Vestibular Testing

What is vestibular testing?

Vestibular testing includes several tests that check how the balance system within your inner ear (vestibular system) is working. These tests are sometimes called a vestibular test battery. Your healthcare provider may order vestibular testing if you have symptoms of dizziness, vertigo or if you’re feeling off balance.

Your vestibular system helps you position and move your body so that you feel a sense of balance within your environment. It includes three semicircular canals (head rotation sensors), two otolith organs (gravity sensors) and the vestibular nerve.

Vestibular testing allows a healthcare provider to evaluate how these parts of your vestibular system work to help you coordinate movements and stay balanced.

When is vestibular testing performed?

Vestibular testing can show if your symptoms relate to an inner ear or a related neurological (brain) issue. Vestibular tests can help your provider diagnose conditions, such as:

• Benign paroxysmal positional vertigo (BPPV).
• Labyrinthitis.
• Ménière’s disease.
• Vestibular neuritis.
• Others.

Vestibular testing can also help your provider rule out an inner ear condition. For example, vision problems, injuries, medications and other health conditions can cause symptoms that suggest a balance disorder — even if you don’t have one.

How do vestibular tests work?

For vestibular testing, an audiologist guides you through various simple tasks while asking questions. Audiologists specialize in hearing and balance disorders.

These tests measure how your body’s sensory systems that control balance work together. To feel balanced, your brain requires input from three systems working together:

• Vision (sight).
• Proprioception (touch).
• Vestibular system (inner ear balance system).

An important reflex within your vestibular system keeps your vision in focus while your head and body move. It’s called the vestibulo-ocular reflex, or VOR. The audiologist will monitor your eye movements to assess your VOR. For example, they may look for involuntary eye movements (nystagmus). Your eyes provide essential visual evidence of how your vestibular system is working.

How do I prepare for vestibular testing?

Follow your audiologist’s instructions on how to prepare. Instructions may include the following:

• Plan to have someone drive you home after the test. You may feel dizzy or unsteady after testing. To be safe, it’s a good idea to have someone drive you home.
• Follow your provider’s guidance about what medications to take. Some medicines may interfere with your test results. Follow your provider’s instructions on which medicines you should take and which ones you should avoid.
• Follow your provider’s guidance about what foods to eat or drink. Your provider may recommend eating only a small meal or avoiding eating before the test. They may ask you to avoid alcohol.
• Don’t wear eye makeup. It’s important that your provider can see all eye movements so they can evaluate your VOR. Eyeliner, mascara and dark eye shadow can make this difficult.

What should I expect during the test?

There are many types of vestibular tests. Your audiologist will determine which ones you need based on your symptoms. You may not need all of them or you may need additional testing.

Electronystagmography (ENG) and videonystagmography (VNG)

Electronystagmography (ENG) and videonystagmography (VNG) measure the health of nerves in your brain that control eye movements, hearing and balance. For these tests, an audiologist measures your eye movements as you perform simple tasks. Tasks include:

• Locking your eyes on a target and following it as it changes directions.
• Moving your head and body into different positions.
• Having warm or cool air or water placed in your ear canal (your eye movement lets the audiologist know if your inner ear responds normally to these changes).

With an ENG, a healthcare provider places metal disks (electrodes) around your eyes that measure your nerve function. With a VNG, you’ll wear goggles with a camera inside that records your eye movements.

Rotary chair

The rotary chair test provides information about how your eyes and vestibular system work together to keep your vision focused while you’re in motion. For this test, you’ll wear goggles and sit in a motorized chair that moves. You’ll keep your eyes open while the chair moves to the right and left. The goggles will record your eye movements.

Modified clinical test of sensory interaction on balance (mCTSIB)

mCTSIB allows your provider to evaluate how your vision, sense of touch (in this case, in your feet) and inner ears might contribute to your dizziness and unsteadiness. For this test, you’ll stand without shoes on a firm surface and then a foam surface. You’ll stay as steady as possible on both surfaces for 30 seconds. Your audiologist may ask you to complete these tasks with open and closed eyes.

Video head impulse test (VHIT)

A video head impulse test (VHIT) provides information on how effectively the three semicircular canals inside your inner ear detect head movements. For this test, you’ll wear goggles that record eye movements while you stare at a target. The audiologist will move your head to the right and left or up and down. They’ll note how successfully your eyes stay focused on the target with your head in motion.

Vestibular evoked myogenic potentials (VEMP)

Vestibular evoked myogenic potentials (VEMP) testing provides information about how your inner ear’s two otolith organs (saccule and utricle) function. For this test, you’ll have electrodes on your neck. You’ll wear headphones. You’ll turn your head to the left and right, with eyes locked on a target, while you listen to a series of tones through the headphones. The electrodes will record your neck muscles’ response to the sound signals.

Dynamic visual acuity testing (DVA)

Dynamic visual acuity testing (DVA) checks how well you can use your vestibular 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. Then, you’ll have to identify a target with your head moving from side to side or up and down.

Risk of falls assessment

This assessment evaluates factors that increase your risk of falling. It includes tests that check inner ear function.

How long does vestibular testing take?

Usually, the appointment is scheduled for two hours. The test time may be shorter depending on your symptoms and test results.

Are there risks associated with vestibular tests?

Vestibular testing is safe. You may feel dizzy or unsteady during the test. These side effects may linger shortly afterward, so it’s a good idea to arrange to have someone drive you home.

What type of results will I get?

You’ll get one of two types of results:

• Normal results mean there were no signs of vestibular dysfunction as a cause for your reported symptoms.
• Abnormal results indicate signs of vestibular and/or neurologic problems contributing to your symptoms.

When will I get results?

Your audiologist will review your test results with you at the end of your appointment or later if they need additional time to review the results. They’ll also share the results with the healthcare provider who referred you for testing.

Your audiologist may include instructions for follow-up care in an after-visit summary highlighting your results. Review results with your healthcare team to develop an appropriate plan of care.

Will I need more tests after a vestibular test battery?

Your test results will determine the next steps.

Your healthcare provider may refer you to another specialist to get a better understanding of a specific result. They may order imaging procedures like magnetic resonance imaging (MRI) to look for damage in soft tissues or a computed tomography scan (CT scan) to look for damage in the bones in your inner ear.

How do I schedule vestibular testing?

You may need a medical order to schedule an appointment, depending on your health insurance. Ask your healthcare provider if they recommend vestibular testing for you.

A note from Cleveland Clinic

Your healthcare provider may order vestibular testing to determine why you feel dizzy or off balance. Knowing that you’ll have to complete various tests can feel overwhelming, but the tests are simple and straightforward. The audiologist conducting the test will walk you through each task step-by-step. Once testing is complete, you’ll be one step closer to receiving the diagnosis and treatment you need to manage your symptoms.