Date: Time: Address: 607 S. New Ballas Rd., Ste. 2300, St. Louis, MO Procedures: VNG (pgs 1-5) VEMP ECochG ABR BPPV Maneuver

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1 Enclosed you will find information about the Dizziness and Balance Center at Sound Health Services. This packet has been given to you to further assist your physician in determining the cause of your dizziness and/or balance concerns. Please review the material and complete all the forms 48 HOURS to your appointment. If you have any questions, please call our office at We will call you within 72 hours of your appointment with your doctor to schedule all your tests. Please call us only if you do not hear from us within 72 hours. Audiologist: o Jaime L. Carmody, MS, F-AAA o Other: Date: Time: Address: Procedures: VNG (pgs 1-5) VEMP ECochG ABR BPPV Maneuver Each test listed above has certain restrictions. Please refer to page 4 for instructions. If you are having a VNG in your test battery, you must adhere to ALL restrictions. Please arrive 10 minutes prior to your appointment and have all your forms completed. Thank you. Please read all the materials in the packet and fill out the questionnaires 48 HOURS prior to your appointment. If you have any questions or need to change your appointment, please call *Please note a $50 cancellation/no show fee will be assessed if you do not cancel within 48 hours of testing. 1.

2 Vestibular Testing Videonystagmography (VNG) Patient Instructions Packet PLEASE READ THESE INSTRUCTIONS 48 HOURS PRIOR TO YOUR APPT. **PLEASE NOTE A $50 FEE WILL BE CHARGED FOR ALL NO SHOW APPTS OR APPTS NOT CANCELLED WITH 48 HOURS OF THE TEST DAY** *PLEASE CONTINUE TAKING your blood pressure medications, heart medications, thyroid medication, insulin, estrogen, etc. Always consult with your physician before discontinuing any prescribed medication. Before we can evaluate your vestibular (or balance) system, it is important that you follow these instructions carefully to ensure an accurate and timely test. We ask that you discontinue the following medications for 48 hours prior to your test.* A short list is provided below. If you have any questions or concerns about discontinuing your medications please consult the physician who prescribed the medication to make sure it is ok in your situation. Certain medications can influence the body's response to the test, thus giving a false or misleading result. PLEASE AVOID THE FOLLOWING MEDICATIONS LISTED BELOW: Do not contact our office about your medications, we cannot tell you whether to continue or discontinue the medications. YOU MUST CALL THE PRESCRIBING DOCTOR. Type of Medication ALCOHOL ANALGESICS NARCOTICS ANTI-HISTAMINES ANTI-SEIZURE MEDICATIONS ANTI-VERTIGO MEDICATIONS ANTI-NAUSEA MEDICATIONS SEDATIVES (including sleeping pills) TRANQUILIZERS Examples Beer, wine, cough medicine Codeine, Demerol, Percocet, Darvocet, Oxycodone, Tylenol with Codeine, Phenaphen, Oxycotin, etc. Chlor-trimeton, Dimetapp, Benadryl, Actifed, Teldrin, Triaminic, Claritin, any over-the-counter cold remedies. Dilantin, Tegretol, Phenobarbital Anti-vert, Ru-vert, Meclizine Atarax, Dramamine, Compazine, Antivert, Bucladin, Phenergan, Thorazine, Bonine, Scopalomine, Transdermal, Zofran, etc Trazadone, Halcion, Restoril, Nembutal, Seconal, Dalmane, and any sleeping pill (lunesta, ambien, tylenol PM, etc.) Valium, Librium, Atarax, Vistaril, Serax, Ativan, Librax, Tranxene, Xanex. 2.

3 VNG TESTING: PATIENT INSTRUCTIONS Testing may cause a sensation of motion during testing and after testing. If possible we encourage you to have someone drive you to and from the appointment; however, we realize this is not always possible. If you are unable to be accompanied to the appointment, please allow yourself an extra 15 to 30 minutes after testing before leaving the office. A comprehensive battery of tests will be performed during the ninety-minute appointment allocated for you. Prior to each test an explanation will be given so that you will have a better understanding of what is being tested and why. See the Tests Page for a more detailed explanation of the tests. We make every attempt to make your visit as comfortable as possible. Once your evaluation is completed each part is carefully evaluated and reviewed by the audiologist and your physician. This process is as important as your test, so please understand that your test results will not be discussed in detail at the time of your evaluation. Once the interpretation has been made you will follow up with your referring physician. Eating/Drinking: If you are having a VNG - PLEASE DO NOT EAT for 8 hours prior to your appointment. DO NOT DRINK CAFFEINE ON THE DAY OF YOUR APPOINTMENT, this includes coffee, tea and soda. If your VNG appointment is in the morning before noon, you may have small amounts of fluid such as juice or water. If you must eat something due to a medical condition such as low blood sugar, you may eat a piece of toast or bread. Do not drink any fluids 4 hours prior to testing. If your VNG appointment is in the afternoon, after 1 pm you may eat a light breakfast before 7:30 AM with juice/water and have fluids throughout the morning, however please do not drink within 4 hours of your appointment. What to Wear: Please dress comfortably. If you have impaired vision, you may wear contacts or eye glasses Please DO NOT wear any eye make-up (concealer, eyeliner, mascara, eye-shadow, etc.) What to Bring with you: Copy of any prior balance testing assessments Reports relevant to your testing (if you have them) What to do if you need to change or cancel your appointment: A $50 fee will be assessed for all no show appointments, and appointments not cancelled within 48 hours of the test day. NO EXCEPTIONS. If you are more than 15 minutes late for your appointment, you will be rescheduled to the next available time and may be assessed the no show fee. Please call (314) if you need to change or cancel your appointment. 3.

