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You are very welcome to our
Heidelberg Dizziness Diagnostics Centre!

Our website provides initial insights into our dizziness diagnostics and therapy.

We use the latest methods for the functional diagnostics of vestibular structures.

We strive to provide patients with full clarification of their illnesses and to ensure that treatment results are long-lasting! Therefore, please complete the questionnaire on the type of dizziness you are experiencing to enable us to diagnose and treat it as precisely as possible.

Dizziness: One symptom – many possible causes

Office hours

By appointment only

Mon-Fri:

8:30 a.m. – 12:00 noon
2:30 p.m. –  6:00 p.m. (except Wednesdays)

Private or self-paying patients’ consulting hours:

Mon:  8:30 a.m. – 12:00 noon
Wed:  2:30 p.m.–   6:00 p.m.
Fri:     8:30 a.m. – 12:00 noon

Phone: 06221 / 314 814
Fax:      06221 / 307 882
Email: info@praxis-heimlich.de

What is dizziness?

Dizziness, medically referred to as vertigo, is a disruption of the sense of balance: The person affected loses the sense of certainty of their body in space and spatial awareness and has a swaying or turning sensation. Dizziness is medically defined as perceived apparent motion between the person themselves and their environment. Types of dizziness include rotary, vestibular, objective, movement and unsystematic dizziness. Other balance disturbances often occur. These include tendency to falling, nausea, vomiting or seeing black spots in front of the eyes. These symptoms occur because the various pieces of information from the various sense organs transmitted to the brain cannot be aligned.

Rather than a stand-alone condition, dizziness is a frequent symptom of many underlying illnesses. In many cases, it is neuro-otological in nature, i.e. affects the “senses” such as the balance organ, but may also be caused by heart and circulatory symptoms, disorders of the spine, brain, eye and psychological disturbances. Dizziness may occur in the form of recurring attacks or be chronically persistent. The proportion of people affected increases with age: The older the patent, the more often dizziness occurs.

The psychological strain on the person affected is often high. Due to the uncertainty of their movement, they seem drunk. The feelings of dizziness are often not taken seriously by outsiders at first. Dizziness patients also cannot drive, as sudden attacks of dizziness may occur at any time.

Dizziness questionnaire

The patient is firstly asked to complete a questionnaire over several pages regarding his or her disorder. The questions are in relation to the properties of the dizziness symptoms, existing illnesses and medicines being taken.

Specific discussion on dizziness

After the dizziness questionnaire has been evaluated and all results provided by the patient have been reviewed, a detailed discussion with the patient is held in order to obtain further information on the illness.

Standing and walking tests

Standing and walking tests as developed by Unterberger and Romberg are among the easiest and at the same time most important test methods. These test methods were named after their inventors. They deliver important indications regarding dizziness disorders. In particular, they provide significant information on disruptions of the balance organ in the inner ear or disturbances in the area of the cerebellum.

Electro or video nystagmography

If there is a disturbance in the balance system, eye movements that are mostly involuntary occur. This condition is called nystagmus. The eye movements are analysed in a darkened room using infrared video glasses. The results are analysed automatically by a computer and may already provide initial indications on the cause of the illness, particularly in dizziness appearing acutely.

Location and position testing using video oculography

In this test, the patient’s eye movements are analysed using video-oculography computer recording with the patient’s body in various positions. For example, if small calcium crystals (otoliths) have become lost in the ear, they may lead to movement-dependent dizziness (benign positional vertigo). This test can be used to verify the presence of this condition.

Head Impulse Test (HIT) / Halmagyi test using video-oculography analysis

One of the main functions of the balance system is to stabilise the field of view, i.e. in head or body movements, the eyes are always angled away from the direction of movement, so that the person always maintains a stable field of view even during a movement. This field of view stabilisation is enabled by what is referred to as the “vestibulo-ocular” reflex.
Thanks to the latest technology, we are now in a position to test this reflex using video glasses that are extremely light and record very quickly. This enables an examination of all three movement axes in the area for the first time.

