Balance Disorders: Symptoms, Causes & Treatments

Vestibular testing is a series of diagnostic procedures used to assess the inner ear's balance system (vestibular system) to determine if vertigo, dizziness, or imbalance stems from a peripheral ear issue or the central nervous system.

A comprehensive balance (vestibular) evaluation is designed to understand how your inner ear, eyes, and brain work together to keep you steady.

Case History: Your visit begins with a detailed conversation about your symptoms. You'll be asked about dizziness, vertigo, imbalance, hearing changes, medical history, medications, and when and how your symptoms occur. This information helps guide which tests are most appropriate.

Audiological Testing: Because hearing and balance systems are closely connected, a hearing evaluation is usually performed.

• Pure Tone Testing (Air, Bone, and Speech): Measures how well you hear different pitches and how clearly you understand speech.
• Tympanometry: Assesses how your eardrum and middle ear are functioning.

Gans Sensory Organization Performance (Gans SOP): A series of balance tasks (standing and walking under different conditions) that helps determine how your visual, vestibular, and proprioceptive systems contribute to your balance.

Video Head Impulse Test (vHIT): This test evaluates how well your inner ear balance organs respond to quick head movements. You'll wear lightweight goggles while small, rapid head turns are performed.

Oculomotor Testing: While wearing goggles, you'll be instructed to follow a series of dot movements on a television screen. These tests measure how your eyes move and track objects. Since the balance system is closely linked to eye movements, this helps identify issues in the brain or inner ear pathways.

Rotary Chair Testing: While seated in a specialized chair that moves gently, your eye movements are recorded to assess how your vestibular system responds to motion. This is especially useful for detecting subtle or bilateral balance issues.

Positional Testing: You'll be guided through specific head and body positions to see if they trigger dizziness. This helps diagnose conditions like positional vertigo, or BPPV.

Caloric Testing: Warm and cool air are blown into the ear canal to stimulate the balance organs. This allows each ear to be evaluated independently and can identify weakness on one side.

cVEMP and oVEMP Testing: These tests measure how certain parts of your inner ear respond to sound stimulation by recording muscle activity in the neck (cVEMP) and around the eyes (oVEMP).

Electrocochleography (ECochG) (if needed): This specialized test evaluates inner ear fluid pressure and can help in diagnosing conditions such as Ménière's disease.

A VNG helps determine whether your dizziness or balance issues are coming from the inner ear (peripheral) or the brain (central). It can identify if one ear is weaker than the other, detect abnormal eye movement patterns, and help diagnose conditions like BPPV.

BPPV (Benign Paroxysmal Positional Vertigo) is one of the most common causes of dizziness, and one of the most treatable.

What does BPPV mean?

• Benign: Not dangerous and doesn't cause long-term harm
• Paroxysmal: Comes on suddenly
• Positional: Triggered by changes in head position (like rolling in bed or looking up)
• Vertigo: A spinning sensation

What causes BPPV? Inside your inner ear are tiny crystals (called otoconia) that help you sense motion and gravity. Sometimes, these crystals become dislodged and move into the wrong part of the balance system (the semicircular canals). When this happens, your brain receives mixed signals that cause that sudden spinning feeling when you move your head.

How is BPPV treated? The good news: BPPV is highly treatable. Audiologists and vestibular specialists use simple, gentle movements called repositioning maneuvers to guide the loose crystals back where they belong. The most common treatment is the Epley maneuver. It's quick, non-invasive, and done right in the clinic. Many people feel relief after just 1–2 treatments.

Find the cause of your symptoms: Dizziness can come from many sources, including inner ear disorders, neurological conditions, or medication effects. A balance assessment helps narrow down where the problem is coming from.

Get the right diagnosis sooner: Conditions like BPPV, vestibular neuritis, Ménière's disease, or central balance disorders can have similar symptoms but require very different treatments. Testing helps avoid guesswork and delays in care.

Guide effective treatment: The results help your provider choose the most appropriate treatment plan, whether that's repositioning maneuvers, vestibular therapy, medication adjustments, or referral to another specialist.

Rule out serious conditions: While most balance disorders are not dangerous, testing helps ensure that more serious neurological causes are not being missed.