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UR Medicine


Vestibular Testing Services


The balance system depends on information from many different parts of the body sending information to be processed in the brain. Our team works to assess how the eyes, ears, and muscles work together to make sense of balance information.  More specifically, Otolaryngology and Audiology evaluate how the ears may contribute to a patient’s balance problem.

Your provider may ask some important questions about your dizziness or imbalance:

  • What do you feel when you get your symptoms (e.g.: room-spinning, unsteadiness, swaying)?
  • How long do your symptoms last? How often do your symptoms occur?
  • Are there other symptoms that go along with your dizziness or imbalance (e.g.: headache, changes in hearing, nausea, panic)?
  • Describe what seems to cause your symptoms and what relieves your symptoms.
  • When did your symptoms begin? Were there any other health events around the time your symptoms began (e.g.: flu-like symptoms, head trauma, medication changes)?
  • Do you have any other long-term health conditions? Do you have any hearing loss or other concerns with your ears?

Common Conditions

Testing may help in diagnosing a variety of balance disorders including, but not limited to:

  • benign paroxysmal positional vertigo (BPPV)
  • vestibular neuritis
  • labyrinthitis
  • superior canal dehiscence
  • Meniere’s disease
  • and many others

Before Your Test

You need to refrain from taking certain medications and substances 48 hours prior to the test time. Certain medications will affect test results.  If you have further questions about discontinuing a medication, please consult your prescribing physician. Medications that should be stopped are as follows:

  • Anti-nausea medication
  • Anti-vertigo/dizziness medication
  • Alcohol and marijuana

Some medications should not be stopped abruptly. Please check with your prescribing physician or pharmacist regarding questions stopping these medications.  If you are unable to stop any of the medications listed above, please let the Audiologist know when you arrive to your appointment.

Do not discontinue diabetes medication, heart medication, blood pressure medication, or any anti-seizure medications.

For the day of the test:

  1. Do not wear any eye make up for the day of the test.
  2. Dress comfortably. Women should wear pants, not skirts/dresses.
  3. Do not eat 4 hours prior to the start of the test other than a light meal. Liquids are fine.
  4. If your vision is corrected, bring glasses/contact lenses.


Testing may include, but not be limited to the following:

Videonystagmography assesses visual and vestibular control of eye movements. During this test, the patient wears goggles that track eye movements while they follow a target on a screen or while in different body positions. Testing can include caloric testing, saccades, smooth pursuit, optokinetic nystagmus, head shake, and dynamic visual acuity.

Vestibular evoked myogenic potential (VEMP) is a test in which sensors are placed on the skin and a repeated sound is presented to the ears. The patient is asked to lift their head or look in particular directions. This test is useful in determining if each ear responds to balance information in an equal way.  It is also useful for screening for structural abnormalities in the balance parts of the inner ear.

Video Head Impulse Tests (vHIT) allow a provider to see how the balance system responds to quick head movements.  The patient wears a set of goggles to track eye movements while the provider moves the patient’s head in quick side-to-side or angled movements.

Modified Clinical Test of Sensory Interaction in Balance (MCTSIB) asks the patient to stand in various conditions (with eyes open or closed on firm and soft surfaces.) This screener allows the provider to see how the eyes, ears, and muscles work together to keep a patient upright.

Management and Treatment

Balance disorders can be complex. However, once the cause or causes of your balance problem are understood, management and therapy can improve symptoms.  This may include specific maneuvers of the head performed by the provider, vestibular physical therapy, surgical procedures, medication, or some combination of these.