Balance testing is a specialized medical assessment designed to investigate issues related to the body’s balance system. It identifies the underlying causes of symptoms such as dizziness, vertigo, and unsteadiness. These tests evaluate how the inner ear, vision, and sensory input from muscles and joints work together to maintain stability, providing objective data for diagnosis.
Reasons for Balance Testing
Balance testing is recommended for persistent symptoms like dizziness, lightheadedness, unsteadiness, or a history of falls. These evaluations help pinpoint the specific origin of the problem.
The tests determine if balance issues stem from the inner ear (vestibular system) or neurological conditions. Identifying the precise cause is an important step towards developing an effective treatment plan.
Common Balance Tests
Common balance tests evaluate different components of the balance system.
Videonystagmography (VNG)
VNG measures involuntary eye movements called nystagmus, which are linked to inner ear and brain balance functions. During a VNG, patients wear special goggles with cameras that record eye movements as they follow moving lights, change head positions, or have warm and cool air introduced into their ear canals.
Computerized Dynamic Posturography (CDP)
CDP assesses an individual’s ability to maintain balance while standing on a specialized platform. The platform may move or the visual surroundings may change to challenge the patient’s balance, helping to determine how well the brain integrates information from the visual, inner ear, and proprioceptive (body position) systems to maintain stability.
Caloric Testing
Caloric testing is often part of a VNG battery and specifically evaluates the function of each inner ear independently. During this procedure, warm or cool air or water is introduced into one ear canal at a time. This temperature change stimulates the inner ear, and resulting eye movements are recorded to assess the balance organs’ response.
Rotary Chair Testing
Rotary chair testing provides information about the vestibulo-ocular reflex (VOR), which helps maintain stable vision during head movement. Patients sit in a motorized chair that rotates at various speeds while eye movements are recorded. Unlike caloric testing, the rotary chair test stimulates both inner ears simultaneously, which can be useful for detecting problems affecting both sides of the vestibular system.
Simpler clinical assessments, such as the Romberg test (standing with feet together, first with eyes open and then closed, to observe sway) and the Fukuda stepping test (marching in place with eyes closed, checking for rotation or leaning), might also be performed.
What to Expect During Testing
Preparing for balance testing usually involves a few specific instructions. Patients are typically advised to avoid certain medications, such as those for dizziness or anxiety, as well as tranquilizers and sleeping pills, for a period of 24 to 48 hours before the appointment. It is also common to be asked to refrain from consuming caffeine, alcohol, and sometimes heavy meals prior to the tests. Patients should arrive wearing comfortable, loose-fitting clothing, and avoid wearing eye makeup or contact lenses, as these can interfere with eye-tracking equipment.
During the appointment, which can last anywhere from 30 minutes to several hours depending on the specific tests needed, patients will undergo a series of evaluations. An audiologist or an ear, nose, and throat (ENT) specialist typically performs these tests. While the tests are generally painless, some procedures, like caloric testing, might induce temporary dizziness or mild nausea. For this reason, it is often recommended to have someone else drive you home after the appointment.
Understanding Your Results and Diagnoses
After completing the battery of balance tests, the collected data is analyzed to provide insights into the cause of the balance issues. The results help healthcare providers determine if the problem originates from the inner ear, a neurological condition, or a combination of factors. For instance, certain patterns in eye movements or postural sway can indicate specific dysfunctions within the vestibular system.
Balance testing can point to various conditions. Benign Paroxysmal Positional Vertigo (BPPV), a common cause of vertigo, occurs when tiny calcium crystals in the inner ear become dislodged. Meniere’s disease, characterized by episodes of vertigo, hearing loss, and ear fullness, can also be identified. Other inner ear inflammations like labyrinthitis and vestibular neuritis, which cause dizziness and sometimes hearing changes, are also detectable.
Beyond inner ear problems, balance tests can reveal indications of central nervous system disorders that affect balance control. The comprehensive nature of these tests allows for a detailed assessment of how the brain processes sensory information. Discussing the test results with a healthcare provider is an important step, as they will interpret the findings in the context of an individual’s symptoms and medical history to formulate a personalized diagnosis and treatment plan.