Dizziness is one of the most common complaints that patients voice to their doctors. Reasons for dizziness, imbalance (feeling unsteady) or vertigo (a sensation of spinning) can stem from problems with the inner ear, medications, migraine, injury or certain medical conditions.

Since the causes of dizziness are so varied, testing and treatment can vary depending on the suspected cause and the treating specialist. Some causes of dizziness do not require specialized equipment to manage, while some causes may be missed without specialized equipment. Your doctor can help you determine whether you would benefit from an examination at the Balance Disorders Program.

Comprehensive Care for Dizziness, Vertigo and Imbalance

The Balance Disorders Program team at Miller Medical Plaza specializes in the diagnosis and treatment of dizziness and vestibular (balance) disorders.

Our team of ear, nose and throat physicians, audiologists, and physical therapists are experts in advanced techniques to manage the full range of balance problems, from benign paroxysmal positional vertigo and vestibular migraine to Meniere’s disease and vestibular neuritis. We are one of only two comprehensive balance clinics in North Carolina.

We understand that balance problems can be debilitating and make even the simplest tasks difficult to accomplish. We work closely with each patient to create a customized treatment plan that improves physical function, quality of life and overall health, so that you can return to the activities that you enjoy.

Common Symptoms of Balance Disorders

  • Patients with balance disorders may experience any of the following symptoms:
  • Vertigo (a spinning sensation)
  • Gait and postural instability (feeling unsteady when walking)
  • Lightheadedness (feeling faint or off balance)
  • Visual blurring (after-motion) with quick head movements
  • Nausea (induced by movement)
  • Disorientation or nausea (induced by external visual movement)
  • Headaches or light sensitivity
  • Tingling around the mouth
  • Tendency to fall
  • Anxiety

There are many types of balance disorders. Our experienced doctors work closely with you to determine the cause of your symptoms and a treatment that provides relief.

Vestibular Conditions We Treat

Wake Forest Baptist physicians have experience using the latest techniques to diagnose and manage dizziness, vertigo and imbalance. We treat the full spectrum of balance disorders, from common dizziness to more complex medical conditions.

Common Vestibular and Non-Vestibular Disorders

  • Benign paroxysmal positional vertigo (BPPV)
  • Vestibular neuritis/labyrinthitis
  • Meniere’s disease
  • Vestibular migraine
  • Superior Canal Dehiscence Syndrome (SCDS)
  • Anxiety/hyperventilation
  • Orthostatic hypotension
  • Multifactorial disequilibrium
  • Central dizziness

The Vestibular System

The primary role of the vestibular, or balance, system is to help us interact and maintain contact with our surroundings in a safe and efficient way. We gather information through visual, somatosensory (sensations like touch) and vestibular (inner ear) senses, which are processed by the brain.

As we move through the environment, our visual and somatosensory reference information constantly changes, but our vestibular reference (gravity) stays the same. As long as this equilibrium is maintained, we move freely with little thought to balance.

Vestibular Function Tests at Wake Forest Baptist

A comprehensive battery of tests will be performed during your appointment. Prior to each test an explanation will be given so that you have a better understanding of what is being tested and why. These tests are designed to help us locate the source of your dizziness or balance disorder. In each of these tests, we stimulate the balance centers of the inner ear or nerve tract connecting the inner ear to the brain. We then record the response to the stimulus. These tests are safe and comfortable, no needles are used, but stimulation of the inner ear may make you temporarily dizzy, you may have a friend or family member stay with you throughout the evaluation.

Optional Tests: As a comprehensive balance disorders program, we offer diagnostic procedures that are typically not available outside the university medical center setting. These can include Video Head Impulse Test (vHIT), skull vibration, and/or Vestibular Evoked Myogenic Potentials (VEMP). While most of the procedures performed at the Wake Forest Balance Disorders Lab can be billed to insurance, there are some newer procedures available that are not covered by all insurance providers. Our goal is to determine the cause of your dizziness and to help you feel better. We will only perform testing that we feel is helpful in determining the next step in that process. However, please inform us if you do not wish to have such testing,
We offer the following vestibular function tests at Miller Medical Plaza:

VNG (Videonystagmography)/ENG (Electronystagmography)

Many inner ear disorders cause nystagmus, or abnormal eye movement, associated with vestibular problems. During VNG/ENG testing, the inner ear is stimulated by rapid changes in the position of the head and body and different temperatures (by irrigating the ear canal with water or air). The goal is to determine if both inner ears function and respond equally to stimulation. 


Audiometric testing is a hearing evaluation that provides information about the health of the ears. It may identify middle ear fluid, which can affect balance, or a hearing loss pattern associated with inner ear disease and vertigo.

Rotational Chair

Rotational chair testing stimulates the horizontal semi-circular canal(s) and avoids stimulating any other part of the balance system. It is a very sensitive test of inner ear abnormality. This test consists of a series of movements in a mechanized chair that rotates side to side at various speeds. The rotational chair test records and analyzes how your inner ear(s) respond to slow movements by examining how your eyes react to the movements in the chair.

vHIT (video Head Impulse Test)

This is a test to see how your inner ear(s) respond to small, but quick, movements of your head while you visually focus on a target. An impairment of the inner ear(s) can cause imbalance or visual blurring with head movement. vHIT evaluates the patient’s ability to use their vestibular system efficiently to maintain visual stability at fast speeds of head movement.

VEMPs (Vestibular Evoked Myogenic Potentials)

This test stimulates your inner ear(s) with either loud clicking noises or skull vibration and quantifies how responsive your ears are by measuring muscle responses below your eyes and on your neck. The cervical (C) VEMP is a test of otolith function, particularly the saccule; while the Ocular (O) VEMP is a test of the utricle. Whereas most vestibular tests examine the horizontal semi-circular canals and superior branch of the vestibular nerve, (C) VEMP examines the inferior branch of the vestibular nerve.

Skull Vibration

Your inner ears are stimulated with vibration to your skull while monitoring your eyes with goggles. If the inners ears disagree on the amount of electrical information being sent to the brain (one inner ear weaker than the other) then this causes your eyes to move.