Section: Saint Barnabas Medical Center News

Keep Your Balance - Balance Questionnaire


Take this questionnaire to
see if you need evaluation and treatment for vestibular problems.

Do you ever feel dizzy? Hear a ringing in your ears? Have trouble getting out of bed or walking without support? If so, you may have a balance problem that can and should be treated.

The Balance Center at Saint Barnabas Medical Center specializes in helping people get the right treatment for whatever is producing their balance problems. “These difficulties could be caused by neurological, visual or physical conditions,” says Marian Hightower, administrative coordinator and patient navigator at the Balance Center.

The center offers a 17-question screening questionnaire (below) to help you determine whether you should seek medical attention for these issues. “The purpose is to help us gauge problems and point the patient in the right direction,” she says. A variety of treatments are available, including medications and a type of physical therapy known as vestibular rehabilitation.

If your score indicates that you need evaluation for possible balance problems, call the Balance Center at 973.322.5075.

The Questionnaire

For each “yes” answer, add the listed number of points to your score.

1. Do you ever feel dizzy or light-headed? (6) ❑ Yes (+6) ❑ No

2. Have you ever suffered a stroke? (4) ❑ Yes (+4) ❑ No

3. Have you ever suffered any type of head or neck trauma, for example, in an auto accident, a sports injury or a work-related injury? (4) ❑ Yes (+4) ❑ No

4. Do objects appear to bounce or jump around when you are walking or running? (6) ❑ Yes (+6) ❑ No

5. If you experience dizziness, do you notice a spinning sensation? (3) ❑ Yes (+3) ❑ No

6. If you have dizziness, do sudden changes in position (such as bending down, tilting your head quickly, turning) make your symptoms worse? (4) ❑ Yes (+4) ❑ No

7. Have you noticed a sudden decrease in hearing? (3) ❑ Yes (+3) ❑ No

8. Do you feel that your hearing is significantly worse in one ear? (3) ❑ Yes (+3) ❑ No

9. Do you experience vision problems such as double vision or blurred vision? (3) ❑ Yes (+3) ❑ No

10. Do you have an increased sensitivity to light and/or sound? (3) ❑ Yes (+3) ❑ No

11. Do you experience dizziness when turning over in bed? (4) ❑ Yes (+4) ❑ No

12. Do you have dizziness when watching a moving object? (4) ❑ Yes (+4) ❑ No

13. If you experience dizziness, do you feel pain or pressure in your ears during an attack? (4) ❑ Yes (+4) ❑ No

14. Have you ever been knocked unconscious? (2) ❑ Yes (+2) ❑ No

15. Do you have frequent headaches or migraines? (4) ❑ Yes (+4) ❑ No

16. Does looking up or down cause you to become dizzy? (4) ❑ Yes (+4) ❑ No

17. Do you experience a ringing, buzzing or other sound in your ear(s)? (2) ❑ Yes (+2) ❑ No


5–9: Possible need for assessment. Your physician may want to consider vestibular diagnostic testing.

10 or greater: Vestibular evaluation, including vestibular diagnosis testing, is indicated.

To learn more about services available at the Balance Center at Saint Barnabas Medical Center, call 973.322.5075 or visit our website.

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