Timothy C. Hain, MD • Page last modified: January 4, 2018Return to testing index


Phillips, Mallinson and Hamid published a paper entitled "Cost-effective evaluation of the vestibular patient" (2011). They state "SUMMARY: Tests of vestibular function are expensive and their ability to diagnose specific vestibular pathologies is lacking. However, there are some tests that, when used in specific circumstances, may be very helpful in the diagnosis and management of patients with these complaints. " In the conclusion, they go on to say that "Contemporary vestibular testing is expensive, lacks accuracy, is operator dependent, and often has little effect on patient outcome. A thorough focussed clinical otoneurological history and examination plus a comprehensive pure tone audiogram, with the careful use of certain tests tailored according to history and examination, are key to optimally managing the vestibular patient".

So in other words, these authors suggest that it is best to depend on the "clinical impression", and prefer a low-budget approach to managing dizziness.

While we understand that ideally medical care should be highly efficient and low cost, practically most people would prefer that medical care be based on evidence, and prefer that the evidence be obtained through instruments that provide an "objective" measurement, as opposed to the conjectures of their physicians combined with a hearing test.

We also are of the opinion that progress in medicine will not be attained through relying on clinical impressions and audiograms, but rather will likely come through a combination of better understanding and better technology.


Our take:

  1. Vestibular tests are tests of function. Their purpose is to determine if there is something wrong with the vestibular portion of the inner ear. If dizziness is not caused by the inner ear, it might be caused by disorders of the brain, by medical disorders such as low blood pressure, or by psychological problems such as anxiety. Recent studies have suggested that vestibular tests are more accurate than clinical examination in identifying inner ear disorders (Gordon et al, 1996). Hearing pathway tests (audiometry, ABR, ECochG) can also be used for the same purpose, and are frequently combined with vestibular tests. In a cost-effectiveness analysis for evaluation for vertigo it was concluded that hearing testing followed by either posturography or ENG (electronystagmography) was the most effective method (Stewart et al, 1999).
  2. To detect central disorders. Recent studies have suggested that internuclear ophthalmoplegia, a central eye movement disorder, is missed by 71% of physicians unaided by quantitative oculomotor testing (Frohman et al, 2003).
  3. To decide if more expensive tests like MRI (Magnetic Resonance Imaging) are needed. Vestibular testing is more accurate than clinical symptoms in predicting whether neuroimaging tests will be abnormal.(Levy and Arts, 1996). Simple vestibular tests are more effective than MRI at detecting strokes that cause dizziness.
  4. To document objectively vestibular conditions such as BPPV and Perilymph fistula, which commonly occur after head injury, vestibular neuritis, and Gentamicin ototoxicity, which commonly is a side effect of medication.