Several months ago I posted an “Open Letter to Dispensing Audiologists” encouraging them to consider adding some vestibular services to their practices. Here are a few practical tips to help get the process started.
Office Layout
Fully equipped vestibular practices are rare due to start up expenses and on-going personnel expenses. For the same reason, they must stay very busy to achieve profitability. Once the medical community is aware of your services, staying busy is usually not a problem.
In order to be successful, full-service vestibular practices need to see more than one patient at a time, using separate rooms dedicated to different portions of the vestibular evaluation. An existing audiology practice could expand to include full-service vestibular services by adding two or three test rooms: one for ENG/VNG and AHR , one for rotational chair and posturography, and a third for vestibular rehabilitation therapy if desired.
The ENG/VNG room should be isolated from the waiting room (in case the patients panics or becomes nauseous), and away from the audiometric suites (secondary to loud conversations and equipment). With certain aspects of the ENG/VNG exam, the patient must be in darkness or have eyes closed, while at the same time, hearing instruments must be removed. This can make for difficult communication. Having an assistive listening device available can minimize shouting.
The room for ENG/VNG can be fairly small, but there needs to be room for the patient to be placed in the supine position, room to maneuver around the patient during Canalith Repositioning, and room for an observer or family member. AHR testing takes up no additional space. Minimally, the room should be 8’ by 10’, and ideally, should contain a sink if water calorics are used. ENG requires a darkened room to eliminate changes in calibration when the eye opens. VNG can be performed in a lighted or darkened room.
The room used for rotational chair and posturography must be larger (12’ by 16’), simply to accommodate the larger equipment. Depending on the type of equipment purchased, it may be necessary to control light in the room. The specific manufacturer can guide the clinician in this regard. One manufacturer recently introduced a combo rotary chair/VNG system, where the entire exam (excluding any type of platform posturography) can be completed in one small room.
Next week, we will discuss the logical order of performing the test battery.
