What Tests Will My Doctor Use to Diagnose Vertigo?

Vertigo, or dizziness, can be because of a wide range of factors, from hormonal fluctuations to brain degeneration/damage. To diagnose vertigo, the physician relies on information like your medical history, your symptoms and the type of vertigo you experience, the frequency of symptoms, and whether other symptoms like vision disturbances or auditory problems like ear ringing accompany it.

On the basis of your symptoms and sign, any of the following tests are advised to diagnose vertigo.

Tests to Diagnose Vertigo

Dix-Hallpike Maneuver

The dix-hallpike maneuver is a diagnostic test to identify benign paroxysmal positional vertigo ( spinning sensation when you move your head ). People with recently developed vertigo accompanied by loss of balance doing everyday tasks, nausea, and vomiting are advised the Dix- hall pike maneuver.

In this test, the physician asks you to sit upright on an exam table with your legs stretched in front of you, and head turned to one side.

You are then asked to lower your head and torso back and lie with your head stretched. Any canaliths or misplaced calcium deposits will trigger vertigo symptoms that will help make a diagnosis, so they are dislodged away from vertigo, causing spots of the ear.

If the test comes out negative, the physician will check for conditions like migraine, ear infection, and vestibular neuritis causing symptoms of vertigo.

Contraindications to Dix-Hallpike maneuver

• When you have recently had a stroke

• Recent neck trauma

• Recent spine fracture

• When you have had cardiac bypass surgery in the past three months

The Head Impulse Test

In the head impulse test, the examiner asks you to sit straight and look at their nose, after which they gently and quickly thrust your head to about thirty degrees to one side to look for a catch-up saccade. Saccades are a rapid ballistic movement of the eyes that abruptly change the point of fixation and amplitudes based on your work activities.

Catch-up saccades are elicited when smooth eye movements lag behind a moving target because of limitations in the frequency response of the patient to the provided target. The head-impulse test is deemed positive when there is a catch-up saccade on the head being tilted to one side.

It is a useful method of detecting patients with acute spontaneous vertigo ( rapid onset of vertigo, nausea, and vomiting with nystagmus, unsteady gait, and head motion intolerance that can last over seconds-hours to days and sometimes weeks.

Contraindications to head impulse test

• In condition of head or neck trauma

• In people with chronic neck pain conditions

• In patients with severe carotid stenosis ( narrowing of carotid arteries )

The Romberg Test

Romberg Test or Romberg Sign is a physical test conducted to evaluate whether you have balance problems because of proprioception ( the body's ability to sense your movements and sensation. It is indicated in patients with myelopathies ( injury to the spinal cord )and sensory neuropathies ( diseases resulting in loss of sensation in the body).

In Romberg's test, you are asked to stand with your feet together or arms crossed on one side. In the first half of the test, you are required to keep your eyes open and stand still for thirty seconds while the examiner assesses your balance and body movements.

In the second half of the test, you are required to close your eyes and stand still for 30-60 seconds while the examiner assesses your balance and body movements. The test is declared positive if you lose your balance while closing your eyes and negative if you stand still with your eyes closed with minimal swaying.

Romberg's test is contraindicated in conditions of severe cerebral ataxia ( damage to the cerebellum because of tumors, alcohol misuse, stroke, or multiple sclerosis).

Fukuda-Unterberger Test

The Fukuda-Unterberger test determines whether you have a vestibular system (a sensory system that provides a sense of balance ) and weakness on one side of the body.

To conduct the test, you must stand in the middle of a room and place a small piece of tape on the floor in front of your toes to mark the starting position. Next, the examiner will instruct you to close your eyes and start stepping with your arms outstretched.

After walking for approximately 50-100 steps, you will be asked to open your eyes. The examiner will observe how much your body rotated to one side or was stable. A Unterberger test is termed positive when the patient can maintain their balance with their eyes open but faces balance issues on closing their eyes.

Electronystagmography (ENG) or Videonystagmography (VNG)

In the electronystagmography method, electrodes are placed on different areas of the face ( one on the center of the forehead, one above the eyebrow, and one below the eye in such a manner as to enable you to close your eyes. Alternatively, the electrodes can be placed on either side of the eye.

Depending on the type of test being performed, you will be asked to look up, down, or to the side, move your head or entire body, or close your eyes, which does not hinder eye movement recording.

Then the examiner makes you sit in a dark room and records your eye movements in different scenarios like

• Putting cold or warm water in your ears to stimulate your vestibular nerve

• Keeping your head still and following a light to stimulate your oculomotor nerves

• Turning your head or sitting up quickly to stimulate your oculomotor or trochlear nerves

If your eye doesn't move as expected during an ENG, it can point to vertigo because of cranial nerve damage. If the ENG results show irregular eye movements, further tests are advised to understand the cause.

Rotation Tests

During rotary chair testing, you are made to sit in a rotational computerized test positioned in the middle of a small, dark room with a seatbelt and security head strap to keep your head and torso in place.

You will be asked to wear infrared video goggles to record your eye movements during the test. Following this, you will be presented with visual displays to determine whether your vertigo is CNS-related or vestibular-induced.

During the first part of the test, your eye movements will be measured in response to moving lights projected on the wall in front. During the next part, you will be turned at various speeds in the rotating chair, and your eye movement will be recorded and analyzed to diagnose your source of dizziness.

The test is conducted during the condition of inconclusive ENG tests and in pediatric or handicapped populations to diagnose the vertigo source.

Other Tests

Other than the tests mentioned above, some other tests used to diagnose vertigo are

Hearing Tests

That help determines if there is a problem in the nerve connecting the ears to the brain, resulting in vertigo.

MRI Scanning

It uses a magnetic field and radio waves to visualize the posterior fossa, the location for the central etiology of vertigo.

VEMP Tests

Evaluates whether the nerves associated with balance are in working condition

Posturography

Measures your sway while standing on a stable platform with eyes open and closed.

Blood Tests

Help the physician determine whether the vertigo is because of blood sugar, blood count, or abnormal thyroid levels.