Balance Tests

What are balance tests?

Balance tests are a group of tests that check for balance disorders. A balance disorder is a condition that makes you feel unsteady or dizzy. Dizziness means different things to different people. It can include:

• Vertigo, a feeling that you or everything around you is spinning
• Feeling as if you're going to fall
• Feeling lightheaded or as if you are going to faint

Balance disorders can be mild or so severe that you may have trouble walking, climbing stairs, or doing other daily activities. They can happen at any age, but they are more common in older people. Balance disorders are one of the main reasons that older adults tend to have more falls than younger people.

Good balance depends on your brain receiving signals about your position and movement from your ears, eyes, and the muscles and touch sensors in your legs. These signals also help your eyes stay focused on objects when you change position. Problems with any of the signals that are part of your sense of balance can cause dizziness and other symptoms.

The part of your ears that controls your sense of balance is called the vestibular system or "the labyrinth." It is in your inner ear. It includes special organs filled with fluid and lined with sensors that have hair-like structures. When you move your head, the fluid in your inner ear moves the hair sensors. This triggers them to send nerve signals to your brain about your head's position and which direction it's moving.

Balance disorders may be caused by conditions in your inner ear, head injuries, or certain medicines and medical conditions that affect your inner ear or brain. Other conditions can also cause problems with balance, such as vision problems, heart disease, blood vessel disorders, migraine headaches, and arthritis.

Balance tests help find the cause of balance problems so that you can get the right treatment to improve your balance and avoid falls.

Other names: vestibular balance testing, vestibular testing

What are they used for?

Balance tests are used to help find the cause of balance problems, so you can get the right treatment to improve your balance and avoid falls. There are many types of balance disorders, including:

• Benign paroxysmal positional vertigo (BPPV). BPPV is the most common cause of vertigo in adults. With this condition, you feel a spinning sensation when you move your head in certain ways. Normally, part of your inner ear has grains of calcium that trigger signals that tell your brain about your head's position and movement. BPPV happens if these grains slip out of place and get into a part of your inner ear where they don't belong. When the grains move around in the wrong place, they trigger confusing signals about how your head is moving.
• Labyrinthitis. This balance disorder can cause dizziness and temporary hearing loss. It happens if your inner ear becomes irritated and swollen, usually from a cold or flu.
• Meniere's disease. This disorder causes vertigo, hearing loss, tinnitus (ringing in the ears), and a full feeling in your ears. It happens when too much fluid builds up in the vestibular system. The cause is unknown.
• Vestibular neuritis. This is inflammation (swelling) of the vestibular nerve. This nerve carries signals from the vestibular system in the inner ear to your brain. It's usually caused by a virus. The main symptoms are nausea and vertigo.
• Perilymph fistula. This happens when fluid in the inner ear leaks into the middle ear, where your eardrum is. It causes an unsteady feeling, dizziness, and nausea. The symptoms usually get worse with activity. Causes include head injury, ear surgery, and having many long-lasting ear infections.
• Mal de Debarquement syndrome (MdDS). This condition is triggered after long periods of motion, such as being on a boat or running on a treadmill. After you stop moving, you still have a swaying or bobbing feeling that can last for hours or days. Severe cases can last months or even years. The cause is unknown.

Why do I need a balance test?

You may need balance tests if you have symptoms of a balance disorder. Symptoms include:

• Dizziness
• Vertigo (a spinning feeling)
• Falling or feeling as if you are going to fall
• Staggering when you walk
• Feeling lightheaded, like you are going to faint, or a floating sensation
• Blurred vision
• Confusion

Other symptoms may include nausea and vomiting, diarrhea, changes in heart rate and blood pressure, and anxiety.

If you're age 65 or older, your health care provider may use simple screening tests to check your balance even if you don't have symptoms. This helps check your risk for falls so you can make changes to reduce your risk if needed.

What happens during a balance test?

