Vestibular testing is a set of diagnostic procedures used to assess the function of the inner ear and the brain pathways responsible for maintaining balance. These tests investigate the sensory systems that work together to keep the body stable, including the inner ear’s vestibular system, vision, and proprioception. Evaluating and treating dizziness, vertigo, and unsteadiness involves a multidisciplinary team of healthcare professionals. This team plays a coordinated role, from collecting the initial data to establishing a final diagnosis and implementing rehabilitation.
The Primary Specialists Who Perform the Tests
The primary specialists who conduct the technical evaluations of the balance system are those with advanced training in hearing and balance disorders. The audiologist, holding a Doctor of Audiology (Au.D.) degree, operates the specialized equipment and executes the precise testing protocols. These specialists are responsible for collecting the raw physiological data that medical doctors will later use to diagnose the patient’s condition. Their expertise lies in the electrophysiological and behavioral measurements of the vestibular system’s response to various stimuli.
A common procedure is Videonystagmography (VNG), which evaluates how the inner ear and brain coordinate eye movements, known as the vestibulo-ocular reflex (VOR). During a VNG, the audiologist fits the patient with goggles that contain infrared cameras to precisely record involuntary eye movements, called nystagmus. This recording occurs while the patient tracks targets or changes head position. The test battery often includes caloric testing, where warm and cool air or water stimulates the inner ear to measure the resulting eye movement.
Specialized Testing
Specialized equipment allows audiologists to perform tests that assess the utricle and saccule, the inner ear organs that sense gravity and linear movement. Vestibular Evoked Myogenic Potentials (VEMPs) testing involves measuring muscle responses in the neck or around the eyes to sound or vibration, providing information about the function of these specific organs. Similarly, Rotary Chair testing is conducted by placing the patient in a computerized chair that rotates at different speeds, allowing the audiologist to measure the VOR across a wide range of motion frequencies.
Physicians Who Order and Interpret Results
The medical specialists who manage the patient’s overall care and establish the final diagnosis rely heavily on the data collected during the technical tests. These physicians order the vestibular test battery and then integrate the objective findings with the patient’s history and clinical examination to determine the underlying cause of the symptoms. The process of diagnosis often involves distinguishing between disorders originating in the inner ear (peripheral) and those stemming from the central nervous system (central).
Otolaryngologists (ENTs)
Otolaryngologists, often referred to as ENT physicians, are specialists who focus on disorders of the ear, nose, and throat, including conditions affecting the inner ear’s balance mechanisms. They frequently treat peripheral vestibular disorders such as Meniere’s disease, which involves fluid pressure changes in the inner ear, or specific nerve issues that result in vertigo. The ENT uses the audiologist’s report to confirm the location and severity of the inner ear dysfunction before formulating a medical or surgical treatment plan.
Neurologists
Neurologists are another group of physicians who frequently order vestibular testing, particularly when symptoms suggest central nervous system involvement. Conditions such as stroke, multiple sclerosis, or migraine-related vertigo can affect the brain’s ability to process balance information, and the test results help confirm or rule out these diagnoses. The neurologist interprets the patterns of eye movement and reflex response to identify central vestibular network misfiring or other neurological issues.
The Rehabilitation Experts
Once a medical diagnosis is established, the patient moves to the phase of physical rehabilitation, which is overseen by specialized professionals. Vestibular Physical Therapists (VPTs) are experts in Vestibular Rehabilitation Therapy (VRT), an exercise-based program designed to promote the brain’s ability to compensate for inner ear deficits. Their role is distinct from testing and diagnosis, focusing instead on restoring function and reducing symptoms like dizziness and unsteadiness.
VPTs develop highly personalized exercise plans based on the specific vestibular impairment identified by the diagnostic team. These programs utilize mechanisms like adaptation, substitution, and habituation to retrain the nervous system. For example, exercises may focus on enhancing gaze stability, which involves maintaining a clear focus on a target while the head is moving, to improve the vestibulo-ocular reflex.
A common condition managed by these therapists is Benign Paroxysmal Positional Vertigo (BPPV), the most frequent cause of vertigo. For BPPV, which is caused by displaced calcium crystals in the inner ear, the VPT performs specific Canalith Repositioning Maneuvers, such as the Epley maneuver, to guide the crystals back to their correct location. Beyond specific maneuvers, VRT includes balance training and postural stability exercises to help patients safely navigate their daily environment, ultimately reducing their risk of falls.