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, which can feel like:

• You or everything around you is spinning (known as vertigo)
• You're going to fall
• You're lightheaded or are about 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 fall more often than younger people.

To test for balance disorders, your health care provider may check your:

• Vestibular system, which controls your sense of balance. This system (also called the vestibular labyrinth) is in your inner ear and includes special organs containing fluid and hair-shaped sensors. When you move (or are in an object that moves, like a car), the fluid in your inner ear moves these sensors. This triggers them to send nerve signals to your brain about your position and in which direction you're moving.
• Eyes, which help you keep your balance with the vestibulo-ocular reflex (or VOR). A reflex is your body's automatic movement in response to certain triggers. For the VOR, the trigger is your head's movement, and the reflex is your eye's ability to move in the opposite direction of your head. Because of this, you can see clearly and stay focused on objects whenever you move.
• Muscles and joints, which also have a reflex that responds to movement. For this reflex, your muscles adjust to any changes in your position and send signals about those changes to your brain.

Good balance depends on how effectively your brain receives signals from each of these body parts. If you have any problems with these signals, you may experience symptoms of a balance disorder, such as dizziness.

There are many tests a provider can use to check your balance. Some of the most common include:

• Videonystagmography (VNG) or electronystagmography (ENG) tests. These tests measure eye movements, called nystagmus, that you can't control. 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.
• 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.
• Dynamic visual acuity (DVA) test. This can show how motion affects your ability to see by comparing how well you can read while your head is still and while you move it.
• 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.
• Vestibular evoked myogenic potentials (VEMP) tests. These measure how certain parts of your inner ear are working.
• Video head impulse (vHIT) or Dix-Hallpike maneuver. These tests can show whether vertigo is caused by changes in head position or a more serious condition.

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). This is the most common cause of vertigo in adults. It happens when grains of calcium in your inner ear slip out of place and get into areas where they don't belong. Normally, these grains help tell your brain about your head's position and movement. When the grains move, they trigger confusing signals that can make you feel a spinning sensation when you move your head.
• Labyrinthitis. This balance disorder can cause dizziness and temporary hearing loss. It happens if your inner ear becomes irritated and inflamed (swollen), usually from a cold or flu. It sometimes goes away on its own.
• Meniere's disease. This disorder causes balance and hearing problems (such as a full feeling in your ears) when too much fluid builds up in the vestibular system. The cause is unknown.
• Vestibular neuritis. This is inflammation (swelling) of the vestibular nerve, which carries signals from the vestibular system in the inner ear to your brain. It's usually caused by a virus.
• Acoustic neuroma. This is a tumor which develops on the nerves involved with hearing and balance. It's usually benign (not cancerous), but it can cause issues with hearing and balance.
• 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.

Balance disorders can be difficult to diagnose. So, to see if any of these conditions are causing your symptoms, your provider may also consider other common causes for balance problems. These include:

• Head injuries
• Certain medicines and medical conditions that affect your inner ear or brain
• Vision problems
• Heart disease
• Blood vessel disorders
• Migraine headaches
• Arthritis
• Certain genetic conditions
• Musculoskeletal conditions
• Neurological disorders such as Parkinson's Disease

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
• Having slower reflexes than usual
• Motion sickness
• Hearing loss
• Tinnitus (ringing in the ears)
• Confusion
• Nystagmus (fast eye movements that you can't control)

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 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, head, and neck.

For a videonystagmography (VNG) or electronystagmography (ENG) test:

• You will sit in an exam chair in a dark room. For a VNG, you'll wear special goggles that record your eye movements. For an ENG, electrodes will be placed near your eyes to record their movement. The electrodes are small sensors that stick either to your skin or to a headband you'll wear.
• Without moving your head, you'll follow moving lights or patterns on a screen with your eyes.
• You'll be asked to move your head and body into different positions so that your provider can see if those movements cause nystagmus.
• Warm and cool water or air will be put in one ear at a time. This should make your eyes move in specific ways.

For a rotary (or rotary chair) test, you will:

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

During posturography, also known as computerized dynamic posturography (CDP):

• 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. It will also measure your balance while you are looking at a moving image on the screen in front of you.

During a vestibular evoked myogenic potentials (VEMP) test:

• You'll lie back in a chair and listen to sounds through earphones.
• While doing this, you will lift and turn your head.
• Electrodes attached to your neck and face will record these muscle movements.

During a Dix-Hallpike maneuver and video head impulse (vHIT) test, your provider will quickly move your head into different positions while monitoring movements in your eyes. For a vHIT, you'll 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 to see if any injuries or tumors are causing your balance problems.

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

Your provider will let you know how to prepare for your test. 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.