Diagnosing Vestibular Disorders: 5 Tests You Should Know

Diagnosing Vestibular Disorders: 5 Tests You Should Know

There is no clear cut test for diagnosing vestibular disorders at this time. This is why many that experience dizziness are seen by numerous providers, imaging and tests with testing coming out as ‘normal’ even though there are numerous symptoms that do not feel normal. Learn about common testing and the importance of diagnostic criteria and someone’s history in addition to testing to reach an accurate vestibular diagnosis.

5 Tests Commonly Seen When Diagnosing Vestibular Disorders

There are many different tests that one might experience when searching for answers to their dizziness, brain fog, fatigue, trouble concentrating, anxiety, nausea, light sensitivity and many other symptoms associated with vestibular conditions. These may vary slightly based on someone’s presentation and history. The goal of this post is to go over tests people tend to be routinely recommended as well as others that might be part of standard testing, but still important considerations based on history or possible plateau in progress.

Five common tests many have experienced when diagnosing vestibular disorders are:

• MRI
• Comprehensive Audiology Vestibular Testing
• Cardiology Workup
• Bloodwork
• Physiotherapy/Physical therapy

In general, many of these tests are initially ordered in attempts to gather information and rule out other possibilities. Other tests help gather more information to add to evidence of patient presentation and history. In additional to diagnostic criteria, this can help with certain vestibular disorders such as vestibular migraine or persistent postural perceptual disorder (PPPD or 3PD) which are diagnoses of exclusion. Meaning, all other possible causes of symptoms need to be ruled out.

If interested in diagnostic criteria for different vestibular conditions, the Barany Society has them all listed here. These documents are great to print off and bring to medical appointments for patient advocacy to have evidence outlining how someone might meet diagnostic criteria for providers that aren’t well versed in vestibular conditions or are resistance to diagnosing.

Improvements can be made without a formal diagnosis, however we encourage those that don’t have one to work on what they can while working towards a formal diagnosis. Proper diagnosis in a medical chart opens up avenues for specialty visits, medications and tests that one might not be able to access or have covered by insurance.

MRI

MRI’s cannot identify a vestibular condition, not even dizziness associated with a concussion or other head trauma. The goal of MRI is to rule out other potential causes to symptoms. Having a clear MRI is overall good news despite the lack of answers as to what is the source of symptoms. MRI’s can look at the structure of our brain and nervous system, but cannot identify how those processes are working together. MRI’s can find the “hardware” problems, but not if there’s an issue with the “software” such as sensory mismatch that is common in vestibular disorders.

Comprehensive Audiology Vestibular Testing

This testing is not as familiar testing for many until it has been recommended to them or someone they know. Comprehensive audiology testing is more than a hearing test and often used in the process of diagnosing vestibular disorders. This testing has different sections that look at the function of the inner ear.

The information from this testing can be normal for those with PPPD and or VM. With conditions such as Meniere’s Disease, this testing may reveal unilateral low frequency hearing loss. Caloric testing may show a hypofunction that can arise in conditions such a vestibular neuritis, vestibular hypofunction, Meniere’s. Positional testing during the exam may identify BPPV. To learn more about these tests, check out this blog post dedicated to audiology testing.

Cardiology Workup or Monitoring

Cardiology testing may involve the wearing of a Holter monitor over days or weeks to track heart activity to determine any abnormalities that may be contributing to symptoms.

Bloodwork

General bloodwork may be taken to identify any deficiencies that may contribute to symptoms. There is no blood test that can be used in diagnosing vestibular conditions at this time. Blood work may show possible inflammation that may be contributing to symptoms but not the exact source of symptoms. Other times bloodwork might fall within an acceptable range but may not be optimal.

Optimizing values can better support the body and overall health, and others have found helpful in improved symptoms and management of vestibular conditions. This may not be an area people start with right away but can be an area to dig deeper if looking for additional information or finding progress has slowed. More on this in this episode of Grounded: The Vestibular Podcast “What is ‘Optimal’ Bloodwork” and a PDF of optimal lab values here that can help guide optimal values and various blood work to discuss with your doctor.

Physiotherapy or Physical Therapy

Physical therapy cannot aid in diagnosing vestibular conditions because PT’s are unable to diagnose as part of their scope of practice. Therapists can evaluate someone through various tests and assessments that can indicate likely diagnoses for the doctor to further consider. PT’s can take information from tests to initiate home exercise program and work towards reducing symptoms and increasing function in a person’s day to day life.

PT’s also assess and treat BPPV in clinic. Based on a patient’s history, presentation and performance on various assessment in clinic, a physical therapist may suggest that information is consistent with certain vestibular conditions. This can aid in referrals that would best fit the person and assisting the doctor in a timely and accurate diagnosis

Other Tests and Considerations

There are some tests that people might benefit from on a more case by case basis. Tests such as sleep studies can impact dizziness symptoms due to overall sleep quality. A sleep study will not be helpful in diagnosing vestibular conditions, but could be helpful in improved symptoms and management of a vestibular condition.

Other areas are similar in vestibular disorders due to lack of concrete diagnostic testing. However, that doesn’t mean these areas don’t impact vestibular conditions and overall management. Hormones and those in perimenopause of menopause may be experiencing difficulty managing or worsening of symptoms due to hormone fluctuations but there isn’t diagnostic testing for these areas at this time. Working with a menopausal informed provider involves some trial and error to determine the best course for each individual.

Bloodwork may reveal inflammation but it does not tell you where the inflammation is or what to do about it. One area that may be helpful for addressing inflammation or possible histamine intolerance is gut health. Providers like Isabel Smith, MS RD CND and Kelli Yates, dietician and holistic migraine care.

Ready to Take the Next Step Towards Healing?

If you’re looking for a supportive, expert-led space to help you regain confidence, reduce symptoms, and rebuild your life after a vestibular diagnosis, join us in Vestibular Group Fit.

This unique coaching program combines movement, education, nervous system retraining, and community — all designed specifically for people living with vestibular disorders. Whether you’re newly diagnosed or have been struggling for years, you are not alone and you can feel better.

👉Click here to join Vestibular Group Fit and starting your healing journey today.