THE DIZZY LAB

Balance is a sophisticated biological system governed by the seamless coordination between the inner ear, the eyes, and the central nervous system, further supported by muscular strength and lower-limb proprioception.

The inner ear houses two primary anatomical components:

• The Cochlea: Responsible for the sense of hearing.
• The Vestibular System: The primary organ responsible for the sense of balance.

The vestibular and cochlear nerves transmit continuous signals from these two components directly to the brain, which immediately processes and translates them into an accurate perception of motion and sound.

Your Body's 12-Sensor System

We possess two vestibular apparatuses (one in each ear). Each inner ear contains 6 distinct sensory organs, establishing a network of 12 sensory receptors that work synchronously day and night:

Throughout your waking hours, your brain relies entirely on constant, highly accurate data streams from the vestibular system to execute the simplest daily tasks, such as rolling over in bed, bending down to tie your shoes, or reaching for items on high or low shelves. Based on these inputs, the brain issues rapid motor commands to your muscles to contract and stabilize your posture.

When a deficit, injury, or weakness occurs in any of these 12 sensory receptors, the information reaching the brain becomes conflicting or erroneous. This sensory mismatch gives rise to balance disorders, which manifest through three distinct clinical presentations:

• Vertigo: Illusion of motion (rotational/spinning, linear sway, or translational tilt).
• Dizziness: Non-rotational spatial disorientation or dynamic clouding of perception without motion illusion.
• Unsteadiness: Feeling of instability, wobbliness, or loss of equilibrium when standing or walking (without head sensation).

• Benign Paroxysmal Positional Vertigo / Ear Crystals (BPPV).
• Persistent Postural-Perceptual Dizziness (PPPD).
• Vestibular Migraine (VM).
• Vestibular Neuritis.
• Labyrinthitis (Inner Ear / Cochleovestibular Inflammation).
• Meniere’s Disease (Endolymphatic Hydrops).
• Unilateral or Bilateral Vestibular Hypofunction.
• Vestibular Schwannoma / Acoustic Neuroma.
• Superior Semicircular Canal Dehiscence (SSCD).

Recent medical epidemiological data underscores the profound socioeconomic and functional impact of vestibular disorders on individuals:

• 1 in 3 adults over the age of 40 exhibit clinical evidence of vestibular dysfunction, with the vast majority remaining unaware of the root cause of their dizziness.
• 1 in 5 working adults suffering from vestibular vertigo are forced to quit their jobs entirely or take extended medical leaves due to their inability to drive safely or focus on digital screens.
• 57% of affected individuals report a severe decline in their overall quality of life, as persistent dizziness restricts them from basic daily activities like grocery shopping, bending down, or turning their heads safely to cross the street.
• Vestibular disorders extend far beyond physical limitations; they impose a critical psychological burden, frequently triggering social isolation, chronic anxiety, and panic loops, making precise diagnosis and integrated rehabilitation an absolute necessity.

At Abdali Hospital, we are committed to delivering precise diagnoses and advanced care, driven by the latest global clinical research and cutting-edge technology. Our fully integrated, multidisciplinary team stands ready to support your recovery journey:

• ENT Consultants (Otolaryngologists).
• Vestibular & Balance Rehabilitation Specialists.
• Audiologists.

We ensure a structured, smooth, and highly tailored diagnostic and therapeutic experience:

1. Initial Medical Consultation: Your journey begins with an appointment with our ENT Consultant for a clinical evaluation to determine if your case requires specialized vestibular lab testing, temporary medical management, or neuro-otological referral.
2. Comprehensive Evaluation at the Vestibular Lab: Upon referral to our lab, your evaluation begins with a baseline audiological assessment and a detailed clinical case history review (~10 minutes). This is followed by advanced diagnostic testing (~60 minutes) to precisely pinpoint and localize the source of the deficit.
3. Custom Care Plan Development: Your specialist devises an individualized rehabilitation plan, discussing its milestones with you to ensure it addresses your functional goals. Test outcomes are co-reviewed with your physician to fine-tune supporting medical therapies if needed.
4. Weekly Tracking and Rehabilitation: Sequential weekly follow-ups are scheduled to monitor your neuro-vestibular compensation through targeted exercises and lifestyle modifications. This phase includes continuous progression of your home exercise program based on your recovery rate.

