Dizziness and Balance


  • Videonystagmography (VNG) – Considered the standard of care for vestibular testing, VNG is used for testing inner ear and central motor functions relating to the vestibular system. More accurate and comfortable than its predecessor (Electronystagmography or ENG), VNG directly measures eye movements in response to vestibular stimulation through infrared cameras. VNG consists of a battery of several sub-tests that are designed to document a patient’s ability to follow visual stimuli with their eyes and how well the eyes respond to information from the vestibular system. These subtests include:
    •   Occulomotor testing – This testing is designed to assess central or neurological function and visual accuracy and acuity in response to both stationary and moving stimuli. Impairments found during this testing may indicate neurological issues or a possible problem with central vestibulomotor pathways to the brain (brainstem).
    • Optokinetic testing – This subtest is used to assess a patient’s ability to track a constantly moving stimulus. During this subtest, the central and neurological pathways are being evaluated for slowness or inaccuracies indicating central site-of-lesion.
    • Positional / Positioning testing – The head and body are manually guided into different positions and the eyes are monitored for
  • Caloric Irrigation – The ear canals are filled with warm or cool air or water. The bi-thermal irrigations measure the nystagmus response to the change in temperature of the vestibular system caused by the irrigations.
  • Video Head Impulse Testing (vHIT) – a new addition to the typical vestibular battery, the head impulse test is the easiest indicator of a semi-circular canal deficiency. This test will give accurate functional information relating to all 6 semi-circular canals and will help point to site of lesion and help with proper rehabilitation.
  • Electrophysiological Testing – This testing is designed to monitor electrical brainstem and muscle potentials using electrodes and advanced computer software and may include:
    •    Vestibular Evoked Myogenic Potentials (VEMP) – The VEMP is a neurophysiological assessment technique used to assess the function of the otolithic organs of the inner ear. This testing complements information provided by vHIT and caloric information relating to a patient’s symptoms of vestibular distress.
    • Electrocochleography (EcochG) – EcochG is a technique of recording electrical potentials generated by the cochlea and auditory nerve in response to sound stimulation and can provide functional information as to whether or not a patient has a normal cochlea, increased inter-cochlear pressures, or an abnormal opening (fistula or dehiscence) in the vestibular system that may be causing symptoms of dizziness or vertigo.
    • Auditory Brainstem Response (ABR) – the ABR is a measurement of electrical activity in the brainstem as a response to sound. It is used to determine approximate level of hearing sensitivity from newborn to adult.
    • Audiological Testing – This testing is designed to assess the peripheral auditory function of a patient and provides valuable information relating to disorders that affect both auditory and vestibular function. Testing includes:
  •    Pure tone audiometry – Basic audiometry evaluates for hearing loss of any type. Patterns of hearing loss, along with detailed case history and other testing information may indicate a particular disorder.
    •   Speech Audiometery – Testing speech is key to audiometry as many disorders involve more central (brainstem or cortical) processing. Therefore, a patient may have a mild hearing loss but severe difficulty understanding speech. This testing is part of our basic battery.
    • Tympanometry – Evaluation of the tympanic membrane and middle ear system is key to knowing if, mechanically, sound can be accurately transmitted to the inner ear. This testing can also provide crucial information that will affect the vestibular batter. For example, if a patient has an ear infection, caloric irrigations will yield inaccurate results. Tympanometery will discover this issue so that it can be treated prior to further testing.
    •   Acoustic Reflex Testing – The acoustic reflex test evaluates how the middle ear system, cochlea, nerves and lower brainstem work together to interpret loud sounds. Along with tympanometry and pure-tone testing, this test will discover if electrophysiological testing is warranted or contraindicated.