VNG Balance Evaluations

Vertigo, dizziness, and balance problems can be life altering. For many people it can affect their ability to do even the simplest daily tasks. If you are experiencing vertigo or balance issues, your doctor may want to refer you for a videonystagmography (VNG) balance evaluation.

What is a VNG balance evaluation?

A VNG is a series of tests that evaluate the health of your vestibular (balance portion of inner ear) and your central motor function. VNG testing can help to uncover the root cause of your vertigo, dizziness or balance issues, and allows your doctor or hearing specialist to treat it appropriately and effectively.

What tests will be performed?

VNG testing consists of a variety of tests to uncover the root cause of your symptoms. Most VNG evaluations consist of four main tests:

Ocular mobility

This test checks for your ability to follow visual targets, such as a moving light on a bar. You will attempt to follow targets with your eyes while an object is jumping, moving slowly, or standing still. Inability to track objects properly could indicate central or neurological problems or possibly an issue with the vestibular system connecting to the brain. Recording and evaluating eye movements is helpful because visual motor neural pathways are connected to the vestibular or balance system of the inner ear.

Optokinetic nystagmus

This test also checks for your ability to follow visual targets. During this test, you will watch a  image that is continuously moving and will be asked to follow the movements. Similarly, this test will give clues to possible central or neurological problems or problems with the vestibular system.

Positional nystagmus

This test will help give an idea of the health of your inner ear system. You will be asked to move your head and body into different positions, allowing the hearing care professional to check for inappropriate eye movements in each position.

Caloric testing

This test can help determine if you have vestibular weakness in one or both ears by checking to see if your vestibular system responds properly to stimulus. Your eyes will be monitored while your inner ears are stimulated (one at a time) with warm or cold air

Video Head Impulse Test (vHIT)

This test incorporates a new technology that uses a high speed, lightweight video goggle to measure (left or right) eye movements. vHIT provides a quick and objective measure of the vestibular ocular reflex (VOR) in response to head movements in the natural range of daily motions.  This test is easy, doesn’t make you dizzy, but is often not covered by your insurance company.

Computerized Digital Visual Acuity Test (AIB-CDVAT)

Computerized testing to assess the balance systems as a screening for falling. Sitting in front of a computer screen, you will watch a series of numbers on the screen.  Using different scenarios, you will move your head and repeat the numbers on the screen.

Gans SOP

Standing on a piece of foam, you will be asked to change footing positions with eyes open and eyes closed.


Testing is completed while lying on a table.  Electrodes are placed on your forehead and neck.  Headphones are also placed in your ear canals.  You lay quietly, and when instructed, you gently raise your head off the table and turn to either the right or left side.  While holding your head in this position, we send clicking sounds through the headphones and measure nerve information through the electrodes.


This is a test of positional vertigo or better known as “crystals.”  The Dix-Hallpike maneuver is a test that doctors use to diagnose a particular kind of vertigo called benign paroxysmal positional vertigo (BPPV). People with vertigo experience a feeling of room-spinning dizziness. 

The Dix-Hallpike maneuver is really just a series of movements you perform while a doctor observes your response. This test has been used since at least 1952 and is considered the “gold standard” doctors use to diagnose BPPV.

While BPPV might have a complicated name, its cause is simple. This type of vertigo happens when calcium crystals in your inner ear, which help you balance, become displaced. This results in symptoms of dizziness and nausea.

BPPV is one of the most common causes of vertigo, and once it’s diagnosed, it’s usually fairly simple to treat.,

Our doctor will ask you to sit upright on the table and your head turned to one side. They you will lay on one side, looking up at the ceiling, turned with one ear down at a 45-degree angle. If there are misplaced calcium deposits (also called canaliths) in the posterior canal of your inner ear, this will trigger vertigo or spinning symptoms.

While you’re lying back, your doctor will check for eye movement called nystagmus, which can indicate dizziness. The doctor may then ask you questions about how you’re feeling before switching sides and testing the opposite ear.

Neurodiagnostic Auditory Brainstem Response

Testing is completed while lying in a reclined position on a table.  Electrodes are placed on your forehead and headphones are placed in your ear canals.  You sit quietly while we send clicking sounds through the headphones.  We measure brain activity through the electrodes.

Electrical Cochlearography (EcochG)

This is a painless test of hearing function that is usually done to determine if there is too much fluid in the inner ear. Often referred to as Meniere’s disease, this condition is known as endolymphatic hydrops. This test is performed while lying down on the exam table.  Electrodes are placed on your forehead and headphones are placed in your ears.  We play a clicking sound and measure brain activity through the electrodes.

Preparing for VNG testing

Because of the nature of the tests, there are some preparations you will need to make before your evaluation. Our staff will provide you with clear instructions on how to prepare for your examination. For example, we may ask you to discontinue certain medications, not to consume any alcoholic beverages or caffeinated drinks at least 48 hours before the tests, to remove makeup and lotion from your face, to remove contact lenses or eyeglasses or to eat light a few hours prior to testing. The exact instructions may vary from patient to patient. If you have any questions about your instructions or how to prepare for the test, give us a call.

The entire VNG evaluation typically lasts about 90 minutes. It is advised that you bring someone with you who can drive you home afterward if you are unable to drive or if you feel disoriented after the tests.