To further exacerbate the problem, much of what the patients would read regarding the diagnostic tests involved are typically reviews latent with terminology that liken the experience to what a spy would endure should they be caught by the enemy (e.g. you will be strapped into place, a harness placed upon you, your vision is obscured, there is a dark enclosure, you would be spun/rotate around, and water will be flushed into your ears etc.) As one patient who has underwent repeated balance tests described to me, "it is an ordeal built upon an ordeal, a strain upon what is already strenuous". Already, it is an uphill battle from the start.
It is therefore critical for the audiologist not only to be aware of the all the symptoms and potential differential diagnostics so as to speed up the diagnostic process; but to be ever ready to cater to the psychological and emotional needs of these patients. Yes, it can be quite difficult at times, and we forever run the risk of being cynical as clinicians, especially if you have seen your fair share of malingerers and conversion disorder patients. The truth of the matter is, all dizzy patients will present you with anxiety, with doubt.
They may want to believe in you, they may want to trust you, but their fear pervades their actions. It behooves the audiologist to alleviate that fear as much as possible. For the reality is this, good raw data are hard to come by when they are convoluted by anxiety and augmentation of psychosomatic manifestations. Technique is essential, but more importantly ministry, compassion, motivation, and encouragement attributes to a significant portion to the success of a balance diagnostic battery. After all, it is an exhaustive battery in all sense of the word.
Little things such as reminding the patient to breath, to unlock their knees, to relax the neck and shoulders go a long way in clearing the data of outliers and artifact. In my personal experience, unconditional positive regards have far reaching effect in making the whole experience for the patient an enlightening and even at times a fun experience. What is more, I have truly found that laughter indeed is the best medicine in those situations. While anecdotal at this point, I have found more often than not when I am capable of making a patient laugh, despite how scared they are, or when i can turn them onto talking about something that is dear to their hearts as means of tasking, I get amazingly clear data. Contrastingly, when I am unable to engage the patient, when I am unable to wholeheartedly cheer them, I get mediocre data which while textbook by virtue of the patient's pathology, is not beautiful.
It is a balancing act to keep the patient engaged and at the same time diverge their attention away from their symptoms. It may also require some acting initially to ward off the negative energy/ vibes that is emitted by a patient when you first encounter them. It is necessary to build a positive rapport from the very beginning; after all, the testing process can become personable for both parties involved.
I have heard a lot of reasons why audiologists have "shy" away from balance testing; from not getting enough reimbursement to testing equipment being hard to come by. Yet, I sincerely urge all of you out there to give it a try. As much as I enjoy helping someone to hear better, as much as I find hearing test to be fascinating, I find my interactions with dizzy patients to be most rewarding. It is a challenge for sure, but when you can connect with a dizzy patient, when you can engage them, be their coach, listen to their life stories, cheer them on, you both walk away from that experience enriched. It is a balancing act, and it is a tough act to follow.
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