Glossary

Acute, sustained vertigo with nystagmus, nausea, gait unsteadiness and head-motion intolerance lasting hours to days. Differential is dominated by vestibular neuritis versus posterior-circulation stroke.

Standards defining the maximum permissible ambient noise levels for audiometric test rooms. Bone-conduction thresholds are invalid in untreated spaces.

Sound-attenuating enclosure meeting ANSI S3.1 / ISO 8253 ambient-noise limits. Non-negotiable for valid audiometry; one of the larger capital items.

Plan-Do-Study-Act loop applied to the clinic: pick a metric (e.g., same-visit diagnosis rate), measure, change one variable, re-measure. Quarterly cadence works for most vestibular clinics.

Brief, position-triggered vertigo from displaced otoconia in a semicircular canal. Diagnosed at the bedside; treated with canalith-repositioning manoeuvres. The clinic's highest-leverage treatment.

Warm and cool water (or air) irrigation of each external ear, with VNG-recorded nystagmus. The only test of low-frequency horizontal-canal function — irreplaceable in unilateral hypofunction work-up.

Document that pairs the clinical need (catchment demand, referrer pain points) with the financial envelope (capital + 12-month operating cost, payer mix, expected volumes). The artefact that wins administrative approval.

One-off purchases that create the clinic's fixed infrastructure: room build-out, audiometric booth, VNG/vHIT/VEMP systems. Amortised over 5–7 years in most budgeting frameworks.

Estimate of how many patients a service can realistically draw from its geography, given population, demographics and competing services. Drives the choice between solo and multidisciplinary models.

Quantitative balance assessment on a moving platform with sway-referenced visual surround. Used for sensory-organisation testing and rehab tracking.

25-item self-report scale of perceived disability from dizziness (Jacobson & Newman 1990). Score range 0–100; functional, emotional and physical sub-scales. The standard outcome measure.

Recording of cochlear potentials (SP/AP ratio) used in the work-up of endolymphatic hydrops; helpful but rarely decisive in Ménière's diagnosis.

Canalith-repositioning sequence for posterior-canal BPPV: four sequential head positions that walk otoconia out of the canal and back into the utricle. Resolves symptoms in ~80% on the first attempt.

Annual maintenance + calibration agreement bundled with the purchase of VNG/vHIT/VEMP systems. Typically 8–12% of capital cost per year; cheaper than ad-hoc repair.

Three-step bedside battery for acute vestibular syndrome — Head Impulse, Nystagmus pattern, Test of Skew. A central pattern is more sensitive than early MRI for posterior-circulation stroke.

Treatment manoeuvre for horizontal-canal BPPV: sequential 90° head rolls toward the unaffected ear. Pair with Gufoni when the diagnosis is geotropic versus apogeotropic.

Endolymphatic-hydrops syndrome with episodic vertigo, fluctuating sensorineural hearing loss, tinnitus and aural fullness. Diagnosis by Bárány criteria; management is stepwise from diet to intratympanic gentamicin.

Four-condition balance test (eyes open / closed × firm / foam surface) that probes the relative weighting of visual, vestibular and somatosensory inputs. Free, validated, and quick.

Weekly case review attended by ENT, neurology, audiology and vestibular physiotherapy. The shared diagnostic vocabulary it builds is more valuable in the long run than any one investigation.

Recurring annual costs — staff salaries, consumables, service contracts, software licences, rehab materials. Often underestimated by a factor of two in first-year budgets.

Distribution of patient funding sources — out-of-pocket, public insurance, private insurance, employer schemes. Affects pricing strategy and the operating margin.

Chronic functional vestibular disorder defined by Bárány Society criteria: persistent dizziness or unsteadiness ≥3 months, worse standing or with visual motion. Treated by education + rehab + SSRI.

Documented route by which primary care, ED or stroke teams can refer to the clinic — single phone/SMS/email lane, agreed turnaround. Friction kills referrals more than diagnostic quality does.

Workflow model where history, bedside tests and (where possible) instrumented testing happen in a single visit. Reduces patient travel burden and improves throughput.

Fraction of new patients who leave the first visit with a working diagnosis (rather than a list of further investigations). Useful efficiency metric; target ≥70% for an established clinic.

How the clinic delivers care: ENT-led, neurology-led or multidisciplinary; weekly half-day vs daily; embedded in an ENT department or standalone. Documents every subsequent decision.

Opening the clinic to a single trusted referrer for 2–4 weeks before going to open access. Surfaces workflow defects with low blast radius.

Structured history-taking framework (e.g., TiTrATE, SO STONED) that captures Timing, Triggers, Associated symptoms, Targeted examination, and Evaluation. Reduces variance across clinicians.

Third-window syndrome with autophony, sound- or pressure-induced vertigo (Tullio, Hennebert) and a low-threshold cVEMP. Work-up needs VEMP and temporal-bone CT; surgical when disabling.

Agreed price for a defined procedure (e.g., VNG, vHIT, vestibular rehab session). Coding accuracy determines cost recovery; under-coding is a quiet but constant revenue leak.

Free, validated mobility test (Podsiadlo 1991) — stand from a chair, walk 3 m, turn, return, sit. >12 s flags fall risk in the elderly. Tracks rehab response.

Short-latency reflexes that probe otolith function — cervical VEMP for the saccule, ocular VEMP for the utricle. Required for confident superior canal dehiscence work-up.

Episodic vestibular syndrome attributable to migraine, by Bárány / IHS criteria. The commonest cause of recurrent episodic vertigo in the under-50s; treated as migraine.

Acute, isolated unilateral peripheral vestibulopathy without hearing involvement. Self-limiting; early vestibular rehabilitation hastens functional recovery.

Exercise-based therapy combining gaze stabilisation, habituation and balance retraining. The most evidence-based intervention in the clinic for unilateral hypofunction and a key pillar of PPPD treatment.

Dedicated open floor with grab rails, foam pads, gaze-stabilisation targets and (optionally) a VR rig. Plan from day one — vestibular rehab is the highest-evidence treatment in the clinic.

Structured fields in the electronic medical record for HIT/HINTS, DHI, nystagmus characteristics, VOR gain and treatment plan. Free-text notes prevent audit; templates pay back inside six months.

Infrared video goggles that abolish visual fixation and record both eyes. The single highest-yield piece of vestibular equipment; first purchase in any setup.

Goggle-based camera test that quantifies the VOR gain for each of the six semicircular canals and flags covert and overt catch-up saccades.

Goggles-recorded battery comprising gaze, smooth pursuit, saccade, optokinetic, positional and bithermal caloric testing. The diagnostic workhorse of an instrumented vestibular service.