What to expect from a vestibular balance assessment

August 14, 2015 Swedish Health Team

close up of an ear


In this article:

  • Vestibular assessments are recommended when people have trouble with their balance.

  • Testing can involve a hearing evaluation, eye movement tests, and more.

  • Preparing for a balance assessment correctly is important for accurate results.

  • A Swedish physician can help you determine whether an assessment is required.

Vestibular assessments, or balance assessments, are recommended for people who have dizziness, vertigo, imbalance and similar symptoms because the vestibular portion of the inner ear contributes 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 by 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 hearing evaluation. Because the inner ears and balance are related, a vestibular problem may also affect one’s hearing in obvious ways as well as in 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) involves wearing a pair of goggles and completing a battery of eye movement tests called ocular motility tests. Eyes and the inner ears of balance are connected by an important reflex, so the eyes can tell us a lot about the inner ears. 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, which involves flowing warm and cool air into the ear canals and measuring nystagmus from the eyes. This can help diagnose a weakness in the function of one or both of the inner ears of balance. 

Vestibular Evoked Myogenic Potentials (VEMPs) and electrocochleography (EcochG) are additional tests that may be requested by your doctor. These involve the placement of gel electrode stickers on different places on the face, head or neck, and listening to clicking sounds.

The amount of time that testing takes 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, you can ask about how long the testing will last.

Preparing for balance testing

These “do’s and don’ts” will help audiologists and other clinicians obtain the most accurate results possible.

  • Do not wear any makeup, including mascara, eyeliner or face lotion. These products can interfere with the recordings.

  • Do not drink any alcoholic beverages for 48 hours prior to the test.

  • Do not drink caffeine (coffee, tea or soda) for 24 hours prior to the test.

  • Do not use tobacco of any form for three hours prior to the test.

  • Do not eat for three hours prior to the test. Please eat lightly on the day of your appointment. If you have diabetes, please eat as you usually do.

  • Certain medications can influence the body’s response to the test, potentially resulting in a false or misleading result. If possible, please refrain from taking the following medications for 48 hours prior to your appointment: 

    • Anti-vertigo or anti-dizziness medications (e.g.  Meclizine, Anti-vert, Ru-vert)

    • Anti-nausea medications (e.g. Atarax, Dramamine, Compazine, Thorazine, transdermal patch) 

    • Antihistamines or decongestants

    • Allergy medications 

    • Sedatives

    • Sleeping pills

    • Tranquilizers 

    • Pain pills

  • DO NOT stop taking vital medications, such as those 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.

Find a doctor

If you have questions about vestibular balance assessments, contact the primary care department at Swedish. We can accommodate both in-person and virtual visits.

Whether you require an in-person visit or want to consult a doctor virtually, you have options. Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction and follow up as needed. If you need to find a doctor, you can use our provider directory.

Join our Patient and Family Advisory Council.

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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