Vestibular (Balance) Assessment and Rehabilitation

The Vestibular System

Your vestibular (balance) system is located within your inner ear. The vestibular organs contain a fluid called endolymph.  When you move your head, this fluid begins to flow, causing tiny hair cells to move and send messages to the brain about your movement. Your vestibular system allows you to sense where you are in relation to other things in the environment and to perform the correct movements to steady yourself.  Degeneration or loss of function in any of these systems can lead to balance deficits. If there is a problem with the vestibular system, your ability to maintain posture and balance may be compromised.

Common symptoms of a balance disorder:

  • Dizziness or vertigo (spinning sensation)
  • Unsteadiness when walking
  • Light headedness, fatigue, disorientation
  • Visual disturbances especially in buy visual environments such as supermarkets


Referrals are received from ENT and GPwSI in ENT.

The assessment day:

When testing the vestibular system, we monitor your eye movements.  This is because eye movements are very closely related to balance function. As your vestibular system perceives movement to one side, a reflex reaction moves your eyes in the opposite direction, this is called the vestibulo-ocular reflex (VOR).

However, if there is a problem within the inner ear, you may perceive movement even when you are still. Your eyes will then try to compensate for this, resulting in an abnormal eye movement (beating of the eyes) known as a nystagmus.

To monitor your eye movements, we use a set of goggles with cameras in that allow us to see the eyes clearly, even in the dark. These goggles allow your eye movements to be tracked and recorded by a computer for further analysis. To allow us to do this you will be asked to keep your eyes open throughout testing, even when in the dark.

Vestibular testing may take up to 90 minutes to perform and may involve a number of tests. 

  • Oculomotor
  • Positional testing including Dix Hall Pike
  • Gaze examination
  • Caloric irrigation
  • Video Head Impulse Testing
  • Cervical evoked myogenic potentials

Before the appointment:

  • Please check with your GP that your ears are clear of wax
  • Do not drink alcohol for 48 hours before testing
  • Do not take any anti-dizziness/vertigo medication for 48 hours before testing (if any problems, please consult your GP.  You must continue to take all other medications as recommended by your GP

On the day of your appointment:

  • Please remove all eye make up
  • Testing may take up to 90minutes to perform (you may be required to return at another time for further testing if necessary)
  • You may bring an adult along to the appointment with you for support, but please do not bring young children
  • Any sensations of unsteadiness during testing will pass quickly (usually within just a few minutes), but do bring your anti-dizziness medication along to the appointment as you may wish to take some after testing
  • You are advised not to drive immediately after your appointment.

What happens next:

Unfortunately, we will sometimes be unable to give you any immediate results at your balance testing appointment.  Once you have attended the appointment, the clinician will need to spend some time analysing the traces of your eye movements.

The results will then be sent to the consultant that referred you for testing and another appointment will be made for him/her to discuss the results with you. 

Diagnosis and identification of possible causes will depend on a thorough history being taken and perhaps a combination of other tests to rule out other causes of dizziness.

If you are given a diagnosis related to inner ear problems you may be given rehabilitation exercises to help your body to compensate for any vestibular dysfunction.  You may be sent to physiotherapy or a vestibular rehabilitation centre for assistance with your recovery.

  • Results will be sent back to referrer and a management plan agreed
  • Direct access BPPV clinics
  • Vestibular Rehabilitation clinics
  • Onward referral to Physiotherapy, Fall Prevention Team as required

Useful websites:

NHS Choices – Vertigo: www.nhs.uk/Conditions/Vertigo

Patient Information – Dizziness: www.patient.co.uk/health/Dizziness.htm

Vestibular Disorders Association (VEDA):  www.vestibular.org/vestibular-disorders.php