Physician

*Most services require a physician referral.

Information for Referring Physician

VESTIBULAR FUNCTION TEST SELETCION GUIDELINES

* Please provide the enclosed patient’s instruction sheet and questionnaire to the patient.
Kindly remind patient to follow the instructions and complete the questionnaire, and email/fax back to the clinic, prior to the test.

1. It is strongly recommended that the patient referred to a Dizziness and Balance Test has a recent hearing assessment within 3 months of time.

   Please fax any available audiogram within a three-month timeframe along with your referral form. If not, a hearing test will be scheduled prior to the Dizziness and Balance Test.

2. Please make sure that the patient’s ears are cleared from wax.

3. Some patients may feel dizzy for a period of time following the test, so please ask patient to arrange for pick-up or consider to take public transit.

4. Complete dizzy test battery may include hearing test, ABR, ENG, ECOG, VAT and VEMP.

5. Auditory Brainstem Response (ABR) is mainly indicated as screening for retro-cochlear pathology and for objective hearing assessment.

   It can also be used to obtain objective threshold information.

6. Electro-Cochleography, ECOG, is mainly indicated to confirm endolymphatic hydrops and Meniere’s disease.

7. Vestibular Evoked Myogenic Potentials (VEMP) is mainly indicated to support diagnose superior canal dehiscence a syndrome, Meniere’s disease, vestibular neuritis,

   otosclerosis as well as central disorders such as Multiple Sclerosis.

8. Vestibular Auto-rotation Test/ Active Head Rotation Test “VAT/AHR” are tests essentially to determine the integrity of mid and high frequency vestibular functions.

9. Video-Head Impulse Test “VHIT” is a new tool to document vestibular asymmetry. It is also valuable to test children and patients with ear drum perforation.

If you would like to refer a patient for a Vestibular Function Test:

For North York Location, please complete Physical Referral.
For Markham Location, please complete Physician Referral.