Madras ENT Research Foundation (P) Ltd

The Vestibular & Balance Laboratory at MERF provides comprehensive assessment and management of dizziness, vertigo, and balance disorders using advanced vestibular diagnostic systems. With a dedicated team led by Dr. Sathiya Murali & Dr. Rajika Ramakrishnan
(Consultant ENT Surgeons – Neurotology & Vestibular Disorders).

Our clinic integrates specialist neuro-otological care with cutting-edge diagnostic technology. Located within a center with extensive experience in Cochlear and Auditory brainstem implantation, the laboratory integrates neuro-otological expertise to accurately evaluate both routine and complex balance conditions, including post-surgical cases.

 

Conditions We Diagnose & Treat

• Benign Paroxysmal Positional Vertigo (BPPV)

• Ménière’s disease

• Vestibular neuritis/Labyrinthitis

• Vestibular migraine

• Bilateral vestibulopathy

• Acoustic neuroma (Vestibular schwannoma)

• Post-traumatic vertigo

• Post-surgical vestibular adaptation

 

Diagnostic Tests Performed

 

Videonystagmography (VNG)

VNG uses infrared eye-tracking goggles to objectively record eye movements during various visual and positional tasks.
This helps identify:

• Spontaneous or gaze-evoked nystagmus

• Positional vertigo patterns (including Dix-Hallpike and roll testing)

• Smooth pursuit and saccadic tracking abnormalities

VNG assists in distinguishing peripheral from central vestibular dysfunction.

 

Caloric Testing (Warm and Cold Water Irrigation)

Caloric testing evaluates the lateral semicircular canal and superior vestibular nerve by irrigating each ear with warm and cold water using standardized bithermal protocols.
This creates endolymphatic flow, producing nystagmus that is recorded and analyzed.

Interpretation of slow-phase velocity responses provides information regarding:

• Unilateral vestibular weakness (canal paresis)

• Directional preponderance

• Symmetry of vestibular function

• Compensation status in chronic or recovering vestibulopathy

Caloric testing remains the reference standard for lateral canal evaluation and is essential in diagnosing:

• Vestibular neuritis / labyrinthitis

• Meniere’s disease

• Bilateral vestibulopathy

• Post-cochlear or ABI vestibular adaptation

 

Video Head Impulse Test (vHIT)

The vHIT Ulmer II system measures vestibulo-ocular reflex (VOR) gain across all six semicircular canals during small, quick head movements.
It allows detection of:

• Subtle peripheral vestibular hypofunction

• Overt and covert saccades

• Patterns of compensation over time

vHIT is particularly valuable in early detection and follow-up of vestibular disorders, including bilateral involvement.

 

Testing Journey for patients

1. Clinical evaluation / referral

2. VNG + Calorics + vHIT testing (approximately 1 hour)

3. Data analysis and interpretation (Report issued within 24 hours)

4. Individualized management plan which may include:

   • Vestibular Rehabilitation Therapy (VRT)

   • Medication adjustment

   • Balance and gait training strategies

   • Surgical evaluation when indicated

This structured process aims to reduce dizziness, improve postural stability, and restore confidence in daily activities.

 

Multidisciplinary Team

The Vestibular Laboratory is supported by:

• Otolaryngologists

• Audiologists trained in vestibular assessment

• Neurologists (as required)

This coordinated approach ensures accurate diagnosis and seamless continuity of care.

 

Appointments & Preparation

Prior appointment needs to be taken :
Monday – Saturday, 1:00 PM to 4:30 PM (via Reception)

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If unable to attend the scheduled appointment, patients are kindly requested to call, inform, and reschedule to ensure smooth coordination and availability.

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Patients are also advised to bring previous VNG reports and all related medical reports, including referral notes, imaging, and past treatment records, to assist in accurate comparison and clinical interpretation.

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Before your test:

• Discontinue vestibular suppressants (e.g., betahistine, cinnarizine, diazepam) 24 hours prior, unless medically advised otherwise

• Avoid alcohol and caffeine for 24 hours

• No eye makeup, as this interferes with infrared tracking

• A light meal is recommended before testing

 

Frequently Asked Questions

 

Will I feel dizzy during the test?
Mild dizziness may occur during positional and caloric testing; it usually settles quickly.

 

Do I need to bring someone with me?

Yes

 

Is a doctor’s referral necessary?
No. Direct appointments are accepted.

 

Technology & Standards

• Eccleris VNG 3D Infrared System

• vHIT Ulmer II Canal-Specific VOR Analysis

• Routine calibration of equipment

• Protocols aligned with Bárány Society and AAO-HNS vestibular testing guidelines