Referral & Assessment
We do not accept patients without a physician’s referral, preferably from a specialist. Our reports assume a working knowledge of each assessment so that the implications of the interpretations provided can be properly appreciated. The referral forms can be faxed to us at: 416-340-3745.
We accept patients only with a physician’s referral, preferably from a specialist. Our reports assume a working knowledge of each assessment so that the implications of the interpretations provided can be properly appreciated.
Our standard tests for a dizzy patient include:
- Electronystagmography/Videonystagmography (ENG/VNG)
- Cervical and Ocular Vestibular Evoked Myogenic Potential (cVEMP and oVEMP)
- Video Head Impulse Test (vHIT)
- Hearing Assessment
- ECOG, ABR, and/or Cortical can be added to test battery
Please note: Our assessments do not include a consultation with Dr. Rutka.
Comprehensive Vestibular Assessment
Vestibular issues are complex and there is no single test that can be done to rule out vestibular dysfunction. Our standard vestibular battery of tests is a comprehensive work-up aimed at helping you identify the source of the issue for your patient. Our standard test battery includes the following tests:
This test assesses for inner ear and central balance function, abnormal eye movements, and benign proxysmal positional vertigo (BPPV).
Interpretation: The videonystagmography (VNG) test assesses each labyrinth to determine if there is a peripheral loss (inner ear and vestibular nerve dysfunction).
This test assesses the inner ear organs that help with up-and-down and forward-and-backwards movements. The two types of VEMP testing that we do is cervical VEMPs (cVEMPs) and ocular VEMPs (oVEMPs).
Interpretation: The cervical VEMP (cVEMP) tests the saccule and inferior vestibular nerve, and the ocular VEMP (oVEMP) tests the utricle and superior vestibular nerve. An absent response can suggest a possible saccular (absent cVEMP) or uticular loss (absent oVEMP).
This test assesses how well the eye focuses when the head is moving.
Interpretation: The video head impulse test (vHIT) assesses the vestibular-ocular reflex (VOR) in the horizontal and vertical planes of movement. Horizonal (or lateral) vHIT tests the VOR in the horizontal semi-circular canals whereas LARP vHIT tests the VOR in the left anterior and right posterior semi-circular canals and RALP vHIT tests the VOR in the right anterior and left posterior semi-circular canals. A reduction in VOR function can occur in any of the semi-circular canals tested.
A hearing assessment includes the following:
Interpretation: A hearing assessment determines the degree of hearing loss (both speech and pure tone), the status of the tympanic membrane and acoustic reflexes (immitance testing) in both ears. The results will also indicate if a patient is a hearing aid candidate.
Additional Tests Upon Request (Auditory Evoked Potentials)
This test assesses the integrity of the cochlea up to the lower brainstem. This is an objective test to determine neural transmission of auditory stimuli.
Interpretation: Auditory Brainstem Response Test (ABR) assesses the integrity of the cochlea and the pathway to the lower brainstem. A significant interaural wave V latency (the latency difference between the Wave V for the left and right ear) could suggest a retrocochlear pathology.
This test assesses the electrical potential generated from the cochlea and auditory nerve. This test can be used to determine endolympathic hydrops.
Interpretation: An ECochG test is used to determine if a patient has endolympatic hydrops (an increase in pressure in the inner ear). An increase in pressure could indicate Menière’s Disease.
This test is an objective hearing test that assesses the integrity of auditory system from the cochlea to the auditory cortex. This test allows us to estimate hearing thresholds.
Interpretation: A Cortical test is an objective hearing test used to determine hearing thresholds. A Hearing Assessment is always completed following a cortical test to compare the objective and subjective results.