Test / Diagnostic Procedure: Hearing and balance testing

Hearing and balance testing uses a combination of tests done by an audiologist to investigate the cause of balance problems and dizziness. Although many medical conditions can cause dizziness and balance issues, these problems are often a result of issues in your balance organ in the inner ear.

Hearing and balance testing may be recommended by your doctor if you experience the following symptoms:

• Vertigo (a feeling of motion or spinning)
• Light-headedness or feeling faint
• Loss of balance or unsteadiness
• Falling over or feeling like you might fall
• Floating sensations or dizziness
• Vision changes, such as blurriness
• Confusion

There are a few things you need to do before a testing appointment to make sure all the necessary tests can be performed and that your results are as accurate as possible.

Before your test appointment, make sure to:

• Clear your ears of wax. Your consultant will provide you with information on using drops to break down and remove wax from your ears. Follow their instructions carefully as your ears must be free of wax for the tests to be carried out
• Remove all eye makeup. This is especially important if you’re having a VNG, vHIT or caloric test (see below) as these cannot be performed with mascara and eyeliner present
• Avoid alcohol. Refrain from drinking alcohol for 48 hours before your appointment
• Avoid loud environments. Stay away from very loud or noisy environments such as nightclubs and concerts for 48 hours before your appointment
• Stop taking any balance medications. Don’t take any medications for your balance problems, such as Stemetil, Stugeron and Serc for at least 48 hours before your appointment. You should continue to take any other medications as normal

On the day of your appointment, have only a light breakfast or a light lunch before your tests. Your tests will take around two hours to complete depending on which ones you’re having.

At your testing appointment, your audiologist will first review your medical history and then conduct a range of tests. Your recommended hearing and balance tests may include:

Hearing tests

Pure tone audiometry

This test involves sitting quietly in a soundproof booth for 15 minutes while a range of pitched tones are sounded through headphones, or a headband, to one ear and then the other. You will be asked to press a button every time you hear the sounds as the tones gradually get quieter. The aim of the test is to measure your hearing sensitivity.

Tympanometry

While sitting down, a soft-tipped probe will be placed in your ear canal for around 2 minutes. You may feel small pressure changes in your ear which will indicate to your audiologist how well your eardrum and middle ear are working. The pressure you might feel is similar to that experienced when passing through a tunnel on a train.

Stapedial reflexes

After completing a tympanometry test, your audiologist will present short bursts of sound through the probe. Another probe will be placed in your other ear and more sounds will be presented. This test takes around 15 minutes and checks the function of the small, middle ear muscle called the stapedius.

Otoacoustic emissions (OAEs) Test

While you’re sitting still, your audiologist will place a soft-tipped probe into the outer part of your ear canal. A buzzing sound will be played through the probe for a couple of minutes with the probe recording an ‘echo’ coming back from the inner ear (cochlea). This test tasks around 10 minutes in total.

Speech audiometry

During this 20-minute test, words will be played into each ear in turn through headphones at low, medium and high volume levels and you’ll be asked to immediately repeat what you hear. This test is done to check how well you can understand speech sounds.

Balance tests

Eye movement recording tests (VNG)

The balance organs in your inner ear and your eyes are very closely connected. Eye movement recording tests are a series of assessments that check this connection and ensure your eyes are moving correctly.

The tests will all be carried out whilst you’re sitting in a chair. Your eye movements are recorded using infrared cameras mounted in a set of goggles, or by placing electrodes on either side of your eyes. Some of the tests are carried out in the dark but the audiologist will be in the room with you. It’s important not to wear any eye makeup for this test. These tests take around 20 minutes to complete.

Positioning tests

This short 10-minute assessment is carried out while you lie on a treatment bed. Your audiologist will move your head through different positions all while you have your eyes fixed on their nose. They will observe if there are any movements in your eyes or if you experience dizziness, which can be treated with a repositioning manoeuvre called the Dix-Hallpike Manoeuvre.

Video head impulse test (vHIT)

For this test, you will be sat in a chair and your audiologist will place lightweight goggles over your eyes. There will be a screen in front of you with a target on it. Your audiologist will ask you to focus on the target while an infrared camera records your right pupil. While you’re focussed on the light the audiologist will turn your head quickly from side to side and then up and down.

The test takes around 10 minutes from start to finish and eye makeup must not be worn. The aim of the test is to detect disorders of the vestibulo-ocular reflex (the reflex that controls gaze during movement) and identify which ear could be causing your balance problems and dizziness.

Posturography   

Posturography is a 10-minute balance test which measures how well you can keep your balance under different circumstances. Your audiologist will ask you to stand on a platform with a foam cushion either with your eyes open or closed. The test results show how you balance organs, eyes, and joints using information to keep you balanced. This helps guide your treatment and can also be used to show and record the improvement in your balance once you’ve had treatment.

Vestibular-evoked myogenic potential (VEMP) test

This test is used to assess the function of a part of your inner ear balance organ that detects gravity and ‘up and down’ movement, such as traveling in a lift. You’ll be sat in a chair and electrodes will be placed on your forehead, neck muscle and collarbone. You’ll put on headphones to listen to some clicking sounds, whilst turning your head from left to right to look over each shoulder. The activity in the neck muscle is recorded to evaluate the function of your balance organs. This test takes approximately 25 minutes to complete.

Caloric test

This important test checks the function of part of the balance organs which detects side-to-side head movement and whether there is a different level of function in each ear.

The test takes around 25 minutes and is performed with you lying on an examination bed. Warm air is pumped into one of your ears for 60 seconds to stimulate the balance organ and produce an eye movement known as nystagmus. Your audiologist will then repeat the test in your other ear, before repeating the test in each ear with cool air. You must not wear any eye makeup having this test as it can interfere with your results.

Some balance tests can make you feel a little dizzy, but this settles quickly once the test is finished. It’s advised you wait for some time before driving yourself home after these tests or ask a friend or relative to pick you up.