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Dizziness and balance problems
A guide for patients and carers
What tests might I have?
GPs refer patients who complain of dizziness to a number of different hospital consultants. They may be referred to see a neurologist - a doctor who specialises in disorders of the brain and nerves, or they may be referred to an otologist - a doctor who specialises in problems of the ear. The latter may be either an audiological physician or an ear, nose and throat specialist (an ENT surgeon). In some specialised departments or “dizzy patient” units, you may see more than one of these specialists. The tests that you have may vary slightly according to the type of specialist you see.
You may have a head or brain scan (e.g. CT or MRI scan), which are basically carried out to rule out any cysts, growths, inflammation or blood supply disorders of the brain. Your doctor may request a number of hearing tests. During some of these you have to say if you can hear certain tones and in others the hearing system itself is assessed directly using wires that are temporarily glued to your scalp.
You may also have to undergo special balance tests. The most common of these records your eye movements with wires attached to the skin surrounding your eyes. This is called ENG (electronystagmography). This test is performed because the balance organs of the ear control the movement of the eyes very precisely and a problem with the ear or brain centres controlling balance can cause abnormalities in eye movement.
Another balance test called the caloric test is very informative. During this test you will have some cool or warm water run into your ears so that the temperature of the balance organs in the inner ear can be modified. This test creates a minor and temporary difference between the balance organs on the left and right sides of your head and makes you feel dizzy for a couple of minutes.
You should bear in mind that all these tests and scans will not be necessary for everyone. Some people may not need any tests at all.
There is one test, however, that almost everyone complaining of dizziness or vertigo will be asked to undergo, and this is called the positional test. This is a clinical test - that is one that will be carried out by the doctor during the examination. This test or manoeuvre will establish if the dizziness is triggered or made worse by movements of the head. Your doctor will ask you to sit on the couch, and then he or she will ask you to lie down rapidly with your head turned to one side and then to the other. Certain forms of dizziness will be brought on by this procedure, but this dizziness will always be short-lived, lasting no more than a minute, and the procedure will not make your dizziness worse.
Your doctor will know by the presence of any eye movements during and immediately after the test what form of dizziness you have. It is therefore of utmost importance that you keep your eyes open while your doctor performs this test. Certain conditions, such as benign paroxysmal positional vertigo (or BPPV), can only be diagnosed by performing this manoeuvre and effective treatment can only be prescribed if the diagnosis is made correctly.
You may also have to undergo special balance tests. The most common of these records your eye movements with wires attached to the skin surrounding your eyes. This is called ENG (electronystagmography). This test is performed because the balance organs of the ear control the movement of the eyes very precisely and a problem with the ear or brain centres controlling balance can cause abnormalities in eye movement.
Another balance test called the caloric test is very informative. During this test you will have some cool or warm water run into your ears so that the temperature of the balance organs in the inner ear can be modified. This test creates a minor and temporary difference between the balance organs on the left and right sides of your head and makes you feel dizzy for a couple of minutes.
You should bear in mind that all these tests and scans will not be necessary for everyone. Some people may not need any tests at all.
There is one test, however, that almost everyone complaining of dizziness or vertigo will be asked to undergo, and this is called the positional test. This is a clinical test - that is one that will be carried out by the doctor during the examination. This test or manoeuvre will establish if the dizziness is triggered or made worse by movements of the head. Your doctor will ask you to sit on the couch, and then he or she will ask you to lie down rapidly with your head turned to one side and then to the other. Certain forms of dizziness will be brought on by this procedure, but this dizziness will always be short-lived, lasting no more than a minute, and the procedure will not make your dizziness worse.
Your doctor will know by the presence of any eye movements during and immediately after the test what form of dizziness you have. It is therefore of utmost importance that you keep your eyes open while your doctor performs this test. Certain conditions, such as benign paroxysmal positional vertigo (or BPPV), can only be diagnosed by performing this manoeuvre and effective treatment can only be prescribed if the diagnosis is made correctly.
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