Do you sometimes feel dizzy, dizzy, or dizzy? Or do you feel unsteady or pulled to one side when you walk? If you experience these symptoms frequently, your doctor may recommend that you undergo a 'vestibular test'. So, you may be wondering, "What is a vestibular test?" Let's talk about it in detail and in a very simple way today.
What is vestibular testing?
Simply put, vestibular testing is a series of tests that measure how well your inner ear balance system (also known as the vestibular system) is working. These tests are sometimes called a 'vestibular test battery.' Your doctor may order these tests if you frequently experience dizziness, vertigo, or feel off-balance.
Think about it, our vestibular system is a pretty amazing thing. It helps us maintain our body position and movements while we stand, walk, and move our heads, helping us stay balanced in the world. This system has several main parts: three semicircular canals that help us detect the direction our head is turning, two otolith organs that help us detect gravity, and the vestibular nerve that carries this information to the brain.
So, with these vestibular tests, a doctor can accurately assess how well these parts of your vestibular system help coordinate your movements and maintain balance.
Why do such a test?
These vestibular tests help determine whether your symptoms, such as dizziness and vertigo, are actually caused by a problem in the inner ear or by a problem in the related nervous system (i.e., the brain).
What kinds of diseases can this detect?
These tests can help doctors diagnose certain medical conditions. Here are a few examples:
- Benign Paroxysmal Positional Vertigo (BPPV): This is when a small calcium crystal in the inner ear becomes dislodged and moves to another location. This causes severe dizziness when you move your head. Labyrinthitis: An infection or inflammation of the inner ear.
- Ménière's disease: A condition caused by increased fluid pressure in the inner ear. Symptoms may include dizziness, ringing in the ears, and hearing loss.
- Vestibular neuritis: Inflammation of the vestibular nerve.
- Other similar diseases.
Also, sometimes these tests can help confirm that your symptoms are not due to an ear problem. Sometimes, vision problems, certain accidents, certain medications, and other health conditions can make you appear to have balance problems, even if you don't actually have one.
How do these vestibular tests work?
During this vestibular test, a hearing and balance specialist (audiologist) will ask you questions as they guide you through a series of simple activities. These specialists are specially trained in hearing and balance disorders.
These tests measure how well your body's sensory systems that control balance work together. In order for us to stay balanced, our brain needs information from three main systems:
- Sight (eyesight): The things we see.
- Proprioception (sense of touch and position): Simply put, things like our limbs, the way our body feels on the ground, and the position of our joints.
- Vestibular system (the balance system in the inner ear): The one we talked about earlier.
A very important automatic response in your vestibular system is the one that helps you keep your eyes focused on one spot even when your head and body are moving. This is called the vestibulo-ocular reflex (VOR) . Imagine, you are riding a bus and you are looking at a sign outside. Even if the bus is shaking, you can still look at that sign, right? That's what the VOR does.
The hearing and balance specialist will assess how your VOR is working by observing your eye movements. For example, they will look for involuntary, uncontrollable eye movements. This is called nystagmus . Your eyes provide important visual evidence of how your vestibular system is working.
How to prepare for the test?
Your hearing and balance specialist will give you advice on how to prepare before the test. This advice may include:
- Bring someone to drive you home after the test: You may feel a little dizzy and lightheaded after the test. So it's a good idea to have someone drive you home for safety reasons.
- Tell your doctor about the medications you are taking and follow their instructions: Some medications can affect test results. Therefore, follow your doctor's instructions exactly about which medications to take and which to stop.
- Follow your doctor's instructions about eating and drinking: Your doctor may tell you to eat only a light meal or not to eat anything before the test. You may also be told to avoid drinking alcohol.
- Don't wear eye makeup: It's important for the doctor to be able to clearly see every movement of your eyes when assessing your ``(VOR)''. This can be difficult with things like eyeliner, mascara, and dark eyeshadow.
What to expect during the test?
There are many types of vestibular tests. Your hearing and balance specialist will decide which tests you need based on your symptoms. You may not need all of these tests, or you may need additional tests.
Here are some of the main tests performed:
Electronystagmography (ENG) and Videonystagmography (VNG)
These `(ENG)` and `(VNG)` tests measure how healthy the nerves in your brain that control eye movements, hearing, and balance are. In these tests, a hearing and balance specialist measures your eye movements while you do a few simple tasks. These tasks may include:
- Keeping your eyes on a target and watching it as it moves back and forth.
