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Vestibular testing refers to a group of specialized diagnostic procedures used to evaluate the function of the vestibular system—the part of the inner ear and brain that controls balance and eye movements. These tests help identify the cause of dizziness, vertigo, imbalance, and related symptoms. Common conditions diagnosed include benign paroxysmal positional vertigo (BPPV), vestibular neuritis, Meniere’s disease, and bilateral vestibulopathy.
Videonystagmography (VNG) uses infrared video goggles to record eye movements. The test includes three parts: oculomotor testing (tracking visual targets), positional testing (moving the head/body to provoke vertigo), and caloric testing (warm/cold air or water in the ear canal to stimulate the inner ear). VNG is considered the gold standard for assessing peripheral vestibular function.
Electrocochleography measures electrical potentials generated in the inner ear in response to sound. It is especially useful for diagnosing Meniere’s disease and endolymphatic hydrops by detecting abnormal fluid pressure within the labyrinth.
Vestibular evoked myogenic potentials (VEMP) assess the function of the otolith organs (utricle and saccule) and their neural pathways. Cervical VEMP (cVEMP) tests the saccule and inferior vestibular nerve, while ocular VEMP (oVEMP) tests the utricle and superior vestibular nerve. These tests are noninvasive and provide site-specific information.
Rotary chair testing involves a computer-controlled chair that rotates the patient at precise speeds while eye movements are recorded. This test evaluates the vestibulo-ocular reflex (VOR) and is particularly helpful for bilateral vestibular loss and central compensation.
Computerized dynamic posturography measures a patient’s ability to maintain balance under various sensory conditions (e.g., swaying platform, altered visual input). It helps differentiate between vestibular, visual, and somatosensory contributions to balance.
Vestibular testing provides objective data that guides treatment decisions. Without accurate testing, patients may be misdiagnosed with other conditions (e.g., anxiety, migraines, or cardiovascular issues). Early and precise diagnosis leads to targeted vestibular rehabilitation, medical management, or surgical intervention when necessary.
Patients are advised to avoid caffeine, alcohol, and certain medications for 24–48 hours before testing. The appointment lasts 60 to 90 minutes. Most tests are noninvasive and involve wearing goggles, sitting in a dark room, or lying on a table. Mild dizziness may occur during positional maneuvers but typically resolves quickly. No needles or sedation are required.
Vestibular testing results are reviewed by an audiologist or otolaryngologist. Abnormal findings may indicate a peripheral (inner ear) or central (brainstem/cerebellum) disorder. For example, unilateral weakness on caloric testing suggests a vestibular nerve lesion, while directional preponderance may point to a central problem. Combined with clinical history, the test battery provides a comprehensive picture of vestibular health.
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