What Is Vestibular Testing & How Is It Done?

If you’re suffering from dizziness or imbalance, your doctor may recommend vestibular testing.

Your response is probably, “What’s that?”

Dr Sriharsha who performs vestibular testing at Sahasra ENT, Madhapur likens it somewhat to an X-ray. Though not as common, vestibular testing is a standard diagnostic tool that can help give your doctor a better idea what’s going on inside your body — your inner ear, specifically.

Your inner ear isn’t only important for hearing. Believe it or not, it plays a crucial role in helping you keep your balance.

“We have a cool system in our inner ears,” says Dr Sriharsha. “Each ear has a little gyroscope that senses rotational and linear movement. When one side isn’t working properly, it can affect a person’s spatial orientation and balance.”

Hence, the dizziness and lack of balance that can result. But these symptoms aren’t always due to inner ear issues. The potential culprits can also be related to vision, the brain, heart, medications you’re taking and more.

“Vestibular testing is one of the steps in determining whether the issue is really in your inner ear,” says Dr Sriharsha. “It’s a piece of the puzzle that can help your doctor come up with the right diagnosis.”

What is vestibular testing?
Vestibular testing is a series of tests that evaluate whether the balance organs in the inner ear are functioning properly.

For instance, the tests can help identify if you have a weakness in your right inner ear. This weakness may be causing dizziness. It can also make you feel off balance, leading to falls,

Or that there’s no issue in your inner ears at all.

“There’s actually no direct way to measure inner ear function,” says Dr Sriharsha. “Instead, we take advantage of a specific reflex in the brain that links inner ear function and eye movements. The eyes essentially become my window into the inner ear.”

The major components of vestibular testing include:

Videonystagmography (VNG) – uses goggles to track eye movement as certain tasks and tests are performed.
Vestibular evoked myogenic potentials (VEMP) – uses electrodes and sound stimulus to measure a response that travels from the neck muscles to the inner ear

Posturography – EquiPoise offers unparalleled precision in the measurement of centre of gravity sway using a high-resolution, large dynamic range force measuring
platform. It extends the Romberg test with objective, real-time analysis,
providing clinicians with essential insights for diagnosis and rehabilitation
planning.

fHIT – Assess vestibulo-ocular reflex function with precision. The intact vestibulo-ocular
reflex is essential for maintaining visual acuity while the head is in motion. During rapid head movements, an intact vestibulo-ocular reflex ensures gaze
stability by precisely moving the eyes within the orbit, counteracting head
motion. EQU f assesses each canal individually by presenting optotypes at
peak head velocity in specific canal planes and directions.

Craniocorpography – employs advanced computer vision technology to track
and analysethe balance

“Each of these larger tests are made up of a lot of little tests,.The testing is extensive and fairly long, taking between 1.5 to 2 hours to complete.”

How is vestibular testing done?
Each component of the testing comes with specifics, but Dr Sriharsha offers a few examples of what to expect during vestibular testing.

“During VNG, one thing we look for is nystagmus, a specific eye movement that relates the eyes and inner ear fluid together. When the inner ear is stimulated in a certain way, this fluid and the eye should move the same.”

For the most part, vestibular testing follows a fairly standard testing protocol and the physician is assessing the results in real-time.

“If the results are looking normal, we simply move through the tests. If not, there are more sophisticated tests.

Most of the basic tests performed during vestibular testing stimulate the inner ear at fairly low frequencies.

What happens after vestibular testing?
At the end of testing, the results are compiled by your doctor who then reads and summarizes the findings.

The most common balance disorders diagnosed include:

Benign paroxysmal positional vertigo (BPPV)
Vestibular migraine
Labyrinthitis
Ménière’s disease

But there are many others. Additionally, dizziness and imbalance can be caused by things other than issues within the inner ear. In these cases, other tests may be needed, such as imaging and blood tests.