Testing for vertigo involves a physical examination and specific tests to determine the cause of the dizziness. Here's how doctors typically test for vertigo:
Common Tests Used to Diagnose Vertigo
Several tests are used to identify the cause of vertigo. These tests assess balance, eye movements, and inner ear function.
1. Physical Examination and Medical History
The doctor will begin by asking about your medical history, including any previous episodes of dizziness, head injuries, medications you're taking, and other relevant medical conditions. A general physical exam will also be conducted.
2. Head Impulse Test (HIT) or Halmagyi-Curthoys Test
The Head Impulse Test evaluates the vestibulo-ocular reflex (VOR), which is the connection between your inner ear and eye movements.
- Procedure: The doctor will ask you to focus on a target (like their nose). They will then quickly and unexpectedly rotate your head to one side.
- Interpretation: If your eyes move off the target and then quickly correct back to the target, it indicates a problem with the inner ear on the side your head was turned towards (usually a problem with the vestibular nerve). This is a positive HIT. If your eyes stay fixed on the target during the head movement, the VOR is functioning normally.
3. Dix-Hallpike Maneuver
This test is specifically used to diagnose Benign Paroxysmal Positional Vertigo (BPPV), a common cause of vertigo.
- Procedure: You sit on the examination table, and the doctor quickly moves you to a lying-down position with your head turned to one side and hanging slightly off the edge of the table.
- Interpretation: The doctor observes your eyes for nystagmus (involuntary eye movements) and asks if you feel dizzy. The direction and type of nystagmus help determine which semicircular canal in the inner ear is affected by the displaced crystals (otoconia) that cause BPPV.
4. Romberg Test
This test assesses your balance and proprioception (your sense of body position).
- Procedure: You stand with your feet together, arms at your sides, and eyes open. Then, you close your eyes.
- Interpretation: If you become unsteady and sway or fall when you close your eyes, it suggests a problem with balance that could be related to vertigo. The direction of the sway can provide clues to the location of the underlying issue.
5. Fukuda-Unterberger Stepping Test
This test also helps assess balance, particularly vestibular function.
- Procedure: With eyes closed and arms outstretched, the patient is asked to march in place, taking approximately 50 steps.
- Interpretation: If the patient rotates to one side, it can indicate a weakness or problem with the vestibular system on that side.
6. Balance and Coordination Tests
Other tests that may be used include:
- Walking Test: Walking in a straight line can reveal balance problems.
- Finger-to-Nose Test: This assesses coordination and may indicate cerebellar dysfunction contributing to vertigo.
7. Electronystagmography (ENG) / Videonystagmography (VNG)
ENG and VNG are tests that record eye movements to assess inner ear and central nervous system function. VNG is more common now.
- Procedure: Electrodes (ENG) or video goggles (VNG) are used to track eye movements as you follow visual targets, and during changes in head position. Water or air of different temperatures might also be introduced into the ear canal to stimulate the inner ear.
- Interpretation: Abnormal eye movements can indicate problems with the vestibular system or the parts of the brain that control balance.
8. Auditory Testing (Audiometry)
Hearing tests are often conducted because hearing loss can sometimes be associated with vertigo. These tests can identify if the inner ear problem affecting balance is also affecting hearing.
9. Imaging Tests
In some cases, imaging tests such as MRI or CT scans may be ordered to rule out other potential causes of vertigo, such as brain tumors, stroke, or multiple sclerosis.
In summary, testing for vertigo involves a comprehensive approach combining physical examination, specific balance and eye movement tests, and sometimes, hearing and imaging studies to accurately diagnose the cause of the vertigo.
