Neuro-diagnostic Vestibular & Balance Testing

There is such a wide range of hearing and balance disorders, many of which have similar symptoms, it’s important for an audiologist to make an accurate diagnosis in order to come up with a successful treatment plan. We are one of the few clinics in the country that has the technology to perform Neuro-Diagnostic testing.  This plays a crucial role in determining the exact condition responsible for a patient’s suffering and developing a specific treatment plan.  Our clinic is a certified Center for Excellence with the American Institute of Balance.  Our clinic has the same technology, equipment, and protocols as the Mayo Clinic.  We are one of the few clinics in the country with this state-of-the-art equipment and protocol.  We are happy to stand behind our clinic’s promise to serve as a Center of Excellence for our community and patients.

Types of Neuro-Diagnostic Vestibular and Balance Tests

There are a number of diagnostic tests available for typical conditions, ranging from X-rays to CT scans to more in-depth tests.  Our protocols are most in-depth testing for Neuro-Vestibular function.  The vestibular system is complex and responsible for many of the body’s functions. In order to narrow down the exact cause of dizziness, it is necessary to administer a variety of tests. These measure eye movements, head movements, hearing and more.

Our protocols include:

  • Acoustic Immittance Measures (Tympanometry). These tests evaluate the eardrum and middle ear.  Tympanometry is a test of the middle ear used to detect fluid, eardrum perforations and tumors. It measures movement of the eardrum in response to air pressure; the results are recorded on a chart called a tympanogram.
  • Acoustic Immittance Measures (Acoustic Reflexes).  The acoustic reflex test measures involuntary muscle contractions of the middle ear and is used to determine the location of your problem (the ossicles, cochlea, auditory nerve, etc.).
  • Otoacoustic Emissions (OAE). This test measures the response of hair cells in the inner ear.
  • Neuro-Diagnostic Auditory Brainstem Response (Neurodiagnostic ABR). This neurologic test helps us evaluate the neural integrity of the nerve going to the hearing part of the inner ear. This test is often used to further explain why a person might have unilateral symptoms or test findings. This test helps us evaluate the nerve quality and function of the inner ear hearing nerve and the auditory pathway between the inner ear and the brain.
  • Electrocochleography (EcochG). This test is used to determine whether there is excess fluid in the inner ear by measuring the electrical currents generated by sound stimulation and can help with the diagnosis of Meniere’s disease and other balance and hearing disorders. This records electricity generated in the inner ear and auditory nerve.
  • Electro-oculography: This testing evaluates very specific eye movements that are coordinated by the equilibrium centers of the brain. Damage to these brain areas can cause dizziness.
  •  Videonystagmography (VNG). This specialized testing is more accurate that older ENG testing.  This test is composed of a number of subtests.  For this test, the patient were very specialized goggles.  The series of tests measures eye movements via infrared video camera attached to the specialized goggles. VNG tests usually consist of four parts: evaluation of rapid eye movements, tracking tests to measure eye movements as they follow a visual target, positional test for measuring dizziness in response to different head positions.   These allow us to watch for small eye movement abnormalities, which can indicate an inner ear problem. There are also sub-tests that can help us identify positional vertigo and/or permanent ear damage. This testing also looks at the top portion of the nerve going to the equilibrium part of the inner ear.
  • Rotary Chair Tests. This advanced test utilizes a rotary chair,a computer -controlled motorized chair,  a patient’s eye movements are recorded with special goggles in response to corresponding head movements; it is used to determine whether symptoms are related to an inner ear disorder or a brain disorder. Goggle-mounted video camera is used to record eye movements. You are seated in a computerized chair that moves. This test provides more detailed information about the function of the balance system than an ENG or VNG test.  This test allows us to assess the overall health of the inner ears and how the brain is adapting to a vestibular disorder.
  • Posturography : Tests measures how well the visual, vestibular and sensory systems work together to maintain balance. With this test, you stand on a platform and follow instructions.  The specialist records movements to determine the degree to which your body sways. This balance test measures the effectiveness of the somatosensory system, vestibular system, and vision to determine which area(s) to focus on when treating a balance disorder.
  • Sensory Organization Performance Test (SOP): This test helps us identify balance problems. With careful evaluation, it allows your audiologist to determine the cause of your imbalance and identify a potential fall risk.
  • Vestibular Evoked Myogenic Potential (VEMP): This neurological test helps to evaluate a very specific portion of the nerve that goes to the equilibrium part of the inner ear. There are two portions of the equilibrium nerve, and this test evaluates the bottom part of the nerve. 

cVEMP testing is used to determine whether the saccule (an inner ear organ) and vestibular nerves are functioning properly. Electrodes are attached to the neck to measure response of the sternocleidomastoid muscle in the neck.

 oVEMP testing measures vestibular function from the utricle via the superior vestibular nerve, which then crosses the midline to the contralateral medial longitudinal fasciculus and the oculomotor nucleus. Electrodes are placed around eye area of the face.  

  • Caloric Testing (Air Calorics): Caloric testing is a procedure used to find damage to nerves in the ear. During caloric testing, cold and warm air are put into your ear canals and system is recorded.
  • Video Head Impulse Test (vHIT): vHIT measures the vestibulo-ocular reflex (VOR) and is used to test the function of each of the six semicircular canals individually.  This test looks at semicircular canal function in the peripheral vestibular system, motor nuclei in the brainstem, and extra-ocular muscles.
  • Speech In Noise Testing: Thistests for functional hearing in the presence of competing sound or noise. The objective of this is to identify their functional hearing ability and higher processing which allows them to sort between useful speech and noise.
  • Tinnitus Assessment:  In depth testing done by a tinnitus specialist to determine if you have tinnitus, at what pitch, volume, pattern, and if you are a candidate for different tinnitus therapies available.
  • Audiometry: This hearing exam measures your ability to hear different sounds, pitches and frequencies. It can determine the nature and extent of your hearing loss and whether you will benefit from hearing aids or surgery.

These diagnostic tests are quick, painless, and can help us diagnose and evaluate a variety of hearing and balance disorders.

These tests may be combined with additional hearing or diagnostic tests depending on the results. 

Call Texas Professional Hearing Center, Inc. at 281-420-8033 for more information or to schedule an appointment with our Neurodiagnostic Vestibular Specialist.