Why Balance Assessment Platforms are Essential as the Prelude to VNG Testing

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Preventative Maintenance for AirStar and CoolStar caloric irrigators

Annual Preventative Maintenance service for AirStar and CoolStar caloric irrigators

Preventative maintenance is always a good idea for your medical devices and equipment.  Cut down on downtime by planning ahead.  In a previous post, we discussed what recommended maintenance procedures you should perform for your Difra AirStar and CoolStar.  Today, we will discuss recalibration and inspections for the caloric irrigators.

Recalibration for air pressure and temperature accuracy 

Keeping your AirStar irrigator clean or as is the case of the CoolStar, changing the filter monthly plus adding clean, distilled water to the jar helps to minimize problems.  However, annually, it is suggested to have your AirStar or CoolStar to be recalibrated for correct air pressure and accurate water temperature.

This is not something that can be completed by your team. You will need to send your caloric unit to us for this service. Our expert technicians will visually inspect your caloric irrigator, then perform a complete recalibration, including a computer print-out of the results that will be sent to you for your records.  It is very important to make sure the air pressure and temperatures are set to the manufacturer's specifications for testing accuracy as well as patient comfort.

Full system inspection

Prior to the recalibration, the technicians will inspect your caloric irrigator for any loose or frayed cables, control panel function, look for any error messages, loose components, or anything else not to manufacturer specifications.  If any area is found to be substandard, we will contact you with an estimated cost to complete those repairs, then the recalibration will be completed.

Loaner AirStar or CoolStar's may be available

Secure Health, Inc. may have a loaner irrigator for you to use while your device is being serviced.  This is based on the availability of our loaner irrigators.  Inquire when scheduling your caloric irrigator for service to the availability of a loaner.  If one is not available, we will schedule your work when a loaner is available.  

There is a charge for us to ship the loaner to you since it involves shipping to you two times and back to us two times.  We ship our loaner using a very durable "pelican" case to make sure our device and yours are secure and damage-free upon arrival at each destination.  For the return shipments, we send you a UPS label to affix to the outside of the pelican case.  

You simply remove our loaner caloric irrigator from the pelican case then place yours into the case exactly in the same position as you received the loaner. You will need to call UPS for a pick-up or have someone drop off the pelican case and irrigator at a UPS facility.

If you choose not to use our loaner, we will ask you to contact us prior to shipping your caloric irrigator to us.  When you call, we will issue you a Repair Order (RO) number.  Please make sure the RO number is on the UPS label or on the exterior of the shipping box. 

We also ask that you pack the irrigator in a sturdy box with plenty of packing material, including around the otoscope handle, to make sure it arrives in good shape, with no damage.  (The otoscope handle houses the thermostat and heating element)

It is your responsibility to make sure it is packaged appropriately and it arrives undamaged.  Any damages caused to your irrigator are at your expense.

Don't forget the speculum tips and CoolStar water filter

While we have your irrigator, you might as well order new speculum tips and if you have the CoolStar, order some spare water filters.  The speculum tips come in two sizes, the green ones are 2.5m and our blue tips are 4.0m.  By far, the green is the most preferred.  The tips have the twist-lock feature specifically made for your AirStar or CoolStar irrigator.

Each comes in a package of 100, minimum order of 100 per size.  Both sizes are priced at $18.95 per package of 100.  For the CoolStar filter, they are 3 to a pack at a price of $32.95 per pack.

Call or email us to schedule your AirStar or CoolStar for recalibration and inspection

Manage and reduce your downtime by ensuring your Difra AirStar or CoolStar are at peak performance and efficiency for your patient's comfort and test accuracy.  Give us a call or email us for pricing, scheduling then issue you your RO.

Call us at 260.804.4041 or email to [email protected]

Dan Scherer

Secure Health, Inc.



Note: prices are subject to change without notice

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Patient Compliance

Patient Compliance VNG Testing

Help patients successfully prepare for VNG tests

Preparation and patient compliance are vital elements for completing a successful series of VNG tests. Many practices distribute pre-appointment paperwork with information such as timing for the following:

--Medications to temporarily discontinue

--Medications to continue

--What to wear: comfortable clothes, flat shoes

--Eye prep, such as not wearing eye makeup or contact lenses

--When to avoid eating food and drinking caffeine or alcohol prior to testing

--What to expect regarding induced dizziness, the possibility of not driving oneself home

The preparation sheets are a helpful reference for patients who have no experience with vestibular disorders or VNG testing. There is quite an extensive list of do's and don'ts, which can be quite overwhelming.