Vestibular compensation and rehabilitation timelines vary based on the underlying etiology, severity, and individual health factors:

• Acute or Benign Conditions (e.g., BPPV): Typically resolve rapidly within 1 to 3 targeted repositioning maneuvers and follow-up rehabilitation sessions.
• Acute Vestibulopathy (e.g., Vestibular Neuritis): Most patients achieve substantial recovery within 4 to 6 weeks of consistent therapy.
• Moderate Conditions: Generally require 6 to 12 weeks of structured, progressive vestibular exercises.
• Chronic or Complex Deficits (e.g., Bilateral Vestibular Loss, Post-Concussion Dizziness): Rehabilitation paths may span 3 to 6 months, or longer depending on neuroplastic adaptation rates.
• Geriatric or High-Anxiety Profiles: Recovery may follow a more gradual trajectory, requiring extended, supportive pacing and specialized fall-prevention care.

Our diagnostic suite is equipped with advanced, gold-standard global medical technologies to perform the following clinical investigations:

1. Video-Nystagmography (VNG) Oculomotor Battery: Isolates central versus peripheral pathways by recording involuntary eye movements via infrared tracking during specialized visual tasks:
   • Saccade Test
   • Smooth Pursuit Test
   • Optokinetic Test
   • Spontaneous & Gaze-Evoked Nystagmus Testing
2. Saccadometry Testing: High-speed micro-degree tracking of rapid saccadic eye movements designed to evaluate the integrity of central brainstem and fronto-striatal cortical circuits:
   • Antisaccade Test
   • Prosaccade Test
3. Video Head Impulse Test (vHIT): Evaluates the high-frequency Vestibulo-Ocular Reflex (VOR) across all six semicircular canals individually during rapid head movements:
   • Horizontal and Vertical vHIT protocols.
   • Suppression Head Impulse Paradigm (SHIMP) testing.
   • Coplanar canal pair analysis (LARP & RALP configurations).
4. Advanced Positional & Positioning Testing: Identifies canal-specific Otoconia displacement (Ear Crystals) to map out mechanical vertigo:
   • Standard Dix-Hallpike Maneuver for vertical canal assessment.
   • Supine Head Roll Test for horizontal canal variants.
   • Multi-positional static and dynamic diagnostic tracking.
5. Bithermal Air Caloric Testing: The international benchmark for evaluating the low-frequency response of individual horizontal semicircular canals using precise thermal irrigation (Caloric Hot & Cold inputs) to calculate unilateral weakness.
6. Vestibular Evoked Myogenic Potentials (VEMP): Neurophysiological testing using acoustic stimuli to isolate otolith organ integrity and specific nerve pathways:
   • Cervical VEMP (cVEMP): Isolates Saccular function and inferior vestibular nerve integrity via neck muscle reflex tracking.
   • Ocular VEMP (oVEMP): Isolates Utricular function and superior vestibular nerve integrity via extraocular muscle reflex tracking.
7. Electrocochleography (ECochG): An advanced electrophysiological test that records the electrical potentials of the inner ear and auditory nerve. This serves as a critical clinical marker to aid in the diagnosis of endolymphatic hydrops (Meniere’s Disease), fluid pressure imbalances, or Superior Semicircular Canal Dehiscence (SSCD).
8. Modified Clinical Test of Sensory Interaction on Balance (m-CTSIB): Objective platform testing that deconstructs a patient's balance profile to map out how effectively they utilize visual, somatosensory (proprioceptive), and vestibular inputs to stay upright.

In addition to the above, our laboratory provides a comprehensive suite of advanced bedside clinical evaluations and internationally validated questionnaires to measure the impact of dizziness on the patient's daily life and closely monitor their recovery trajectory.

To ensure the accuracy of your test results in our laboratory, please adhere to the following preparation guidelines:

Discontinuation of Certain Medications Prior to Testing

Betaserc (Betahistine): Preferably discontinue 5 days prior to testing.

48 Hours Prior to Testing: Avoid alcohol completely, and discontinue medications that suppress the inner ear or affect eye movements, including:

• Anti-Dizziness and Anti-Nausea Medications: Such as Meclizine (Navidoxine), Betahistine (Betaserc), Dramamine, and Zofran.
• Antihistamines, Allergy, and Cold Medications: Such as Zyrtec, Claritin, Allegra, and nighttime multi-symptom cold syrups.
• Sedatives, Anxiolytics, and Sleeping Aids: Such as Valium, Xanax, and Ambien.
• Narcotic Analgesics and Muscle Relaxants: Particularly formulations containing Codeine.

