What is vestibular testing?

Last update on Jun, 21, 2021

Dizziness and balance problems are symptoms that, when they occur frequently and last a long time, can be traced back to different pathologies. The vestibular examination allows the ENT doctor to diagnose the disorder that causes them and, in some cases, resolve it during the session itself. The tests that make up this examination verify the vestibular function. This involves the vestibule and labyrinth which provides the brain, through a series of processes, with information on the position of the body and head in space. Related dysfunctions, such as labyrinthitis or benign paroxysmal positional vertigo, are the most common cause of balance disorders.

What happens in a vestibular examination?

The vestibular examination is mainly based on the observation of the nystagmus, that is of the involuntary movements of the eyeballs, either spontaneous or caused by some specific stress. The patient wears special glasses, or mask-like devices, to stop them staring at one point. The examination takes place on a examination table and the patient undergoes some maneuvers and movements of the head to check which positions and which stimuli cause nystagmus. The position in which the presence of these eye movements is observed, and their typology, give the doctor the elements to make a diagnosis or to ask for further investigations. Vestibular tests last about fifteen minutes and can cause dizziness and nausea . For this it is necessary to fast for at least four hours and to come to the exam accompanied. Taking dizziness medications can distort the test result. It is therefore necessary to stop these kinds of treatment two days before the vestibular examination. No contact lenses of any kind may be worn during the tests. The examination must be preceded by an ENT examination to rule out the presence of ear infections or earwax plugs.

Romberg's Test

During the vestibular examination, further tests may be carried out at the discretion of the specialist who is performing it. Romberg's test, which is also used in neurology, is very simple. The patient must balance for 30 seconds, with heels together and the arms extended along the body and with the eyes open. Maintaining a position without excessive oscillations can exclude neurological causes for vertigo. The test is repeated with eyes closed for another 30 seconds: in case of vestibular neuritis, the patient cannot maintain balance and tends to swing towards the side of the damaged vestibule.

Head Impulse Test

Another very useful clinical examination is the head impulse test. The patient must keep their gaze fixed on one point while the examiner moves his head to the right or left with unpredictable and fast movements. In the presence of vestibular damage, moving the head towards the damaged ear, the gaze cannot remain fixed on the pre-established point.

Caloric Test

The vestibular caloric test (Caloric-reflex test) consists of the thermal stimulation of the labyrinth. Water is introduced into the ear at different temperatures for 30 seconds. In healthy subjects this causes dizziness that lasts about a minute. Those who have a vestibular disorder instead either do not experience any vertigo, or experience it intensely.

Results of Vestibular Testing

If BPPV is diagnosed during the vestibular examination , during the same visit some so-called release maneuvers can be performed. This disease is in fact caused by the movement of the otoliths, small crystals similar to pebbles present in the inner ear which act as movement "sensors",  from their natural site. Thanks to some specific movements of the head and body (for example the Semont maneuver, Epley maneuver, or the McClure maneuver) they can be correctly repositioned.

If other vestibular problems are identified, such as labyrinthitis or Ménière's Disease, further investigations may be required, such as a specific ENT examination or an audiological evaluation, to identify the most appropriate therapy. In some cases, an MRI or CT scan may be needed. If the vestibular examination excludes pathologies of the inner ear as a cause of dizziness, further investigations are necessary. Vertigo and balance disorders, in fact, may have neurological, orthopedic, psychological origins or be linked to low blood pressure.

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