To further improve patient compliance, practices who distribute papers and/or web information with Q and A's of what is actually involved with the VNG testing can go that much further to assist their patients. Most people are already feeling nervous about a doctor visit, especially when they are undergoing tests that they have no idea of what is involved. I know I was completely caught off guard when I learned that a full battery of VNG tests involves a series of eighteen tests and that it would take up to 30 or 45 minutes.

The information doesn't have to be clinical or complex, just keep it simple such as:

What to Expect for Your VNG Testing

Overall Objective

The overall objective of your VNG testing is to stimulate and visually record your eye movements under various circumstances. This is very likely to make you feel dizzy. Be prepared for dizziness and even the possibility of feeling nauseous or even throwing up in some cases. Both are common reactions during VNG testing. Your technician will help you as much as possible.

First Phase of VNG Testing

--The first portion of the tests, you will be asked to wear head gear consisting of goggles that have built in camera/s

--One eye will be shielded with a cover and the other one will be video recorded

--Keep your eyes wide open so the camera can record the movements of your pupil

--You will be asked to look at a dot on a monitor and follow the dot with your eyes

--Don't try to anticipate the pattern of the movements of the dot

--Each eye will repeat the same testing sequences and will be video recorded, one eye at a time*

--Please let your technician know if you are experiencing any adverse reactions to the testing procedures

*Unless your practice has a binocular VNG, in which case the eyes will be recorded at the same time

Second phase: Caloric Irrigator Tests

--A medical device called a caloric irrigator will be used for the second phase of testing

--A caloric irrigator is used to evoke your inner ear response to a stimulus

--You will be asked to wear headgear: goggles with the camera/s and lie down on an exam table

--A lighted tip connected to the caloric device will blow warm and cool air into your inner ear

--Keep your eyes wide open so the camera can record the movements of your pupil

--The camera/s will record the movements of your eyes, one at a time

--Expect a sequence of caloric testing, including physically changing movements while lying on the exam table

--You may need to lie on the exam table for a few minutes once testing is complete in order to recover from the dizziness you may experience

--Do not attempt to sit up, stand up, walk or drive unless you do not feel dizzy

--Please let your technician know if you are experiencing any adverse reactions to the testing procedures

For practices who are using ENG or older, outdated VNG testing equipment, consider upgrading to premium VNG devices and caloric irrigators manufactured by Difra Instrumentation. Difra's software is designed to reduce the time consuming aspects of testing. Difra software eliminates the need to mark up tests during during the testing procedures and therefore allows technicians to accurately test more patients with less labor for the tech and less time for the patient as well. For more information about Difra products, please contact Secure Health or review the product information contained on this web site.

If you have questions or just want to talk about this post or you have any other questions, please contact Secure Health, Inc.  We look forward to hearing from you.

Lana Scherer
Marketing Director, Secure Health, Inc.
260-418-6835 / [email protected]

Secure Health, Inc. is the exclusive US agent for Difra Instrumentation, a world's leading manufacturer of diagnostic balance disorder technology for more than 48 years.


The opinions and information contained in this website are for general information purposes only. We make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the website or the information, products or services contained on the website for any purpose. Any reliance you place on such information is therefore strictly at your own risk.In no event will we be liable for any loss or damage including without limitation, indirect or consequential loss or damage, or any loss or damage whatsoever arising from or in connection with, the use of this website.


No portion of the photos, images, information, content or intellectual property contained in this web site may be reproduced or used without prior express written permission.

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Accurately Assess Patients with a Balance Assessment Platform

Balance assessment platform Secure Health Inc

Accurately Assess Patients with a Balance Assessment Platform

For more than ten years, we have promoted the use of a balance assessment platform, which is a useful tool to assist with better identifying those at high risk of falling, including older adults. Many times, the patient will not report dizziness or instability to their health care team. By having patients complete a balance evaluation questionnaire along with conducting a balance assessment test with Secure Health's Better Balance Analyzer (BBA) platform, patients who test in the high-risk category can be more easily identified.  These patients with sway and mobility issues are truly a fall waiting to happen.

Effective Fall Risk Assessment Tool

Balance assessment screening devices, such as the balance assessment platform combined with a balance evaluation questionnaire provide an accurate assessment for older adults.

