Balance Tests

What are balance tests?

Balance tests are a group of tests that check for balance disorders. A balance disorder is a condition that makes you feel unsteady on your feet and dizzy. Dizziness is a general term for different symptoms of imbalance. Dizziness can include vertigo, a feeling that you or your surroundings are spinning, and lightheadedness, a feeling like you are going to faint. Balance disorders can be mild, or so severe that you may have trouble walking, climbing stairs, or doing other normal activities.

Different systems in your body need to work together for you to have good balance. The most important system is called the vestibular system. This system is located in your inner ear and includes special nerves and structures that help you keep your balance. Your vision and sense of touch are also essential for good balance. Problems with any of these systems can lead to a balance disorder.

Balance disorders can happen at any age but are more common in older people. It’s one of the main reasons that older adults tend to fall more often than younger people.

Other names: vestibular balance testing, vestibular testing

What are they used for?

Balance tests are used to find out if you have a problem with your balance, and if so, what is causing it. There are many causes of balance disorders. They include:

• Benign paroxysmal positional vertigo (BPPV). Your inner ear contains calcium crystals, which help control balance. BPPV happens when these crystals get shifted out of position. It can make you feel like the room is spinning or your surroundings are moving. BPPV is the most common cause of vertigo in adults.
• Meniere’s disease. This disorder causes dizziness, bouts of hearing loss, and tinnitus (ringing in the ears).
• Vestibular neuritis. This refers to inflammation inside the inner ear. It is usually caused by a virus. Symptoms include nausea and vertigo.
• Migraines. A migraine is a type of throbbing, severe headache. It is different than other types of headaches. It can cause nausea and dizziness.
• Head injury. You may get vertigo or other balance symptoms after a head injury.
• Medicine side effect. Dizziness can be a side effect of certain medicines.

Once you learn the cause of your balance disorder, you can take steps to help manage or treat your condition.

Why do I need a balance test?

You may need a balance test if you have symptoms of a balance disorder. Symptoms include:

• Dizziness
• Feeling like you are in motion or spinning, even when standing still (vertigo)
• Loss of balance while walking
• Staggering while walking
• Ringing in the ears (tinnitus)
• Feeling like you are going to faint (lightheadedness) and/or a floating sensation
• Blurred vision or double vision
• Confusion

What happens during a balance test?

Balance testing may be done by a primary health care provider or a specialist in disorders of the ear. These include:

• An audiologist, a health care provider who specializes in diagnosing, treating, and managing hearing loss.
• An otolaryngologist (ENT), a doctor specializing in treating diseases and conditions of the ears, nose, and throat.

Diagnosing balance disorders usually requires several tests. You may get one or more of the following tests:

Electronystagmography (ENG) and videonystagmography (VNG) tests. These tests record and measure your eye movements. Your vision system needs to work right for you to have a good balance. During the test:

• You will sit in an exam chair in a dark room.
• You will be asked to look at and follow patterns of light on a screen.
• You will be asked to move into different positions as you watch this light pattern.
• Then warm and cool water or air will be put in each ear. This should cause the eyes to move in specific ways. If the eyes don’t respond in these ways, it may mean there is damage to the nerves of the inner ear.

Rotary test, also known as a rotary chair test. This test also measures your eye movements. During this test:

• You will sit in a computer-controlled, motorized chair.
• You will put on special goggles that will record your eye movements as the chair slowly moves back and forth and in a circle.

Posturography, also known as computerized dynamic posturography (CDP). This test measures your ability to maintain balance while standing. During this test:

• You will stand barefoot on a platform, wearing a safety harness.
• There will be a landscape screen around you.
• The platform will move around to test your ability to remain standing on a moving surface.

Vestibular evoked myogenic potentials (VEMP) test. This test measures how certain muscles respond in reaction to sound. It can show if there is a problem in your inner ear. During this test:

• You will recline in a chair.
• You will put on earphones.
• Sensor pads will be attached to your neck, forehead, and under your eyes. These pads will record your muscle movements.
• Clicks and/or bursts of tones will be sent to your earphones.
• While the sound is playing, you’ll be asked to lift your head or eyes for short periods of time.