Caloric testing using video-oculography analysis

During this test, the most sensitive receptor of the balance organ, referred to as the horizontal arch, and the upper balance nerve are tested separately for each side using cold air.

Cervical vestibular evoked myogenic potentials (cVEMP, oVEMP)

The aforementioned head impulse test as well as video nystagmography measurement methods determine the capacity of the inner ear to perceive rotating movements. The measurement of vestibular evoked myogenic potentials (VEMPs) enables the functional inspection of the scacculus (c-VEMPs) and the utriculus (o-VEMPs) separately for each side.

The oVEMPs tests the utriculus, as well as the nervus vestibularis superior (superior balance nerve), for example. Among other things, the utriculus is responsible for horizontal movements. The measurement is used as a supplement to the VNG tests and is applied for the diagnosis of Superior Semicircular Canal Dehiscence (SSCD) or total vestibular failure, for example.

The vestibular-ocular reflex can be used in the oVEMP measurement. The potential difference of the extra-ocular musculature is measured using surface electrodes. In order to obtain good results, the patient looks straight up. The point of this is not to tighten the muscle more, but to bring the lower oblique muscle closer to the electrode.

In the cVEMPs, the sacculus is tested, as well as the nervus vestibularis inferior (inferior balance nerve), for example. The sacculus is responsible for the perception of vertical movements. The measurement is used as a supplement to the VNG tests and is applied for the diagnosis of Superior Semicircular Canal Dehiscence (SSCD), Morbus Menière, partial or total vestibular failure/Neuritis Vestibularis, vestibular migraines, vestibular schwannoma or otosclerosis.

The vestibular-collic reflex is used in the cVEMP measurement. The patient flexes the M. sterocleidomastoideus by turning his or her head to the contra-lateral shoulder (turned away from the stimulus side). The contraction of the extraocular musculature triggered by the stimulus is measured ipsilaterally using surface electrodes. The tension reduces when the stimulus is supplied. The louder the stimulus, the greater the reflex.

Posturography and determination of risk of falling

A second important function of the balance system is the maintenance of balance in the body. As the name indicates, posturography is used to test a patient’s posture. In this test, the body’s swaying motion is analysed within the scope of four different test situations (eyes open or closed, with or without foam cushion). Depending on the sway template, it is possible to draw conclusions on the cause of the dizziness condition and estimate the individual risk of falling.

Determination of the subjective visual verticals

By determining the subjective visual verticals, the functioning of the utriculus can be inspected during the differential diagnostics of the otolith apparatus in the balance organ. The otolith organs – utriculus and sacculus – in the balance labyrinth play a key role in the correct spatial orientation and stabilisation of the body’s position. For a patient suffering from vertigo, the world is not upright.
Information on this can be obtained by measuring the subjective visual verticals. To achieve this, a laser line has to be set is a straight position in a darkened room. The result provides the doctor with an insight into where the problem could lie early in the diagnostic process and is additionally useful for monitoring progress.

3D imaging (DVT)

In dizziness diagnosis, alongside magnetic resource imaging (MRT) of the skull to assess the brain, digital volume tomography (in short: DVT) is also available for the precise diagnosis of the middle and inner ear structures as well as the upper cervical spine.

In digital volume tomography, a spatial X-ray image of the skull is generated which can be observed in all levels and all layers. It is possible to view an individual point from various directions at the same time.

The high imaging performance, which can be seen in both the maximum resolution and the effectively minimised radiation exposure, is a form of technical progress which directly benefits our patients.



Please understand that most of the services listed above may not be provided at the expense of the statutory health insurers. They have to be paid by the patient according to GOÄ digits (private fee schedule).

Therapien

Medicinal therapies

In many cases, vertigo can be successfully treated using medication, allowing patients to be largely or totally free from dizziness symptoms.