--Effective for patients who don't self-report mobility issues

--Accurately assess physical function

--Improves thoroughness

--Helpful for guiding fall intervention

--Motivates patients and their care givers

--Better for monitoring progress

Your Fall Risk Assessment Stats

How many Fall Risk Assessment's (FRA's) are you doing every month? How many new patients do you see each month?  Of the new patients, what is the number who are over age 60? How many Medicare patients do you see each month?  Were you aware that the FRA using a balance questionnaire and assessment platform should be included with every annual wellness exam?

Statistically, here's what we have observed over the years.  For every 10 patients over the age of 60 that you do an FRA, five will be low risk and another 2.5 will be in the moderate category. The remaining 2.5 will likely test as high risk with the results showing as "abnormal." In this case, further testing with the Clinical Test of Sensory Integration and Balance (CTSIB), may be warranted using the balance assessment platform, providing there are no complicating factors as determined by the physician.

After completing the balance evaluation questionnaire and undergoing a CTSIB, the physician may decide a videonystagmography (VNG) test is warranted to try to identify a vestibular disorder.  Using proper protocol, you have created a clear pathway to medical necessity and quantitative justification for the VNG testing.

Balance Platform Assessments Help Guide Fall Intervention

When used properly, a balance assessment platform is an effective tool to establish a patient's falls risk assessment (FRA) and helps identify what, if any, further diagnostic tests are needed.  It takes just five minutes to conduct a balance and falls risk assessment with a balance assessment platform.  The data collected by the software quickly compares your patient's results with more than 20,000 others to give a very strong indication of a patient's risk of falling.

The patient stands on the platform with their feet about shoulder-width apart, arms at their side, and eyes closed for four twenty-second segments.  Once completed, a report is generated with one of three categories:

  1. Low Risk
  2. Moderate Risk
  3. High Risk

Results are also shown in a chart that compares results to the normative database

After the Falls Risk Assessment (FRA), what's next?

Low Risk of Falls - No further testing is necessary at this time. FRA results should be included in patient files for future comparisons.

Moderate Risk of Falls - If the patient’s FRA results are in the moderate category, they should be further evaluated by the physician to determine if further testing is warranted. Further tests may include:

--Clinical Test of Sensory Integration and Balance (CTSIB) using the balance assessment platform;

--And/or the balance evaluation questionnaire.*

No further cause of action may be required at this time.

High Risk of Falls - If the patient balance assessment platform results indicate a high risk of falls, the patient should complete an additional test, the Clinical Test of Sensory Integration and Balance (CTSIB) with the balance assessment platform. CTSIB tests the four phases of the vestibular system using firm and perturbed (foam pad) surface with eyes open and then eyes closed.

Following the CTSIB test, the patient should complete a balance evaluation questionnaire.

After completing the FRA, CTSIB evaluation and balance evaluation questionnaire, the physician evaluates the results, in addition to existing patient history to determine if further testing is warranted. Additional tests may include videonystagmography (VNG), MRI or CT scans. The physician has enough data from these tests to determine medical necessity and make an informed decision to improve their patient's FRA or dizziness symptoms.

It's Time to Review Your FRA Protocol

Have you established your balance assessment protocol? Are you maximizing the use of your balance assessment resources?  If not, it's time to review and decide what modifications you can integrate into your practice.  Not only do you make a solid return on your investment with a balance analyzer platform, but also quantitatively establish why the VNG tests are warranted.  Using the statistics we discussed earlier, does that not better establish the need for your VNG tests?

If you don't already have a BBA balance assessment platform or premium VNG equipment, call us to discuss adding these effective diagnostic devices into your practice. You will be pleasantly surprised by how this diagnostic equipment can work for you.  I look forward to hearing from you soon.

--Dan Scherer, CEO

Secure Health, Inc.

260-804-4041 or [email protected]

Secure Health, Inc. has assembled the finest vestibular and balance products in the world. Our Better Balance™ technology is comprised of proven systems that identify, diagnose and treat vestibular and balance disorders. An essential component of our Better Balance™ technology is premium VNG diagnostic equipment manufactured by Difra Instrumentation. Difra Instrumentation is a global leading manufacturer of diagnostic balance disorder technology for more than 48 years. CALL 260-804-4041 FOR MORE INFORMATION or via email: [email protected]

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