Dix hallpike maneuver. This test measures how your eye reacts to abrupt movements. During this test:

• Your provider will move you quickly from sitting to lying down position and/or move your head in different positions.
• Your provider will check your eye movements to see if you have a false sense of motion or spinning.

A newer version of this test is called a video head impulse test (vHIT). During a vHIT test, you’ll wear goggles that record your eye movements while a provider gently turns your head in different positions.

You may also get one or more hearing tests, since many balance disorders are related to hearing problems.

Will I need to do anything to prepare for a balance test?

You should wear loose, comfortable clothes. Depending on the test, you may need to make changes in your diet or avoid certain medicines for a day or two before your test. Your health care provider will let you know if there are any special instructions to follow.

Are there any risks to balance tests?

Certain tests may make you feel dizzy or nauseous. But these feelings usually go away within a few minutes. You may want to make arrangements for someone to drive you home, in case the dizziness lasts for a longer period of time.

What do the results mean?

If your results were not normal, your provider may order more tests and/or put you on a treatment plan. Depending on the cause of your balance disorder, your treatment may include:

• Medicine to treat an infection.
• Medicine to help control dizziness and nausea.
• Positioning procedure. If you were diagnosed with BPPV, your provider may perform a series of specialized movements of your head and chest. This can help reposition particles in your inner ear that have gotten out of place. The procedure is also known as the Epley manoeuvre or canalith repositioning.
• Balance retraining therapy, also known as vestibular rehabilitation. A provider specializing in balance rehabilitation may design a program of exercises and other steps to improve your balance and prevent falls. This may include learning to use a cane or a walker.
• Diet and lifestyle changes. If you were diagnosed with Meniere’s disease or migraine headaches, certain lifestyle changes may ease your symptoms. These can include increasing physical activity, avoiding certain foods, and quitting smoking. Ask your health care provider about which changes may be best for you.
• Surgery. If medicines or other treatments are not working, you may need surgery to correct a problem in your inner ear. The type of surgery will depend on the specific cause of your balance disorder.

If you have questions about your results, talk to your health care provider.

