5 useful audiology tests for vestibular disorders

5 Main Audiology Tests for Vestibular Disorders
With vestibular audiologist Dr. Alexandra Smith, Au.D, CCC-A, F-AAA.

Dr. Alexandra Smith is based in Santa Fe, NM (you can find her clinic here) and works to identify, diagnose, treat and prevent various diseases, injuries or defects of the ear. Audiologists are also able to assist their clients with maintaining good hearing and can assist with hearing devices. Dr. Smith perform audiology testing for vestibular disorders and is going over them in more detail to help you better understand your test results and know what to expect. If you think you’d benefit from audiology testing for vestibular disorders, talk to your doctor about comprehensive audiology testing.

This blog post covers some content Dr. Smith covers with Dr. Madison Oak, vestibular physical therapist for our vestibular group fit members. These tests are common when evaluating for vestibular disorders but aren’t always well known or explained. Read below to learn more about audiology tests for vestibular disorders and what they can help tell you about your vestibular condition.

What is a vestibular audiologist?

A specialty within audiology which includes: 

1. Hearing and tinnitus evaluations 
2. Surgical implant care
3. Vestibular evaluation
4. Select vestibular treatments (like the epley maneuver for BPPV) 
5. Diagnostic tests which we’ll go into more detail below! (ECOG, audiogram, VNG, brain wave testing, positional testing and more)

Using audiology tests for vestibular disorders can be another piece of information to consider with other testing (MRI, physical therapy, occupational therapy, ENT, Neurology etc) to best determine a plan of care to manage your vestibular condition. 

What is the role of a vestibular audiologist?

What does audiology testing and vestibular disorders have to do with each other? Anatomically, our inner ear has both a spatial awareness system (the vestibular system) AND hearing portions (the cochlea) that make up the inner ear. The nerve that connects our inner ear to the brain also branches from the same nerve to reach both of these sections. It is also common to have other ear symptoms or hearing changes with vestibular conditions, so it’s important to get  testing done by a specialist in the hearing portion of our inner ear, an audiologist! 

What are the 5 main audiology tests for vestibular disorders?

Common audiology tests for vestibular disorders include: 

1. VNG (Videonystagmography exam)
2. Caloric testing 
3. ECOG (Electrocochleography exam)
4. VEMP (Vestibular evoked myogenic potential)
5. Audiogram

Below, we’ll go into more detail on what these tests measure, what to expect, and how these tests can help with vestibular diagnostics. 

VNG (Videonystagmography exam)

• Goggles are worn to measure and track eye movements using special software and is tracked on a chart
• Wearing the goggles, the audiologist will perform an oculomotor exam (tracking targets, saccades/looking between multiple targets other eye movements) 
• Positional testing such as the Dix hall pike (for BPPV testing) 
• caloric testing, read on to learn more about this one
• VNG can help determine any positional dizziness like BPPV and identify any central signs that may warrant a referral to a neurologist, or peripheral signs that could point to a vestibular condition

Caloric testing

• Done with air or water, each ear gets 1 minute of warm and  1 minute of cool  air/water
• The temperature of the warm and cold air/water is mild.  This temperature change stimulates your vestibular system. This can cause uncomfortable sensations of movement or rotation.
• It is normal to feel dizzy for part of the test and it will go away. All you have to do is keep your eyes open!

• The stimulation of the vestibular system causes the dizzy sensation and eye movements (nystagmus- more on that here)
• These eye movements are being measured with infrared video goggles. The left and right ear are compared to see if the movements are symmetrical.
• If the left and right ear are asymmetrical, this could indicate a unilateral vestibular weakness or vestibular hypofunction (you can learn more about this here)

You are in control and can stop at anytime, it is NOT AN ATTACK.

ECOG (Electrocochleography exam)

• A brain wave test that looks for increased fluid pressure in your endolymphatic sac in your inner ear (indicative of meniere’s disease) 
• NOT a test in isolation of meniere’s disease-more accurate in the middle of an episode but more people don’t get into a clinic for testing during an episode

VEMP (Vestibular evoked myogenic potential)

• Cervical and ocular VEMPS are cVEMP or oVEMP
• Testing otolith function ( the utricle and saccule) 
• Analyze the two branches of your vestibular nerve.
  • Can see if one nerve is stronger than the other or if one side is weaker 
• Can test for 3rd window syndrome like superior canals dehiscence syndrome
• Laying down on the table, one head movement and one eye movement.

Audiogram

• A hearing test, typically for first test you get in a audiologists office 
• Can be very helpful in what’s going on and even help address what you’ve been experiencing 
• Can tell you if you have hearing loss and where (what type of frequencies), and tympanic reflexes that can let us know about any ear pressure that man be going on 
• Labyrinthitis will cause hearing loss
• Meniere’s disease also causes low frequency hearing loss on the affected side 
• Age related hearing loss tends to be in both ears and at higher frequencies.

Can you have normal testing and still have a vestibular disorder?

YES! Certain vestibular conditions will not show up on this testing. Migraine will not show up on MRI, CT scans, ECOG VEMP or VNG or audiograms. These tests can still be helpful for these conditions that require a diagnosis of exclusion to rule out other conditions that these tests can reveal. Audiology tests for vestibular disorders can help lead us to identify specific diagnoses. If testing comes out normal, audiology tests for vestibular disorders can also help consider other diagnoses that would show normal testing. 

Audiology tests for vestibular disorders is one piece of testing to be considered with other providers testing and listening to what you’ve experienced. Listening to your experience and looking at all the test results can help get the right team of providers (OT, PT, Neuro, ENT) in your corner to start your healing journey. It’s natural for this team to change slightly, or change focus for periods of time with certain providers based on your needs. Keep your team in the loop so they can help adjust accordingly, they’re here to help YOU. 

Want to learn more about vestibular testing, ear pressure, tinnitus and other vestibular tools to get back to your daily life?  Find out more at this link: https://tvd.flywheelstaging.com/about-group/

Disclaimer:

Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.