Building the clinic
Equipment & technology
Twelve items, three tiers, four cost bands. The decision is not which technology is most impressive — it is which yields the most diagnostic information per rupee for the patient mix you actually see.
The clinic's equipment falls into four families: audiometric (hearing tests in a quiet room), vestibular bedside (goggles and a couch), vestibular instrumented (recorded VOR, otoliths) and rehabilitation (the space and tools for vestibular physiotherapy).
You do not need all of it on day one. You need the bedside goggles, the couch, a valid audiogram, and a place to do vestibular exercises. Everything else is a capability upgrade.
The instrumented battery (VNG with calorics, vHIT, cVEMP and oVEMP) is the diagnostic backbone of a mature service.1,5 Bithermal calorics remain the only test of low-frequency horizontal-canal function, even as vHIT has revolutionised high-frequency canal testing — they are complementary, not substitutes.4
VEMPs add otolith-specific information; cervical VEMP probes the saccule via the inferior vestibular nerve and ocular VEMP probes the utricle via the superior nerve.3,2 Both are essential for confident superior canal dehiscence work-up.
A pragmatic procurement sequence: audiometric booth + audiometer + tympanometer first (you can't manage Ménière's, labyrinthitis or SCDS without audiometry), then video Frenzel goggles, then VNG, then vHIT, then VEMP. Posturography and ECochG are optional and should wait until clinical volume justifies them.
Bake the service contract into the capital purchase. Equipment that goes a month uncalibrated is equipment whose results cannot be relied upon — and discovering the drift only on audit is worse than not having the kit at all.
Tier × cost matrix
Each dot is one piece of equipment, plotted by clinical tier (essential, recommended, optional) against cost band ($ to $$$$). Click a dot for purpose, rationale and the conditions it most powerfully informs.
Essential — cannot run a vertigo clinic without these
These deliver the bedside workflow a vertigo clinic must run on day one: a recordable eye exam, a Hallpike-capable couch, a sound-valid audiogram, the free CTSIB battery and a rehab space. Without all five, the clinic cannot honestly call itself a vertigo service.