and is performed by an audiologist.  Due to the interconnected nature of your vestibular (balance) system and your visual (occulomotor) reflex, measuring eye movement can provide important information with regard to balance system functioning.  ENG detects and records rapid eye movements, called nystagmus, through the use of electrodes or goggles.  The first part of the test involves following visual targets with your eyes.  In the second part, eye movement is recorded as you lie in different positions.  The final component of this test involves irrigating each ear with cool and warm air.  By irrigating each ear separately, the balance mechanism on each side can be stimulated and measured independently.
 
Dynamic Posturography (Equilibrium Platform Test)
This test will assess the components of your balance system in an upright position.  Testing is performed on a machine, which has the ability to alter specific sensory inputs you use to maintain balance.  You will be closely monitored during the evaluation in addition you will be fitted with a safety jacket to eliminate any risk of falling.  Your task is to try to maintain balance throughout the process.  Six test conditions will be performed using three 20-second trials for each.  This test takes between 20 to 30 minutes.
 
Vestibular Function Test (Rotary Chair Testing)
This test measures the vestibular-occular reflex.  During head movements the vestibular system (located in the inner ear) sends signals to your occular (eye) muscles to stabilize your vision.  This test will assess this reflex.  You will be fitted with a  headpiece that houses two small cameras to record eye movements.  Afterwards, you will be seated in a chair within a six-foot enclosure.  The chair will move slowly back and forth to stimulate the reflex while the mounted cameras record eye movements.  The test is made up of 8 parts, the longest lasting 3 minutes.  Breaks can be taken between tests as needed.  The entire test time should not exceed 30 minutes.
 
Visual-Vestibular Integration Test (Rotary Chair Testing)
Test preparation is described above.  Testing determines your ability to either enhance or suppress your vestibular reflex.  During testing you will be instructed to follow certain targets with your eyes without the chair moving.  Test time is 15 minutes.

 

We offer Vestibular Rehabilitation as a treatment option for our patients with vestibular/balance disorders.  Vestibular Rehabilitation is a form of Physical Therapy that utilizes specialized exercises to address specific areas of the individual's vestibular/balance disorder.  The individual goals of vestibular rehabilitation vary, depending upon the type, cause and duration of vertigo/disequilibrium.   Your physical therapist will work with you to develop a program to meet your specific needs. 

Vestibular Rehabilitation services are offered at our Waterman Street and East Greenwich Locations.

Testing Instructions

  1. Do not take medications for dizziness, tranquilizers, antidepressants, antihistamines or sleeping pills up to 48 hours before your appointment.  If you have questions about specific medications please call the office and one of our physicians will review and give you specific recommendations.  It is not recommended that you discontinue scheduled medications without authorization from your prescribing physician.  
  2. If you are on medication for heart problems, diabetes, blood pressure or seizure disorder, you must continue your daily dose.
  3. Please avoid caffeine for 24 hours prior to the testing.  This is recommended for best test results.  If you have had decaffeinated coffee, or a small amount of caffeine and it has been several hours, you will likely be able to proceed with your test anyway.
  4. Please avoid alcoholic beverages for 24 hours prior to testing.  Alcoholic beverages can negatively impact your testing. 
  5. Please do not wear any facial or eye makeup to your appointment. Dark eye makeup, such as mascara or eyeliner will have to be removed prior to testing as it interferes with our recording equipment which is designed to detect eye movement by focusing in on the darkest part of the eyes, your pupils.
  6. Please allow yourself 60-90 minutes for testing. 
We offer comprehensive balance testing to evaluate each individual and assist in developing treatment strategies.  The following is a description of our testing:

When you book your appointment for balance testing, you will receive a set of instructions to follow prior to your testing.  It is important to review these instructions at least two days prior to your testing to ensure that you are able to follow them.  If you have any questions regarding your instructions, you can contact us and we will be happy to direct you to the appropriate resource to answer any questions you may have.  The pre-test instructions are included below for your convenience.