References

1. American Speech-Language-Hearing Association (ASHA) [Internet]. Rockville (MD): American Speech-Language-Hearing Association; c1997–2020. Balance System Disorders: Assessment; [cited 2020 Jul 27]; [about 4 screens]. Available from: https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589942134§ion=Assessment
2. Audiology and Hearing Health [Internet]. Goodlettsville (TN): Audiology and Hearing Health; c2019. Balance Testing Using VNG (Videonystagmography); [cited 2019 Apr 22]; [about 3 screens]. Available from: https://www.audiologyandhearing.com/services/balance-testing-using-videonystagmography
3. Barrow Neurological Institute [Internet]. Phoenix: Barrow Neurological Institute; c2019. Mohammad Ali Parkinson Center: Balance Testing; [cited 2019 Apr 22]. [about 3 screens]. Available from: https://www.barrowneuro.org/specialty/balance-testing
4. Familydoctor.org [Internet]. Leawood (KS): American Academy of Family Physicians; c2019. Benign Paroxysmal Positional Vertigo (BPPV); [updated 2017 Jul 19; cited 2019 Apr 22]; [about 2 screens]. Available from: https://familydoctor.org/condition/benign-paroxysmal-positional-vertigo
5. Johns Hopkins Medicine [Internet]. Baltimore: The Johns Hopkins University; c2019. Vestibular Balance Disorder; [cited 2019 Apr 22]; [about 3 screens]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/vestibular-balance-disorder
6. Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c1998–2019. Balance Problems: Diagnosis and treatment; 2018 May 17 [cited 2019 Apr 22]; [about 4 screens]. Available from: https://www.mayoclinic.org/diseases-conditions/balance-problems/diagnosis-treatment/drc-20350477
7. Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c1998–2019. Balance Problems: Symptoms and causes; 2018 May 17 [cited 2019 Apr 22]; [about 3 screens]. Available from: https://www.mayoclinic.org/diseases-conditions/balance-problems/symptoms-causes/syc-20350474
8. Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c1998–2019. Meniere’s disease: Diagnosis and treatment; 2018 Dec 8 [cited 2019 Apr 22]; [about 4 screens]. Available from: https://www.mayoclinic.org/diseases-conditions/menieres-disease/diagnosis-treatment/drc-20374916
9. Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c1998–2019. Meniere’s disease: Symptoms and causes; 2018 Dec 8 [cited 2019 Apr 22]; [about 3 screens]. Available from: https://www.mayoclinic.org/diseases-conditions/menieres-disease/symptoms-causes/syc-20374910
10. Michigan Ear Institute [Internet]. ENT Ear Specialist; Balance, Dizziness and Vertigo; [cited 2019 Apr 22]; [about 5 screens]. Available from: http://www.michiganear.com/ear-services-dizziness-balance-vertigo.html
11. National Center for Biotechnology Information [Internet]. Bethesda (MD): National Center for Biotechnology Information, National Library of Medicine; InformedHealth.org: How does our sense of balance work?; 2010 Aug 19 [updated 2017 Sep 7; cited 2019 Apr 22]; [about 3 screens]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279394
12. National Institute on Aging [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Balance Problems and Disorders; [cited 2019 Apr 22]; [about 2 screens]. Available from: https://www.nia.nih.gov/health/balance-problems-and-disorders
13. National Institute on Deafness and Other Communication Disorders [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Balance Disorders; 2017 Dec [updated 2018 Mar 6; cited 2019 Apr 22]; [about 2 screens]. Available from: https://www.nidcd.nih.gov/health/balance-disorders
14. National Institute on Deafness and Other Communication Disorders [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Meniere’s Disease; 2010 Jul [updated 2017 Feb 13; cited 2019 Apr 22]; [about 2 screens]. Available from: https://www.nidcd.nih.gov/health/menieres-disease
15. The Neurology Center [Internet]. Washington D.C.: The Neurology Center; Videonystagmography (VNG); [cited 2019 Apr 22]; [about 3 screens]. Available from: https://www.neurologycenter.com/services/videonystagmography-vng
16. UCSF Benioff Children’s Hospital [Internet]. San Francisco (CA): The Regents of the University of California; c2002–2019. Caloric Stimulation; [cited 2019 Apr 29]; [about 4 screens]. Available from: https://www.ucsfbenioffchildrens.org/tests/003429.html
17. UCSF Medical Center [Internet]. San Francisco (CA): The Regents of the University of California; c2002–2019. Rotary Chair Testing; [cited 2019 Apr 22]; [about 5 screens]. Available from: https://www.ucsfhealth.org/education/rotary_chair_testing
18. UF Health: University of Florida Health [Internet]. Gainesville (FL): University of Florida Health; c2019. Vertigo – associated disorders: Overview; [updated 2019 Apr 22; cited 2019 Apr 22]; [about 2 screens]. Available from: https://ufhealth.org/vertigo-associated-disorders
19. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; c2019. Balance Disorders and Dizziness Clinic: Balance Laboratory Testing; [cited 2019 Apr 22]; [about 3 screens]. Available from: https://www.urmc.rochester.edu/balance-clinic/tests.aspx
20. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; c2019. Health Encyclopedia: Migraine Headaches; [cited 2019 Apr 22]; [about 2 screens]. Available from: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=85&contentid=P00814
21. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2019. ENT- Otolaryngology: Dizziness and Balance Disorders; [updated 2011 Aug 8; cited 2019 Apr 22]; [about 4 screens]. Available from: https://www.uwhealth.org/ear-nose-throat/dizziness-and-balance-disorders/11394
22. Vanderbilt University Medical Center [Internet]. Nashville: Vanderbilt University Medical Center; c2019. Balance Disorders Lab: Diagnostic Testing; [cited 2019 Apr 22]; [about 3 screens]. Available from: https://www.vumc.org/balance-lab/diagnostic-testing
23. Weill Cornell Medicine: Otolaryngology Head and Neck Surgery [Internet]. New York: Weill Cornell Medicine; Electronystagmogrophy (ENG) and& Videonystagmography (VNG) Testing; [cited 2020 Jul 27]; [about 3 screens]. Available from: https://ent.weill.cornell.edu/patients/clinical-specialties/conditions/electronystagmogrophy-eng-videonystagmography-vng-testing#:~:text=ElectroNystagmoGraphy%20(ENG)%20and%20VideoNystagmoGraphy%20(,organ%20or%20central%20vestibular%20system