Balance System Disorders

Roles and Responsibilities of Audiologists

Audiologists play a central role in the screening, assessment, diagnosis, and management of persons with balance system disorders, often as part of an interdisciplinary team. Professional roles and activities in audiology include clinical/educational services (diagnosis, assessment, planning, and management); prevention and advocacy; and education, administration, and research. See ASHA's Scope of Practice in Audiology (ASHA, 2018).

Appropriate roles for audiologists include the following:

  • Maintaining general knowledge of anatomy, physiology, and pathophysiology of the balance system, including the peripheral and central vestibular, visual, and somatosensory systems as well as interactions among these systems.
  • Maintaining general medical knowledge of various conditions and events that may affect the balance system.
  • Conducting calibration and function checks on equipment associated with assessment and management of patients with dizziness and/or balance disorders as needed or appropriate.
  • Administering and appropriately altering vestibular test protocols for diagnostic and rehabilitative assessment of dizziness and/or balance disorders (e.g., videonystagmography [VNG]/electronystagmography [ENG] test batteries, rotary chair testing, posturography, video head impulse testing [vHIT], and vestibular-evoked myogenic potentials [VEMPs]).
  • Utilizing various patient-report tools to determine functional impact of dizziness and/or balance disorders.
  • Completing audiologic assessments as indicated.
  • Supervising support personnel conducting balance assessment procedures.
  • Interpreting and integrating vestibular and balance test results and related data for establishment of baseline function, which may be used for outcome measures regarding future rehabilitation and/or management.
  • Identifying the presence of BPPV (posterior, lateral, and anterior semicircular canal variants) with clinical assessment of symptom-provoking maneuvers.
  • Maintaining knowledge of procedures necessary to distinguish among posterior, lateral, and anterior semicircular canal BPPV and to distinguish between canalithiasis and cupulolithiasis.
  • Maintaining familiarity with and understanding of general management options for dizziness and balance disorders (e.g., medical, surgical).
  • Determining patient candidacy for vestibular and balance rehabilitation based on integration of information from patient history, test results, functional assessment, and collaboration with other professionals.
  • Maintaining knowledge of and familiarity with general medical conditions in order to assess their impact on or contraindication of the assessment and management of balance disorders.
  • Performing canalith repositioning procedures (CRP) on patients with BPPV of posterior, lateral, or anterior semicircular canal origin.
  • Ensuring patient comfort and safety during all aspects of balance assessment and management.
  • Making referrals as appropriate.
  • Accurately documenting all information collected from the patient, tests performed, results and recommendations stemming from assessment and/or management of the patient, and patient condition during all stages of assessment/management (including any adverse reactions).
  • Consulting on the design of an individualized vestibular rehabilitation program.
  • Participating in multidisciplinary team consultation for assessment and management of patients with dizziness and/or balance disorders.
  • Developing and using outcome measures to determine efficacy of vestibular rehabilitation provided (e.g., CRP).

As indicated in the Code of Ethics (ASHA, 2016a), audiologists who serve this population should be specifically educated and appropriately trained to do so.

Roles and Responsibilities of Speech-Language Pathologists

Speech-language pathologists may encounter individuals with complaints of dizziness and/or imbalance within the populations they serve. See ASHA's Scope of Practice in Speech-Language Pathology (ASHA, 2016b).

Appropriate roles for speech-language pathologists include the following:

  • Providing appropriate referrals for patients who complain of dizziness and/or balance disorders.

Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting.