You’ve been experiencing dizziness, vertigo or balance problems, and you’ve been referred for vestibular testing. Read on to find out what to expect from your first visit to an audiologist, and what the next steps may be.
Your first visit with an Audiologist
You’ve been referred to an audiologist for vestibular testing because your symptoms- usually dizziness, vertigo or balance issues- may be related to an issue in your inner ear (read more about how the inner ear contributes to your balance system here (read more: The Human Balance System). This visit will determine whether a problem in the inner ear is the source of your symptoms. This will guide your healthcare team toward the best treatment options for you.
Many patients are anxious about their first audiologist appointment. You may already be feeling ill from your symptoms, and you might be fearful about participating in activities that worsen them. However, the anticipation of the appointment is often the worst part. While a few of the tests may bring on some of your symptoms, this will typically not last long. Healthcare professionals who conduct this testing work with many dizzy patients and are experts at helping them through the process. Also, always remember: even if you have some dizziness, these important tests will bring you one step closer to a diagnosis and a treatment plan. This will help you feel better as soon as possible.
Preparing for the audiologist:
- Ask about your medication. Find out from the facility where you are being tested if you should temporarily stop taking any medications before your appointment. Certain medications prescribed for your symptoms (as well as other unrelated ones) may interfere with the testing, and could cause you to need to repeat or reschedule some of the tests. You want to feel better as soon as possible, and accurate test results are an important first step! You will need to stop taking certain medications 24-72 hours before your vestibular system can be tested. If you have any concerns about temporarily stopping your medications, please discuss your concerns with your primary care provider.
Bring a list of any medications you take regularly- including vitamins and supplements- along with you to your appointment. It might be easiest to bring a list if you take several medications.
- Get a good night’s sleep. Some of the tests require concentration and attention, and you will do best if you get good rest the night before.
- Write down & gather details about your symptoms. Make a list of activities, positions or situations that make your symptoms worse (e.g. rolling out of bed, looking up, bending over or driving) and better (e.g. sitting still, resting or changing lighting). Also, make note of how long your symptoms last when they occur, and how often you have them. You may find it helpful to use a tracker or an app to track symptoms. This will assist you and your healthcare provider in figuring out if you have any specific triggers. VeDA has some tools you can use to track your symptoms ( Patient Logs). There are also free apps available for iPhone and Android like Migraine Buddy, DizzyQuest and Symple.
- Gather any other reports or test results related to your symptoms (e.g. if you went to the emergency room, bring a copy of the report). Even if these were already sent to the testing facility, it can be helpful to have them in hand for your provider.
- Find a loved one or friend to accompany you. Most patients feel fine after testing, but it is nice to know you can rely on someone to help you and drive you home from your appointment if you are experiencing symptoms or are tired from the testing.
On the day of your appointment:
- Wear comfortable clothes and shoes. Loose-fitting, comfortable clothes and athletic shoes (sneakers, tennis shoes) are best. You will be changing positions several times so it’s best to wear comfortable pants instead of slacks or dresses.
- Don’t wear makeup. Proper diagnosis of your condition relies on the measurement equipment’s ability to track your eye movements. Eye makeup in particular may interfere with the measurements, so do not wear any.
- Avoid eating a few hours before the test. It’s best to avoid eating for at least four hours prior to testing. Eat healthy, light meals the day of your appointment, and try to avoid heavy or particularly rich foods. Most patients feel fine during the testing, but some patients feel queasy if the tests provoke symptoms .
- Avoid caffeine and alcohol. It’s ok to have a cup of coffee if you usually drink coffee in the morning, but avoid high-caffeine beverages like energy drinks. Avoid all alcohol for 24 hours before the test as that may affect the test results.
- Try some stress reduction techniques if you are anxious. Square breathing (free tutorial), non-sleep deep relaxation ( free scientifically backed scripts), yoga nidra ( free script) or meditation may help you calm nerves you have before your appointment. Remember, this appointment is the next step to helping you feel better.
At your audiologist appointment:
Disscuss your symptoms and the testing done so far. Your audiologist will take a thorough case history and should ask several questions about how your dizziness feels and how it started. Be sure to share information about any “attacks” you have had (if any) and your list of activities that make your symptoms worse or better. If you kept a symptom diary as suggested above, please bring it with you to your appointment.
The test battery will depend on the facility as well as the symptoms you are experiencing. Keep in mind that not all dizziness centers do all the tests described below. Here are some of the common tests performed:
- A hearing test: you will sit comfortably and let your tester know when you hear soft beeps. Your hearing organ (cochlea) and vestibular organ are closely related and rely on the same nerve. Your hearing status may provide important information about how your vestibular organ is doing.
- Vision and visual testing: you will be asked to follow a light moving in different directions. Your eye movements will help your provider test and diagnose abnormalities in your vision and balance systems throughout the rest of the tests.
- Positional testing: you will be placed in different positions to see if they affect the movements of your eyes or how you feel. In many facilities, you will wear special goggles for this and several of the next tests. Your provider may also move your head in a few different ways to measure how your vestibular system responds.
- Calorics: warm and cool water or air will be gently placed in your ear canal while your provider measures movements of your eyes. The air or water stimulates the balance organ in each ear separately, which can be very important in determining how best to manage your symptoms. Many patients can sense that their balance system is being stimulated during this test and report feeling “swimmy” or “spinny.” However, most people tolerate this testing just fine. Be sure to let your provider know how you are feeling.
- Rotary chair: you will sit in a chair that moves in different directions to see how your eyes and balance system respond. The movements will be short and predictable, and typically will not provoke strong symptoms.
- Computerized dynamic posturography: you will stand on a platform, which will move to see how your balance system responds. Don’t worry, you will be secured, so you will not fall!
- Electrophysiological testing: small sensors (electrodes) will be placed on various spots on your head and neck, and measurements will be taken to see how your inner ear responds. These tests usually don’t require much work on your part. In some cases, you may be asked to lift your head up to tighten your neck muscles. Be sure to let your provider know if you have neck pain.
Some causes of dizziness, such as BPPV, may be able to be treated immediately at the time of your testing. Your provider will be able to tell you if you have signs of BPPV. Usually, your healthcare provider will not be able to give you all of your results on the day of the test. He or she will send a report to the provider who referred you for testing.
After your appointment:
Take a few deep breaths! You just took a big step in getting to the bottom of what has been causing your symptoms. Be sure to follow any after-appointment instructions provided by the audiologist or testing center. If you were treated for BPPV, typically you will not have any restrictions following treatment.
Follow up with the healthcare provider who referred you for testing to find out your next steps.
So what ARE the next steps?
What happens next depends on the testing that was performed and the results of your assessment.
If your results are normal, you may be scheduled for further vestibular testing with an audiologist, or you may be referred for consultation with experts in other specialties (e.g. neurology, cardiology).
Sometimes, just a few of the tests described above will be performed at your first appointment (e.g. hearing test, VNG, calorics). If the results of these tests are normal but your provider still suspects you have a vestibular disorder, specialized testing may be recommended to further investigate and test your vestibular system.
Alternatively, if your results indicate you do not have a vestibular disorder, you may be referred for testing with other specialties. A wide range of medical conditions can cause dizziness, and it is important to discover the cause of your symptoms to find treatment that will help you. The good news is that vestibular testing may help point you in the right direction, even if you don’t have a vestibular disorder. Certain patterns of results can help narrow down the possible cause of your dizziness and guide you to the appropriate specialist.
If your results suggest you have vestibular issues, further vestibular testing may also be recommended. This may occur in a testing center and include more of the tests described above, or it may occur with a vestibular therapist and focus on how your symptoms affect your daily life. More specific, targeted information on the source of your symptoms will empower you and your provider to create a treatment plan that will improve your quality of life.
Treatment options will depend on which disorder is affecting you. Treatment options may include physical therapy, lifestyle modifications, dietary changes and/or medical treatment. Surgery is rarely prescribed for vestibular disorders.
Author: Yonit Arthur, AuD, CFSC-2