Diagnostic testing for vestibular disorders: a comprehensive guide

Diagnostic testing for vestibular disorders-explained

Entering the realm of diagnostic testing for vestibular disorders can be overwhelming, to say the least. But fear not; this guide aims to shed some light on the process, helping you navigate through the labyrinth of medical terminology and procedures.

When first going to a doctor for dizziness, it’s normal for tests to be ordered to gather more information as to what might be going on. Below are common diagnostic testing for vestibular disorders to assist providers in gathering more information on the function of each vestibular organ. These are commonly performed by an audiologist. Other tests performed by a physical therapist are in detail here.

Taking into account each individuals story is so important. Your provider will listen to your experience, consider other medical history factors to assist in further referrals. Typically an MRI or CT scan will be ordered to rule out other causes.  In most cases, this type of imaging will come out normal in those with vestibular conditions. MRI and CT scans are not great at finding vestibular related conditions. MRI and CT are good at ruling out other causes (stroke, tumor, MS etc).

CT scan is useful with identifying Superior canal dehiscence or thinning of the temporal bone. Symptoms such as “hearing your eyeballs move” or dizziness with sneezing or coughing are common symptoms that prompt this type of imaging.  In most other cases however, MRI and CT scan are just the beginning of tests. Below includes testing to determine the status and function of the vestibular system.

Quick vestibular system background

Let’s quick talk about what it is that we’re testing–the vestibular system. The vestibular system, nestled within the inner ear, plays a pivotal role in maintaining balance and spatial orientation. When this delicate system becomes disrupted, whether due to injury, infection, or other underlying conditions, it can wreak havoc on your equilibrium, leading to a myriad of symptoms such as dizziness, vertigo, nausea, difficulty concentrating, unsteadiness, neck pain and more. Diagnostic testing for vestibular disorders looks at directly testing the nerve the shares information between the vestibular system and brain to determine possible diagnoses.

Diagnostic testing for vestibular disorders

Listed below are common tests used to gather more information. This information can assist with other physical assessments and personal report to help with diagnosis and moving forward with a treatment plan.

1. Electronystagmography (ENG): This test tracks your eye movements in response to various stimuli, helping to identify abnormalities in the vestibular system.
2. Videonystagmography (VNG): Similar to ENG but utilizing infrared video technology for more precise measurements of eye movements. This includes tracking objects, looking between targets and other eye movements. Positional testing to assess any dizziness when in different head and body positions are performed with eye movement recorded and measured. This can help identifying any signs that don’t indicate a vestibular/peripheral cause, and other conditions such as BPPV.
3. Caloric Testing: By stimulating each ear with warm and cool air or water, this test assesses the superior branch of the vestibular nerve. Movement sensations are a very normal sensation to have here. It is not an attack. The temperature differences is stimulating only one side of the vestibular system on purpose. This produces involuntary eye movements (nystagmus). By comparing one side to the other. This test looks for symmetry of each vestibular signal and can help identify asymmetries.
4. Rotary Chair Testing: You’ll be comfortably seated in a rotating chair while your eye movements are monitored, providing valuable information about your vestibular function.
5. Vestibular Evoked Myogenic Potentials (VEMP): This test evaluates the inferior branch of the vestibular nerve which helps with the otolith and saccule function. This involves electrodes on the head/neck with some head movements and sounds. This can help in diagnosing: vestibular neuritis, Meniere’s disease, superior semicircular canal dehiscence.
6. ECOG (electrocochleography Exam): This looks for increased fluid pressure in the inner ear. This can be indicative of Meniere’s disease. This test is not used in isolation to diagnose Meniere’s disease as this test isn’t as accurate if being done in between attacks. This involves some electrodes and a few sounds played. A relatively quick and easy test!
7. Audiogram: A basic hearing test can help determine any hearing loss and what type. Meniere’s disease can cause low frequency hearing loss on the affected side. Labyrinthitis will also cause hearing loss.
8. Auditory Brainstem Response (ABR): Similar set up to an ECOG this test helps measure for any hearing loss. Typically this is done in those that are unable to perform an audiogram.

Other considerations

Other considerations include vision exams to determine a need for vision therapy, or blood work to determine thyroid function, any deficiencies, or inflammatory markers in bloodwork that may be contributing to symptoms. These areas might not be explored initially, but are good to keep in mind as more information is gathered.

There are also additional tests that can help indicate vestibular involvement performed by a physical therapist. More on that in the blog post here. For more info on what to expect during testing, check out this post here

To learn more

Want to learn more about testing, diagnoses, and listen to an interview with a vestibular audiologist?  Learn about other vestibular tools from the experts and be a part of a supportive community 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.