Vestibular Test Battery

Overview

What is a vestibular test battery?

A vestibular test battery includes several different tests that will tell your healthcare provider how well the vestibular portion of your inner ear system is working Your provider may order a vestibular test battery if you have symptoms of dizziness, vertigo or feeling off balance. The tests will show if these symptoms are due to an inner ear problem or a neurological (brain) problem and will help your provider develop the best treatment plan.

The testing is performed by an audiologist (a hearing and balance specialist) in a laboratory setting. During testing, the audiologist will look for the presence of nystagmus (involuntary eye movements) that may be due to vestibular or neurological problems.

What is the vestibular system?

For the body to feel balanced, the brain requires input from three sensory systems working together: vision (sight); proprioception (touch); and vestibular (inner ear). The vestibular system in each ear involves three semicircular canals (our head rotation sensors), two otolith organs (our gravity sensors), and the vestibular nerve.

All three of the sensory systems work together to:

  • Help keep you standing upright.
  • Prevent falls.
  • Walk gracefully.
  • Let your eyes follow moving objects.

The vestibular system in particular helps to keep your vision in focus and stable while your head and body are moving. This happens because of a reflex response called the vestibulo-ocular reflex or VOR. The vestibular test battery evaluates the function of the VOR response.

What causes dizziness, vertigo and imbalance symptoms?

Symptoms of dizziness, imbalance or vertigo may have many different causes. These symptoms may be due to problems associated with:

  • Your inner ear.
  • Your vision.
  • Your brain.
  • Your heart.
  • Medications.
  • Other health conditions.

In addition, injury, illness and the aging process can affect one or more of the components of the overall balance system.

Test Details

How do I schedule a vestibular test battery?

Depending on your health insurance, you may need a medical order to schedule this appointment. Talk with your healthcare provider to see if they recommend a vestibular test battery for you.

How long does the vestibular test battery take?

Usually, the appointment is scheduled for two hours. While the test time may be shorter depending on your symptoms and test results, you should plan on being at the testing facility for the entire time.

What happens during the vestibular test battery?

The audiologist may perform any of the following tests during your appointment:

Videonystagmography (VNG): Provides information about how certain parts of the inner ear system and eye reflexes are functioning. This test will require you to wear goggles around your eyes in order to monitor eye movement. You’ll perform tasks such as following a target in various directions and moving your head and body into different positions. Your eye movement responses will be recorded when warm and cool water are put into your ear canal.

Rotary chair: Provides information about how your inner ear balance system is working. This refers to the reflex between your ears and eyes. For this test, you’ll wear goggles and sit in a motorized chair that moves. You’ll be asked to keep your eyes open and answer questions while the chair moves to the right and left.

Modified clinical test of sensory interaction on balance (mCTSIB): Tells your provider how vision, the sense of touch in your feet and your inner ears are contributing to your dizziness and unsteadiness. For this test, you’ll stand without your shoes on a firm and foam surface. Your task will be to stay as steady as possible for 30 seconds in each position.

Video head impulse test (VHIT): Provides information on the parts of your inner ear balance system (three semicircular canals) that help detect head movements. For this test, you’ll wear goggles to record eye movement while you are told to stare at a target. The clinician will move your head to the right and left or up and down in order to see how well the semicircular canals are working..

Vestibular evoked myogentic potentials (VEMP): Provides information about how parts of the inner ear balance system (saccule and / or utricle) are functioning. For this test, you’ll sit in a chair and turn your head to the left and right and stare at a target while you listen to a series of tones.

Dynamic visual acuity testing (DVA): Evaluates how well you can use your inner ear balance system with your head in motion. For this test, you’ll sit in front of a computer screen and identify a target that appears on the screen while your head is still and then with your head moving either right to left or up and down.

Risk of falls assessment: Evaluates factors that may predict which people are likely to experience future falls and injuries. This group of tests includes tests of inner ear function.

What happens after the vestibular test battery?

The audiologist will review the results of the appointment and provide an after-visit summary for you to take home. In addition, the results will be forwarded to your referring provider for review.

Results and Follow-Up

When will I find out the results of the vestibular test battery?

The audiologist will review your test results with you at the end of your appointment and provide you with an after-visit summary for you to take home. Sometimes additional time is needed to review the test results. If this happens, your audiologist may schedule a later discussion with you.

What will the vestibular test battery results mean?

A normal test means there were no signs of vestibular dysfunction as a cause for your reported symptoms.

An abnormal test may mean that there are signs of vestibular and/or neurologic problems contributing to your symptoms.

Will I need more tests after a vestibular test battery?

The healthcare provider who referred you for testing may order more tests to get a better understanding of your symptoms, or you may be referred to see another specialist based on the results of the vestibular test battery.

What kind of follow-up care might I need after a vestibular test battery?

The audiologist may include some instructions for follow-up care in the recommendation section of your after-visit summary. Review these with your healthcare team to develop an appropriate plan of care for you based on the test results.

Additional Details

What happens before, during and after the vestibular test battery?

Vestibular Test Battery Checklist

Before the test

  • Complete any online questions assigned by your provider.
  • Bring someone with you who can drive you home after the testing has been completed.
  • Medications may interfere with test results. Take only essential medications during the two days before your appointment. These include heart medicines, blood pressure medicines, diabetes medicines, seizure medicines and psychiatric medicines. Please avoid the following medicines during the two days before your test: sleeping pills, tranquilizers, narcotics, antihistamines, medications that make you dizzy, like meclizine (Antivert®) and glycopyrrolate (Robinul®) and over-the-counter cold or allergy medications.
  • Please don’t consume any beverages containing alcohol 24 hours prior to your test session.
  • Many people tolerate the tests well, but you may feel symptoms of nausea or unsteadiness. Just in case, don’t eat anything four hours before testing, unless you have diabetes. If so, you may eat a small meal like toast and juice prior to your test.
  • Please don’t wear eye makeup. Eyeliner, mascara and dark eye shadow can interfere with testing.

During the test

  • Follow test instructions.
  • Let the audiologist know if you are experiencing any of your symptoms during testing.

After the test

  • Review results with the audiologist.
  • Take home the after-visit summary and review considerations.
  • Talk to your referring provider to determine plan of care.

A note from Cleveland Clinic

Your healthcare provider may order a series of tests called the vestibular test battery to find out why you’re feeling dizzy or off balance. You’ll need to follow some instructions before and during the test. You’ll also need to have a responsible adult with you to drive you home. Make sure you understand all of the instructions you get, especially in terms of what medicines you can or can’t take. Finding out what’s causing your dizziness will lead to the best treatment.

Last reviewed by a Cleveland Clinic medical professional on 04/27/2021.

References

  • Vestibular Disorders Association. Tests for Diagnosing Vestibular Disorders. (https://vestibular.org/article/diagnosis-treatment/diagnosis/) Accessed 4/27/2021.
  • Priesol AJ, Cao M, Brodley CE, Lewis RF. Clinical Vestibular Testing Assessed With Machine-Learning Algorithms. (https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2089809) JAMA Otolaryngol Head Neck Surg. 2015;141(4):364–372. doi:10.1001/jamaoto.2014.3519
  • Cohen HS. A review on screening tests for vestibular disorders. Journal of Neurophysiology. 2019;122(1):81-92. doi:10.1152/jn.00819.2018.

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