Balance and Dizziness

If you are experiencing balance and dizziness issues, Levine Hearing can help you get to the bottom of it.

Did you know that Audiologists are health care professionals who diagnose, manage and treat both hearing and balance problems? At Levine Hearing we take a comprehensive look at your hearing and vestibular (balance) systems both individually and together.

85% of dizzy disorders actually originate in the ear, which is why it is an excellent place to start if you are experiencing dizziness or imbalance. The inner ear is our gyroscope that tells our brain how we are moving through the world. Whether we are walking, sitting, turning, or bending, our ears send signals to the brain to help us stay balanced and sure of our surroundings. It is actually a delicate system and so there are many small nuisances that can cause our balance system to get thrown off. Medications, head trauma, and sometimes just bending over or rolling over in bed can lead to dizziness. Sometimes it subsides on it’s own, while other times it is obvious that help is needed.

Levine Hearing’s Balance Center

When Madison founded Levine Hearing in 2015, she was laser focused on helping patients hear better. It wasn’t until her husband experienced a bad bout of vertigo in 2021 that she became acquainted with the very difficult world of dizzy diagnostics in Charlotte. She found that appointments were booked out months and that advanced diagnostic equipment was sorely lacking in Charlotte. This is why she launched Levine Hearing’s premiere balance diagnostic clinic in 2022.

Levine Hearing has equipment that cannot be found within an hour drive of Charlotte. Our full diagnostic battery includes videonystagmography (VNG) equipment, as well as special testing that is determined by your provider after a thorough case history. This can involve rotational chair testing, caloric irrigations, or electrophysiologic testing called a vestibular evoked myogenic potential (VEMP). While the VNG can evaluate only parts of the vestibular system, our comprehensive approach allows us to assess all organs of the ear to help pinpoint exactly where the problem originates. This is why many local Primary Care and Ear, Nose & Throat (ENT) doctors refer patients directly to Levine Hearing for their care.

Who Benefits from Vestibular (Balance) Testing?

Vestibular testing can help to diagnose an acute issue like a sudden case of vertigo but can also be very beneficial for someone who is just encountering a new feeling of being off balance.

If you are experiencing any of these issues below, the insights from a balance test could provide much needed information and guidance.

• Vertigo or dizziness
• Feeling unsteady on your feet
• Falling or feeling like you might fall
• Staggering when walking
• Difficulty getting up from a seated position
• Loss of balance when standing still
• Needing to grab onto something when moving around
• Problems judging distances while walking
• Numbness or loss of sensation in your legs
• Trouble walking on inclined surfaces

Treatment and Referrals

Finding the right diagnosis is the first step to feeling better and more balanced. Disappointingly, the majority of people will bounce between multiple providers over multiple months before finding the correct diagnosis, but as mentioned above, 85% of dizzy disorders actually originate in the inner ear. This is why we recommend addressing inner ear balance testing before going on to other specialties, as it is very likely to be the source of the problem. Discussing your issue with your primary care should always be the first step as they will take a look at current medications, blood pressure, and other issues that could be simple explanations for your balance and dizziness concerns. If these are cleared, consider asking for a vestibular referral at Levine Hearing next.

Patients with Blue Cross Blue Shield and United Healthcare insurance can simply call to “self refer” themselves to our office, while Medicare patients will need a referral from their primary care doctor to our office. We can easily facilitate that paperwork if you call us directly (704) 540-3081. We do have self-pay rates available for those that do not have in-network insurance. We are accepting new patients at this time and would love to help you!

Common Diagnosis and Possible Recommendations

• Benign Paroxysmal Positional Vertigo (BPPV) or positional vertigo: A brief but intense type of vertigo that is triggered by a specific change in the position of the head. You might feel as if you’re spinning when you bend down to look under something, tilt your head to look up or over your shoulder, or roll over in bed. If you have ever heard that “crystals can get out of place in your ear”, this is the condition. BPPV can result from a head injury, or can develop just from getting older. Around 20% of patients evaluated for dizzy concerns will have BPPV which is thankfully fairly easily treatable in the office. In 1 to 2 visits, most patients have complete resolve of their vertigo symptoms.
• Labyrinthitis: An infection or inflammation of the inner ear that causes dizziness and loss of balance. It is often associated with an upper respiratory infection, such as the flu. In some cases, this diagnosis could warrant a prescription from your doctor and in others, vestibular rehabilitation therapy (similar to PT) can help to improve balance and safety.
• Ménière’s Disease: To be diagnosed with Meniere’s disease, you need the trifecta of vertigo, (fluctuating) hearing loss, and tinnitus(a ringing or buzzing in the ear). It is often accompanied by a feeling of fullness in the ear. We often see this diagnosis as a catch-all without proper evaluation of symptoms so consider vestibular testing if you suspect that something else may be going on. There is no cure but symptoms can be anticipated and managed.
• Vestibular Neuritis:An inflammation of the vestibular nerve that can be caused by a virus, and primarily causes vertigo. Similar to labrynthitis, a patient may benefit from prescription treatment, often with a corticosteroid, as well as potential vestibular rehabilitation therapy.
• Perilymph Fistula: A leakage of inner ear fluid into the middle ear. It causes unsteadiness that usually increases with activity, along with dizziness and nausea. Perilymph fistula can occur after a head injury, dramatic changes in air pressure (such as when scuba diving), physical exertion, ear surgery, or chronic ear infections. Common treatments include potential bed rest as well as surgical options
• Mal de Debarquement Syndrome (MdDS): A feeling of continuously rocking, swaying, or bobbing, typically after an ocean cruise or other sea travel, or even after prolonged running on a treadmill. Usually the symptoms go away within a few hours or days after you reach land or stop using the treadmill, but severe cases, can last months. Medications can help although motion sickness medications will not be effective. Vestibular rehabilitation therapy and symptom management are usually primary recommendations.

What to Expect at Your Appointment

• Our comprehensive vestibular testing appointment is usually scheduled for 90-120 minutes.
• A BPPV follow up appointment is usually scheduled for 15 minutes. You will receive instructions prior to your appointment that may tell you to refrain from eating for a period of time prior to your appointment.
• If you are currently taking medications to suppress dizziness symptoms, you may be instructed to stop taking these medications prior to testing.
• You will be sent a case history questionairre prior to your appointment which is quite thorough. This is because case history can sometimes make up 70% of the clinician’s information for diagnosis.
• It is possible that your doctor may be able to diagnose your condition in your appointment, but in some cases, they may need time to construct their diagnosis, in which case they will schedule a phone call with you to review results.