Scheduling Letter for Vestibular Evaluation -part 2

This is the back page of a letter we send out to all patients scheduled for vestibular evaluation. We are aware that most of our patients have never even heard of much of the testing we do. We do get some amusing responses when we walk into the rotary chair room. I can’t tell you how many times I’ve heard, “Is this the chair that flips you upside down and shakes the rocks out of your head?”


Electrophysiologic Tests

A comprehensive battery of tests will be performed during your two-hour appointment. Prior to each test an explanation will be given so that you have a better understanding of what is being tested and why. Your evaluation will be conducted by a team of physicians, audiologists, and technicians. These tests are designed to help us locate the source of your balance disorder. In each of these tests, we stimulate the balance centers of the inner ear or nerve tract connecting the inner ear to the brain. We then record the response to the stimulus. These tests are safe and comfortable, no needles are used, but stimulation of the inner ear may make you temporarily dizzy.



A basic hearing evaluation gives us important information about the health of the ears, and helps rule out common problems (such as ear infections and earwax as a possible cause for your symptoms) before more sophisticated tests are performed.

ENG/VNG (Electronysragmography/Videonystagmography)

Many inner ear disorders cause an involuntary movement of the eyes called nystagmus. This nystagmus can be recorded and analyzed through ENG/VNG testing. Stimulation of the inner ear for this test includes rapid position changes of the head and body, and caloric (temperature) stimulation of the inner ear through irrigating the ear canal with different temperatures of air or water. The goal is to determine if both inner ears are functioning and responding equally to the stimulation. Additionally, test of voluntary eye movement serves as a screening for possible neurologic disorders.

Rotational Chair

Rotational chair testing allows us to stimulate the inner ear and avoid stimulating any other part of the balance system. It is a very sensitive test of inner ear abnormality. The patient is placed in a motorized chair and eye movements are recorded and analyzed. The rotational chair is in our Bluefield office only, so patients undergoing screening exams in Princeton may be referred to the Bluefield office for the second appointment.

 ABR (Auditory Brainstem Response)

Balance problems can come from the inner ear or the nerve pathway between the inner ear and the brain. This test involves recording the transmission of sound traveling up the auditory nerve. Hearing and balance information travel the same nerve pathway. Results of this test can help us rule out the possibility of nerve degeneration or small auditory nerve tumors that may be affecting balance and/or hearing.

CDP – Computerized Dynamic Posturography (Sensory Organization Test)

Good balance depends on the efficient use of all balance information available. This test allows us to evaluate one’s reaction to a variety of difficult balance situations. This is done by having the patient stand on a platform that measures center of gravity, and any sway from the center, while at the same time provoking them with conflicting balance information. By doing this, we can determine what type of situation is most likely to result in a fall. This information helps us design a customized therapy plan to enhance balance and minimize the risk of falling.

We want your visit with us to be as helpful and comfortable as possible, so please don’t hesitate to ask any questions.




About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.