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Balance Testing

Your sense of or equilibrium, relies on a series of signals that pass from the vestibular organs in the inner ear. These signals pass through a branch of the vestibular nerve to the brain. The inner ear contains a complex system of fluid-filled chambers and passageways, known as the labyrinth. Changes in body position disturb fluid in the labyrinth and stimulate tiny vestibular hair cells, which then send messages via the vestibular nerve to the cerebellum and brainstem, the balance centers of the brain. This series of signals allows your muscles and eyes to respond almost instantly to changes in position. Irregularities affecting any part of this system can lead to dizziness, vertigo, and other balance disorders. Recent studies have documented that balance tests are more accurate than clinical examination in identifying inner ear disorder.

The way you maintain your balance is a complex process that relies on information from your senses and coordinated movements from different areas of your body. Being able to diagnose a balance problem and its specific cause or causes can be difficult because of the complexity. Fortunately, there are several medical tests that can accurately determine why you have a balance problem.

Although most balance disorders are caused by inner ear abnormalities, many balance disorders are caused by central nervous system abnormalities, cardiovascular problems or both. In order to determine the cause of a balance problem, you will first be given a physical exam and asked to describe your problems and symptoms. Depending on your descriptions and exam results, your doctor will develop a working diagnosis. Based on what he or she determines, your doctor may then order tests designed to confirm the diagnosis. There are specific observational tests that can help your doctor figure out what is causing your balance problems.


Balance Tests

Assessment of Eye and Head Movement Functions:

The ability to coordinate movements of your eyes and head is essential to seeing objects in your environment clearly while you are in motion during such tasks as walking, running, or driving a car. In order to test your eye movement control, you may be asked to shift your direction of gaze from one object to another as quickly as you can. You may also be asked to look as far as you can to the left, right, up, and down while facing directly forward. To test eye and head coordination, your physician may observe how accurately you can stay focused on an object while shaking your head.


Assessment of Cerebellar Function:

This includes specific physical examination testing to evaluate your cerebellum, the part of your brain that is essential to your ability to control balance and movements. When your cerebellum has been damaged you can still move, but your movements become jerky, making it harder to get your hands or legs to stop moving just where and when you want them to. Your doctor can test how well your cerebellum is working by asking you to reach out and touch points with your index fingertip, tap your hand rhythmically, and move your arms and legs accurately.


Assessment of Walking Function:

Your doctor can learn about your balance and movement control by observing how well you walk. He or she may ask you to walk in a straight line without veering from side to side and then quickly and accurately turn and walk in the opposite direction without hesitating or stumbling. A more challenging walking task is called “heel to toe” walking, where each new step is placed directly in front the preceding step.

The type of medical tests you need will vary based on what your physician suspects is the problem. If balance problems are detected, further tests would be warranted to pin point your risk factors and accurately identify their causes. On the other hand, if your symptoms and exam results are suggestive of a specific cause, your doctor may order tests designed to confirm a diagnosis and suggest the best course of treatment. Some common tests that may be ordered for someone with a balance disorder are described below.


Audiometric (Hearing) Tests:

Your doctor may order hearing tests as the hearing and motion sensing parts of your inner ears are sometimes both affected by the same disease. Basic hearing tests are designed to determine how well you can sense very faint sound at different frequencies, as well as how well you can comprehend speech.


Nystagmography Tests:

This is a series of tests designed to determine your ability to follow visual objects with your eyes and how your eyes respond to some types of information from your vestibular system. To monitor the movements of your eyes, your doctor may place electrodes around your eyes or may use an infrared video camera. Eye movement tests are useful, because some patients with balance system problems have problems seeing clearly when moving, or they get the inaccurate sense that objects are moving.

1. Occular Motility:

You will be asked to follow with your eyes objects that jump from place to place or move smoothly. Your doctor will be looking for any slowness or inaccuracies in your ability to follow visual targets.

2. Optokinetc Nystagmus:

You will be asked to view a large, continuously moving visual image to see if your eyes can appropriately track these movements.

3. Positional Nystagmus:

Your doctor will move your head and body into various positions to make sure that there are no inappropriate movements of your eyes when your head is in different positions.

4. Caloric Test:

Your doctor will stimulate both of your inner ears with warm and then cold water. He or she will be monitoring the movements of your eyes to make sure that both your ears can sense this stimulation.


Once tests have been conducted, your physician will review the test results and consider them along with your symptoms and findings from other tests to reach a diagnosis. Possible causes for balance problems include abnormalities affecting the inner ear, cerebellum, brainstem, and vestibular nerve. Treatment and prognosis depend on the nature of the problem.

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