Special medications, referred to as antivertiginous, play a role in acute and severe attacks of dizziness in particular; they improve the symptom, not the disease. Treatment may also comprise cortisone, circulation-promoting medications as well as anti-histamines as acute medication during an attack as well as for motion sickness, partially as an infusion also. There are also effective formulations for concomitant nausea and vomiting. This medication is based on the respective clinical picture and of course the accompanying illnesses.

The injection of medications into the middle ear (intratympanic therapy) may be a very good therapy option for the treatment of certain forms of dizziness. 

Also, the insertion of a drain in the eardrum alone eliminates the some patients’ balance disruptions permanently (especially in M.Meniere). These small measures may be carried out under local anaesthetic. This procedure has an additional advantage. It allows medications to be administered directly into the middle ear.

In Labyrinth anaesthesia, a small cut is made in the eardrum and then an anaesthetic is dropped into the middle ear. The narcotic spreads from there into the balance organ and calms or deactivates the sense of balance. However, the data situation of this form of therapy is weak and the duration of efficacy of the local anaesthetic is max. 8 hours.


Dizziness training

In treating vestibular dizziness, we distinguish between the following two general therapy types:

Release manoeuvre
Vestibular rehabilitation therapy

“Release manoeuvres” as developed by Epley or Sémont are applied in the treatment of benign positional vertigo. In all other clinical pictures, the manoeuvres make less sense because they were developed in such a way that they cause the “stones” which trigger the positional vertigo to go from the semicircular canals of the balance organ back to their point of origin.

The manoeuvres are carried out by either/both the doctor/therapist or/and the patient him/herself. The treatment consists in a sequence of positions which are carried out with the patient lying down or in a seated position or on his/her side, depending on the manoeuvre.

A guide to the manoeuvres is provided on the website of the German Dizziness Centre. We currently do not recommend the videos on YouTube. Many of them contain errors which could make the manoeuvre ineffective.

Vestibular rehabilitation therapy comprises the following measures: Voluntary eye movements, active head movements with and without focusing the gaze, balance and walking exercises.

 


Biofeedback as dizziness therapy

Neurofeedback training, as developed by Prof. Ernst, is a new non-medical therapy for the treatment of dizziness. It is a special type of balance training, where stimuli are given repeatedly, which lead to the habituation of the balance system.

In this vibrotactile neurofeedback training, targeted vibration stimuli are delivered to the body via a small machine attached to the hips by a belt. Specific, tailor-made exercises and frequent repetition enables stimulation of the entire balance system and the information is transmitted to the brain and stored, which significantly reduces dizziness and feelings of insecurity. To achieve an optimal training outcome, the training is carried out in our practice over the course of 2-4 weeks or several times during one week for approx. 30 minutes.

This very intuitive type of feedback shows noticeable results after just the first one or two training sessions. Rather than muscle training, these consist of a correction of the balance processing in the brain. The additional stimulus signals the brain that the body stability does not correspond to that of a healthy person. The brain in turn rapidly converts this into a corresponding compensation of the body stability.

In an international placebo-controlled multi-centre study, the effectiveness of biofeedback dizziness training was tested for various risks of falling causes and it was found that the effectiveness of the training could be demonstrated in over 95% of the patients.


Surgical dizziness therapies

Acupuncture

We also use body and ear acupuncture to treat dizziness symptoms. By directing needle stimuli into the skin at specific points, dizziness symptoms can be positively influenced. As a treatment method, acupuncture is practically free from risks and side effects.

Bioresonance therapy

In our practice, bioresonance therapy offers a good alternative or supplement to conventional medicine in the treatment of dizziness symptoms.


Operative dizzyness therapy

If therapies from conventional or alternative medicine used to treat dizziness do not lead to the desired success, surgical therapies can be used, as applicable.

However, it must be stated that, in principle, surgery is used only very rarely or not at all in the treatment of dizziness. There are only a few illnesses, such as inflammations or therapy-resistant M. Menière in which the surgery promises recovery.

Potentially laborious procedures such as saccotomy or sacculotomy may be used in these cases.