What to expect from a vestibular balance assessment

August 14, 2015
Vestibular assessments, or balance assessments, are recommended for people who have dizziness, vertigo, imbalance, and other related symptoms, because the vestibular portion of the inner ear contributes largely to our ability to stay upright. Visual input, somatosensory input and the central nervous system also contribute to our balance. Vestibular assessments are usually done by an audiologist. Because several body systems contribute to our balance, a patient who has dizziness may also be evaluated via clinical exam with an otologist or neurotologist or with imaging and blood work.

What happens during a Vestibular Assessment or Balance Test?
  • A comprehensive balance test has several parts, including a recent hearing evaluation. Because the inner ears of hearing and balance are closely grouped, a vestibular problem may also affect one’s hearing in large ways, or in small ways that a patient may not perceive. 
  • GANS Sensory Organization Performance testing tells the audiologist about which senses a patient depends on most to maintain balance. The test involves standing with the eyes open and closed in a few different stances, on the floor and on a foam pad. 
  • Videonystagmography (VNG) testing is an important part of the vestibular assessment. VNG testing involves wearing a pair of goggles and completing a battery of eye movement tests called ocular motility tests. Eye movements that we use in everyday life are assessed, and the goggles allow the audiologist to examine these eye movements up close. Also included in the VNG testing are different positional and positioning tests where the patient is guided through different head and body positions and the eyes are assessed for involuntary movements called “nystagmus.” Finally, we use the VNG goggles to complete caloric testing. Caloric testing involves flowing warm and cool air into the ear canals and measuring nystagmus from the eyes. This test is important in diagnosing a weakness in function of one or both of the inner ears of balance. (Why is so much emphasis placed on the eyes, when we’re looking for information about the inner ears of balance? Well, the eyes and inner ears of balance are connected by an important reflex, so the eyes can tell us a lot about the inner ears.)
  • Vestibular Evoked Myogenic Potentials (VEMPs) and electrocochleography (EcochG) are additional tests which may be completed if requested by your doctor. These tests may further inform your care team about certain inner ear of balance problems. These tests involve the placement of gel electrode stickers on different places on the face, head or neck, and listening to clicking sounds.
  • Note: The amount of time that you will spend at our office depends on which tests are ordered, and whether or not you have had a hearing test recently. If you are scheduling an appointment for a vestibular assessment, please ask the patient scheduling representative you work with about how long testing will last.


Preparing for Balance Testing

Here are some “Does and Don’ts” for balance testing. Following these steps will help us obtain the most accurate results possible.

1. Do not wear any makeup, including mascara, eyeliner, or face lotions. These products can interfere with the recordings.
2. Do not drink any alcoholic beverages for 48 hours prior to the test.
3. Do not drink caffeine (coffee, tea, or soda) for 24 hours prior to the test.
4. Do not use tobacco of any form for 3 hours prior to the test.
5. Do not eat for 3 hours prior to the test. Please eat lightly on the day of your appointment. If you have diabetes, please eat as you usually do.
6. Certain medications can influence the body’s response to the test, thus giving a false or misleading result. If possible, please do refrain from taking the following medications for 48 hours prior to your appointment: Anti-vertigo or anti-dizziness medications (ie: Meclizine, Anti-vert, Ru-vert); Anti-nausea medications (ie: Atarax, Dramamine, Compazine, Thorazine, Transdermal patch); Antihistamines or decongestants; Allergy medications; Sedatives; Sleeping pills; Tranquilizers; Pain pills.
7. Vital medications SHOULD NOT be stopped. Continue taking medications for diabetes, heart, blood pressure, thyroid, anticoagulants, birth control, and seizures. If you are unsure about discontinuing a particular medication, please call your physician to determine if it is medically safe for you to be without the medication for 48 hours.

Questions or concerns about balance testing?

Feel free to contact me (Elizabeth Harland, AuD, CCC-A) at the Center for Hearing and Skull Base Surgery, which is located in the Swedish Neuroscience Institute at the Cherry Hill Campus. The telephone number for scheduling an appointment, making a referral or for general questions is 206-215-4327.

Topics: Audiology, Services