Vestibular Testing and Treatment

Testing vestibular system: Bedside tests and Lab tests.

Bedside tests

Office Tests of Vestibulo-Spinal Reflex and Postural Control function

Musculoskeletal Assessment Ankle, Knee, and Hip Joint Range-of-Motion, Ankle, Knee, and Hip Joint Strength, Sensation in the Distal lower limbs, Deep-Tendon Reflexes

Tandem (Sharpened) Romberg.
Modified Clinical Test • for Sensory Interaction of Balance
Fukuda Stepping Test
Casual Gait-With and Without Reciprocal Horizontal Head Movements.

Lab Tests

  1. Sensory vestibular system: (peripheral vestibular system), Central connections and interaction, and Motor part of Vestibular system. (CDP).
  2. Tests which can diagnose these lesions (VOR based tests, VCR based tests and VSR based tests)
  3. Tests based on site of lesion: (anatomical region): ENG: Lateral canal(caloric), Positioning (All canals, optokinetic tests (central), vHIT: All canals, ABR: Integrity of Auditory part of vestibulocochlear N, cVEMP: Inf Vestibular N (only test which can assess Inf. V N and Saccule) Also a usefull test to diagnose SCD, oVEMP: Sup Vestibular N and Utricle, Ecoch.G: Meniere disease and Endolymphatichydrops,  Rotary Chair test: Mostly used to confirm  bilateral vestibulopathy, VAT:  high frequency vestibulopathy. CDP,(identifying malingers)


In Summary Test Battery available for Hearing and Balance disorders:

Hearing test: Acts as a baseline for other tests and can also be abnormal in MD.

ABR: Useful in detecting retrocochlear pathology.

Ecoch.G: Diagnostic test in MD and Endolymphatic Hydrops.

cVEMP: The only tests for Inf Vestibular nerve function and Saccule.

: The only test to assess the utricular function.

vHIT: Can test all the SSC a new and promising test to find out high frequency Vestibular disorders.

VAT: Another test to sind out high frequency vestibular disorders.

VNG/ENG: Considered almost a gold standard in vestibular testing. But has deficiencies as it can only test Lateral Canal through Caloric test. Occulomotor tests help us diagnose any central vestibular pathologies. Also helps diagnose BPPV.

Rotatory chair: Tests mid frequencies and also a gold standard for bilateral lesions.

CDP: Helps diagnose functional effects of vestibular disorders. Also helps find malingerers.

No Single test can assess the entire sense organs of vestibular system so most physicians use a selection of tests based on individual history, examination and clinical presentation of the patient.