The diagnosis of the dizzy patient should be guided by the presenting symptoms and office examination. Tests such as ABR (auditory brainstem response), ECOG (electrocochleography), ENG/VNG (electronystagmography/ videonystagmography), VEMP (vestibular evoked myogenic potential), vHIT (video head impulse test), CDP (computerized dynamic posturography) and RCT (rotational chair testing) should only be ordered if clinically indicated. In general, advanced balance tests should be ordered and interpreted by otolaryngologists with specialized training in the diagnosis and treatment of vestibular disorders (otologists/neurotologists). Clinical indications for testing can include: side localization and stage of progression for Meniere’s disease, assessment of central compensation for acute vestibular loss and confirmation of superior semicircular canal dehiscence syndrome. Specialized tests are rarely indicated in the management of benign paroxysmal positional vertigo.
Sources:
Furman JM, et al. Vestibular disorders. 3rd ed. New York: Oxford University Press; 2010. Chapter 4, Vestibular laboratory testing; p. 30-40.
Johnson JT, et al. Bailey’s head and neck surgery: otolaryngology. 5th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2013. Chapter 165, Clinical evaluation of the patient with vertigo; p. 2673-700.