- Turning your head and body into different positions.
- Injecting warm or cool air or water into your ear canal (your eye movements can tell if your inner ear is responding normally to these changes).
In an `(ENG)` test, a doctor places small metal plates (called electrodes) around your eyes, which measure your nerve activity. In a `(VNG)` test, you wear goggles with a camera inside, which records your eye movements.
Rotary Chair Test
This rotary chair test provides information about how your eyes and vestibular system work together to keep your vision focused as you move. For this test, you wear the same goggles as before and sit in a motorized chair. You keep your eyes open as the chair moves left and right. The glasses record your eye movements.
Modified Clinical Test of Sensory Interaction on Balance (mCTSIB)
This `(mCTSIB)` test allows your doctor to assess how your vision, sense of touch (in this case, your feet), and inner ear are contributing to your dizziness and vertigo. For this test, you will stand without shoes, first on a hard surface, then on a foam surface. You will be asked to remain as still as possible on both surfaces for 30 seconds. The audiologist will tell you to do these activities with your eyes open and then with your eyes closed.
Video Head Impulse Test (VHIT)
The video head impulse test (VHIT) measures how well the three semicircular canals in your inner ear detect head movements. This test involves you wearing goggles and looking at a target. The audiologist will quickly move your head left and right, or up and down. They will record how well your eyes stay focused on the target as your head moves.
Vestibular Evoked Myogenic Potentials (VEMP) test
This ``(VEMP)`` test provides information about how the two otolith organs in your inner ear (the saccule and the utricle) are working. For this test, small sensor pads (electrodes) are attached to your neck. You wear headphones. You focus your eyes on a target and listen to a series of sound waves coming from the headphones as you turn your head left and right. The sensor pads record the response of your neck muscles to the sound signals.
Dynamic Visual Acuity (DVA) test
This ``(DVA)`` test measures how well you can use your vestibular system when your head moves. This test requires you to sit in front of a computer screen and first identify a target on the screen without moving your head. Then, you have to identify a target on the screen while moving your head from side to side or up and down.
Risk of Falls Assessment
This assessment looks at factors that increase your risk of falling. It also includes tests to check the function of your inner ear.
How long does this test take?
This test usually takes about two hours, but depending on your symptoms and test results, the test may take less time.
Are there any risks with these tests?
Vestibular tests are very safe tests . However, you may feel a little dizzy or lightheaded during the test. These side effects may last for a while after the test. That's why we've said before that it's a good idea to have someone drive you home.
What kind of results can we expect?
You can get one of two main types of results:
- Normal results: This means that the symptoms you reported are not due to a dysfunction of the vestibular system. That is, there is no problem with your balance system.
- Abnormal results: This indicates that your symptoms are being caused by a problem with the vestibular system and/or nervous system.
How long does it take to get results?
Your hearing and balance specialist will discuss your test results with you either at the end of your test appointment, or they will let you know later if they need additional time to review the results further. They will also share these results with the doctor who referred you for the test.
The audiologist may also provide you with an after-visit summary that highlights your results and includes recommendations for future care. It is important to discuss these results with your medical team to develop a care plan that is right for you.
Will further tests be needed after a vestibular test?
What you do next will depend on your test results.
Your doctor may refer you to another specialist for further investigation of a specific finding. Or, they may order imaging tests such as a Magnetic Resonance Imaging (MRI) to look for damage to the soft tissues of the inner ear, or a Computed Tomography scan (CT scan) to look for damage to the bones of the inner ear.
How do I book a vestibular test?
Depending on your health insurance, you may need a medical order to schedule a test appointment. Ask your doctor if it's okay for you to have a vestibular test.
Your doctor may order a vestibular test to help find out why you're experiencing dizziness, vertigo, and other symptoms. It can be a little intimidating to know that there are so many different tests to do. But these tests are very simple and straightforward. The hearing and balance specialist who performs the test will walk you through each procedure step by step.
Finally, things to remember
If you are experiencing symptoms like dizziness and loss of balance, it is best to talk to a doctor about it. Vestibular testing may be able to help you find the cause of your problem. Although these tests may cause a little dizziness, they are not dangerous . These tests will be a big step towards getting an accurate diagnosis and getting the treatment you need to manage your symptoms. So, don't be afraid and face these tests with a calm mind. I wish you a speedy recovery!
` Dizziness, balance, vestibular tests, inner ear, `BPPV`, `Ménière's disease`, `VNG`, `ENG`
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