Balance disorders can be difficult to diagnose. If you have symptoms of a problem, your provider may suggest that you see a specialist in disorders of the ear. These include:

• An audiologist, a health care provider who is trained to diagnose hearing loss and balance disorders. They also can provide certain treatments to improve these conditions.
• An otolaryngologist (ENT), a doctor who specializes in treating diseases of the ears, nose, throat, and head and neck.

You may need several tests to help find out if you have a disorder in your inner ear. Common tests include:

Electronystagmography (ENG) or videonystagmography (VNG) tests. These tests measure eye movements that you can't control, called nystagmus. Normally, these eye movements happen briefly when you move your head into certain positions. If they happen at other times or don't happen when they should, you may have a problem in your inner ear.

During the test:

• You will sit in an exam chair in a dark room.
  • For an ENG, electrodes will be placed near your eyes to record their movement. The electrodes are small sensors that either stick to your skin or are put in a headband that you wear.
  • For a VNG, you'll wear special goggles that record your eye movements.
• You'll follow a light on a screen with your eyes.
• You'll be asked to move your head and body into different positions. The provider will also move your head into certain positions.
• Warm and cool water or air will be put in one ear at a time. This should make your eyes move in specific ways.

Rotary test, also called a rotary chair test. This test measures how well your eyes and inner ear are working together to help you keep your balance. During this test:

• You'll sit in a computer-controlled chair with a motor that makes it move.
• You'll wear special goggles that records your eye movements as the chair moves back and forth and turns at different speeds.

Posturography, also known as computerized dynamic posturography (CDP). This test measures how well you can keep your balance while standing. It can help find out whether a balance disorder is caused by a problem with your inner ear, eyes, or nerve signals from your feet and legs. During this test:

• You'll stand barefoot on a platform facing a screen.
• You'll wear a safety harness to catch you if you lose your balance.
• Your balance will be measured when the platform is still and when it's moving while:
  • Your eyes are opened and closed
  • You are looking at a moving image on the screen in front of you

Other tests include:

• Vestibular evoked myogenic potentials (VEMP) tests to measure how certain parts of your inner ear are working. This test involves lying back in a chair and listening to sounds through earphones while you lift and turn your head. Electrodes attached to your neck and face record your muscle movements.
• Dix-Hallpike maneuver to check how your eyes move when your provider quickly moves your head in different positions. This test can show whether vertigo is caused by changes in head position or a more serious condition. A newer version of this test is called a video head impulse test (vHIT). For this test, you wear goggles that record your eye movements while your provider moves your head.

Tests for balance disorders may also include hearing tests. That's because many balance disorders are related to hearing problems, such as tinnitus. You may also have imaging tests of your head and brain.

Will I need to do anything to prepare for a balance test?

Your provider will let you know how to prepare for your tests. It's best to wear loose, comfortable clothes. Depending on the test, you may need to avoid certain foods or medicines before your test. But don't stop taking any medicine without talking with your provider first.

Are there any risks to balance tests?

Certain tests may make you feel dizzy or sick to your stomach. But these feelings usually go away in a few minutes. You may want to plan to have someone bring you home in case the dizziness lasts longer.

What do the results mean?

If your results show that you may have a balance disorder, your provider may order more tests and/or start treatment. Treatment depends on the type of disorder you have. For example:

• For benign paroxysmal positional vertigo (BPPV), your provider may move your head in different positions to move calcium grains in your inner ear back where they belong. The procedure is called the Epley maneuver or canalith repositioning.
• For Meniere's disease, your provider may suggest diet and lifestyle changes, such as increasing physical activity and quitting smoking. Medicines may also help.

If your balance problems are from medicine or a condition that's not in your inner ear, changing medicine or treating the condition may help.

If treatment doesn't help enough, balance retraining therapy, also called vestibular rehabilitation, may help you learn to cope with your symptoms and reduce your risk of falling.

If you have questions about the results of your balance tests, talk with your provider.

Learn more about laboratory tests, reference ranges, and understanding results.