• 3 Hours Prior to Testing (Dietary Restrictions): Refrain entirely from heavy meals, and avoid coffee, tea, energy drinks, or any caffeinated products. Plain water is permitted.
• Day of the Test (Facial & Ophthalmic Cosmetics): Do not apply any eyeliner, mascara, eyeshadow, face powder, or foundation. Our Video-Nystagmography (VNG) suites utilize specialized infrared cameras to track pupil boundaries; cosmetic products alter skin reflectance and can obstruct camera tracking, compromising data accuracy.
• For Dry Eye Patients: If you have a history of dry eyes, please use your prescribed lubricating drops (artificial tears) regularly in the days leading up to and on the day of the test. This minimizes ocular irritation and prevents excessive blinking, which can cause artifacts in the camera recordings.
• Transportation & Safety: We strongly advise arranging for a companion or driver to accompany you to the appointment. Certain diagnostic maneuvers are designed to intentionally provoke temporary dizziness, making it unsafe for you to drive immediately after the session.
• Attire: Wear comfortable, flexible, or athletic clothing that allows you to move freely during physical and positional maneuvering.

Completing a comprehensive neuro-otological evaluation can be physically and mentally fatiguing. Here is what you need to know regarding your post-test recovery and next steps:

1. Temporary Post-Test Dizziness & Vertigo
   • During Testing: Specific core procedures (such as Positional and Caloric testing) are designed to stimulate the inner ear to isolate side-specific deficits, which intentionally provokes brief episodes of dizziness or nausea.
   • After Testing: These symptoms typically resolve within 10 minutes post-test.
2. Transportation, Rest, and Safe Return Home
   • We strongly recommend having a family member or friend drive you home. Because temporary disorientation or residual unsteadiness can occur, avoiding driving immediately after the session ensures your safety.
   • Avoid Strenuous Activities: We advise scheduling your day so that you have no physically demanding, high-movement, or high-exertion commitments following your appointment. Please leave ample time between your assessment and any subsequent tasks to allow your body and vestibular system to rest and fully recover.
3. Resuming Diet and Medications
   • You may resume normal eating and drinking immediately after the session.
   • You may restart your anti-dizziness or previously paused medications only upon explicit confirmation from your specialist, ensuring they align with your newly structured care pathway.
4. Test Results and Care Plan
   • Following your testing session, our vestibular team will analyze your diagnostic traces, discuss the preliminary physiological findings, and outline your customized rehabilitation program.
   • Note: Comprehensive analytical test reports are finalized and released within 5 to 7 business days.

If you experience any of the following symptoms, we highly recommend booking a comprehensive balance evaluation:

• Sudden, short-lasting spinning sensations triggered by rolling over in bed or tilting your head back.
• Persistent unsteadiness while walking, making you feel the urge to touch walls or rely on a companion.
• A feeling of pressure, fullness, or ringing (tinnitus) in one ear accompanied by fluctuating bouts of dizziness.
• Spatial disorientation or visual blurring when looking at computer screens, scrolling through smartphones, or walking down grocery store aisles.
• A history of recurrent trips, stumbles, or falls due to sudden loss of balance.

Abdali Hospital provides a fully integrated therapeutic ecosystem designed to end the patient’s journey of uncertainty. Here is what makes our facility a unique, premier destination in Jordan:

• Integrated Multidisciplinary Care System

  At Abdali Hospital, we operate on a collaborative, co-managed care model. Our department brings together an integrated team of specialists working in direct coordination under one roof—including ENT Surgeons, Vestibular Rehabilitation Specialists, and Audiologists. This synergy guarantees a seamless, unfragmented clinical pathway from initial consultation through to final recovery.

• Exclusive Diagnostic & Advanced Rehabilitation Technologies

  Our laboratory uniquely combines state-of-the-art diagnostic equipment with cutting-edge therapeutic and motor technologies, such as visual and motor biofeedback systems. These interactive technologies are specifically designed to retrain the brain and central nervous system to restore balance function efficiently and safely, providing an advanced rehabilitation environment that accelerates full recovery.

• Patient-Centered, Goal-Oriented Care

  We believe every patient presents a unique clinical profile. Rather than offering generalized solutions, we design fully personalized rehabilitation pathways tailored to each individual’s daily functional goals. Coupled with structured weekly tracking and continuous support, we empower patients to regain their independence, stability, and confidence in daily life.