4 Evaluating & Treating Equilibrium Disorders Tests you may have at your visit Dizziness, vertigo and unsteadiness are symptoms associated with the human equilibrium system and cannot be physically examined. Your physician will request any and/or all of the following studies to assist in the proper diagnosis. 1) Audiologic and Immittance Testing (aka: hearing test and pressure test) These tests should be done prior to your appointment. Balance disorders are often accompanied by changes in hearing and/or the ears function. It is highly recommended that you receive a hearing test prior to any vestibular testing. If you have not received a hearing test within 6 months or after a recent onset of dizziness, please call your physician to obtain the test before coming to this appointment. 2) Videonystagmography Testing (VNG) FOLLOW the EATING RESTRICTIONS This is one test that could be administered at your appointment. This is a sophisticated computer generated test used to evaluate the inner ear fluids, nerve conduction pathways, the central nervous system, and the connections between the inner ear, eye movement and the brain. During testing you will wear infrared camera goggles that monitor your eye movements. You will asked to look at lights on a light bar, you will be put in a series of positions (lying down, sitting up, turning your head side to side) and your ears will be irrigated with cool and warm AIR to see how your balance system is working. 3) Vestibular Evoked Myogenic Potentials (VEMP) NO eating restrictions unless scheduled with a VNG. If deemed necessary, you may also have VEMP testing to test an additional area of your balance system. This test consists of putting some electrodes on your head and neck and having you raise your head up and down when you hear a sound. This test is only administered on patient s 60 years of age and under and only if there are no contraindications of the neck/spine. 4) Electrocochleography (ECochG) SALT LOAD for 1-2 days prior to testing, if scheduled with a VNG, follow the eating restrictions on test day. These tests may be administered if your doctor deems them necessary. These tests are administered by placing electrodes on your head and behind your ears and lying still while listening to sounds in your ears. For 48 Hours prior to this test, you should salt load, in your diet, meaning to eat as many salty foods as you can. During this test, you will have to relax, keep your eyes closed, and if you can sleep, that gives the best results. 5) Auditory Brainstem Response (ABR) These tests may be administered if your doctor deems them necessary. These tests are administered by placing electrodes on your head and behind your ears and lying still while listening to sounds in your ears. There are no restrictions for the test. During this test, you will have to relax, keep your eyes closed, and if you can sleep, that gives the best results. 6) Maneuvers for BPPV FOLLOW the EATING RESTRICTIONS If deemed necessary by the audiologist and your physician, treatment is performed following testing. The treatments administered in our office are for Benign Paroxysmal Positional Vertigo and are called Canalith Repositioning Maneuvers. These treatments are only administered if the audiologist deems them necessary. 4.

5 All about Dizziness and Balance Disorders Understanding Dizziness The balance system consists of three major areas: your vision, your feet (proprioception) and your inner ear (vestibular system). When any of these systems are damaged, the result can be unsteadiness, dizziness, and/or vertigo. Facts about Dizziness Dizziness or loss of balance is the 2 nd most common complaint heard in doctor s offices. It is estimated that dizziness will occur in 70% of the nation s population Vestibular problems may affect individuals of all ages from infants to elderly. Vestibular disorders may be due to syndromes, diseases, trauma or toxins. The symptoms of dizziness or vertigo can occur suddenly, or develop over time. There are over 500 known syndromes or causes that affect the audio-vestibular system. The most common causes of Dizziness 1. Benign Paroxysmal Positional Vertigo (BPPV) symptoms of vertigo lasting seconds that occur with head movement such as looking up/down and/or rolling over in bed 2. Vestibular Neuronitis sudden vertigo without hearing loss that can occur in single or multiple attacks 3. Vestibular Labyrinthitis dizziness or vertigo accompanied with a hearing loss in one ear 4. Meneire s Disease characterized by vertigo, hearing loss, tinnitus, and possible pressure/fullness in the ears 5. Other causes of dizziness, lightheadedness and vertigo may include: cardiac problems, migraines, vision disturbances, hyperventilation, decreased blood flow, dehydration, central nervous system disorders, stress, tension, fatigue, and many more.