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Balance Testing Preparation Patient:________________ Appointment date:____________ Time:_____ Mark Brown, MD, FACS Head and Neck Surgery General Otolaryngology Pediatric and Adult Lindsay Young, MD Head and Neck Surgery General Otolaryngology Pediatric and Adult You have been scheduled for a test of your balance mechanism. The examination is a simple, painless procedure requiring about an hour. The test will involve moving the head and body into different positions, as well as stimulating the ears with cool and warm water. If you have any problems with your neck or back, please inform us prior to the beginning of the evaluation. This test will likely cause some dizziness that generally passes within a few minutes. In rare instances, the dizziness lasts a little longer, making it inadvisable to drive for a short time. You should make arrangements for someone to be available to drive you home in the event you are unable to do so. Instructions below are intended to prepare you for the testing so you will be as comfortable as possible, and to avoid anything that may interfere with the test results. Please read them carefully. Call our office (512-258-2300) if you have questions. It is imperative that you DO NOT take any allergy pills, antihistamines, sedatives, sleeping pills, narcotic pain medicines, decongestants, stimulants, nerve pills, dizziness pills, and antidepressants for 48 hours prior to testing. These medications include but are not limited to: Antivert, Meclizine, Bonine, Dramamine, Scopolamine and antihistamines – both over the counter and prescription forms of these medications. Paige Peterson, AuD, PhD, CCC-A Hearing and Balance Hearing Aids You may continue your medications for your heart, blood pressure, diabetes, seizures, or hormones. Barry Castaneda, PA-C General Otolaryngology If you cannot go without a medication listed above, please call our office at (512) 258-2300 to discuss this prior to coming to the evaluation. 11762 Jollyville Road Austin, Texas 78759 Abstain from alcohol for 48 hours before testing. ALL alcoholic beverages affect the results of this test. Phone 512 258 2300 Fax 512 904 2294 No eating, drinking, or smoking for 4 hours prior to the time of your appointment. www.greathillsent.com DO NOT wear any make-up, including eye liner or mascara. Please dress comfortably, women way wish to wear slacks. If you wear contact lenses, please bring your glasses with you in case you to remove your lenses. You may also wish to bring your eyeglass holder. Please note: Due to time constraints and schedule flow, patients arriving late may need to be rescheduled. If you need to cancel or reschedule your appointment, please do so 24 hours in advance to avoid a $30 cancellation charge PER TEST. Private pay fees are as follows: VNG testing is $430. Auditory Brainstem Response (ABR) testing is an additional $245. ECochG testing is an additional $165.