What questions might my doctor ask?
As well as asking you about your symptoms, your doctor will ask you about the circumstances of your dizziness to find out how long it lasts, whether it started spontaneously, whether it appears to be related to the movement or position of your head, whether it came out of the blue, or whether it first started after you had a bad cold or influenza (the ‘flu).
You should try to answer your doctor’s questions as accurately as possible.
Your GP might treat you with medication before referring you to a specialist.
What tests might I have?
GPs refer people with dizziness and balance problems to many different hospital specialists. You might be referred to see a neurologist (a doctor who specialises in the diagnosis and treatment of people with brain and spine conditions) or an otologist (a doctor who specialises in the diagnosis and treatment of people with problems relating to the ear). The otologist might be an audiovestibular specialist or an ear, nose and throat specialist (an ENT surgeon). Some GPs refer people directly to physiotherapists.
In some specialised hospital departments, or dizziness clinics, you might see more than one of these specialists. The tests you have will vary slightly according to your particular symptoms and the type of specialist you see.
CT or MRI scan
You might have a scan of your ear or ears, or a scan of your brain. It is most likely to be a CT (Computerised Tomography) scan or an MRI (Magnetic Resonance Imaging) scan. The scan is to check for any cysts, abnormal growths, inflammation, or problems with the blood supply to your brain that might be causing your dizziness.
(You might be interested in reading our fact sheet with information on brain scans for further details.)
You might have your hearing tested. This could involve you having a series of different hearing tests. Some of them might involve you saying when you can hear certain tones and others involve you having your hearing system assessed directly by electrical wires. The wires are connected to small pads that are gently attached to your head.
Special balance tests
The Hallpike test (positional test)
The Hallpike or positional test is the key test that most people with dizziness and balance problems will have. It is a clinical test carried out by the specialist during your examination.
The Hallpike test will establish whether your dizziness is triggered or made worse by particular movements of your head. Sitting on a couch or bed, you will be asked to lie down very quickly with your head turned to one side, then the other.
The manoeuvre can bring on certain forms of dizziness but they will be temporary and should not last more than a minute. The procedure will not make your dizziness problem worse.
It is crucial that you keep your eyes open during the test because the doctor will establish from your eye movements during and immediately after the test what form of dizziness you have. Certain conditions like benign paroxysmal positional vertigo (BPPV) can only be diagnosed by performing the Hallpike test and effective treatment can only be prescribed after an accurate diagnosis.
Electronystagmography (ENG) is one of the more common balance tests and records your eye movements. It can be carried out using video goggles or with electrical wires connected to small pads that are gently attached to the skin surrounding your eyes.
An ENG test is performed because the balance systems in the inner ear control the movement of our eyes very precisely and a problem with the balance centres in the ear or brain can cause abnormalities in our eye movement.
The caloric test involves you having a small amount of cool or warm water trickled into your ears to modify the temperature of the balance organs in your inner ear. A small amount of pressurised air might be used instead of water. This test temporarily creates a small difference between the balance systems in the left and right sides of your head respectively. It can make you feel dizzy for a few minutes but will help diagnose problems with the balance mechanism in the ear.
For this test, a soft tip is placed in your ear canal. You will hear a low tone for a short while, and feel a slight pressure. The movement of your eardrum is monitored and plotted on a chart. This will show the audiologist if you have any congestion behind your eardrum.
The Roll Test
This test consists of turning your head from side to side quickly, whilst laid down. Once you have turned your head, your eyes will be looked at by the audiologists. This test is used for suspected Benign Paroxysmal Positional Vertigo (BPPV).
Vestibular evoked myogenic potential (VEMP)
This is a test of the saccule, a part of the balance organ, which is responsible for detecting ‘up and down’ movements of the head. You will be asked to lie down, and have earphones placed in your ears, where you will then hear loud sound for about 45 seconds. During this time, you will be asked to raise you head from the bed and hold it there. If this is too difficult, you may be able to do the test sitting up instead, whilst turning your head to one side.
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