The Adult Diagnostics Audiology Department at the Royal National ENT and Eastman Dental Hospitals provides a comprehensive range of vestibular (balance) assessments to help find the cause of your dizziness.
This page is designed for patients scheduled to attend our department. It outlines the various tests that may be conducted during your appointment.
Before you attend for your balance assessment
Before your appointment, please ensure your ears have been recently checked by your GP to confirm they are clear and healthy. This is important because the presence of earwax can affect test results, potentially preventing the assessment from proceeding. If your ears have not been examined recently, we kindly ask you to visit your GP to confirm they are free of wax.
If you are currently taking medication for dizziness, please refrain from taking it for 48 hours before the test. Additionally, avoid consuming alcohol during this period, as both can influence the accuracy of the results. Please do not wear eye make-up on the day of your appointment, as it may interfere with certain tests.
If you wear hearing aids, please bring them and any glasses you require. We also encourage you to bring a family member, friend, or carer for support during your visit.
If you require an interpreter, including for British Sign Language (BSL), we are happy to arrange this in advance.
During the appointment
Please be aware that we are a teaching department, and we would appreciate the co-operation of patients in supporting our students in their training. Please let the audiologist know if you are uncomfortable with a student being present and we will try to accommodate accordingly.
Each assessment will be fully explained to you by the audiologist to ensure you understand, and to give you an opportunity to ask questions.
The audiologist will begin by talking to you about your balance problems, you may be asked to complete a questionnaire about your symptoms.
The full range of balance assessments
Please note it may not be necessary to conduct every listed assessment. The audiologist will determine which tests are most appropriate for you during your appointment.
Balance tests are designed to help identify the cause of your dizziness and imbalance. When your inners are stimulated you will make involuntary eye movement; these involuntary eye movements are called nystagmus. During most balance assessments we are observing, measuring, and recording these eye movements either by provoking them with movement or recording them naturally.
Duration: 20 minutes
Purpose:
The test assesses the vestibulo-ocular reflex (VOR), this reflex stabilises your gaze when you move your head.
Process:
You will be asked to sit in a chair and wear video goggles. The audiologist will place their hands on your head, and move your head in short, small movements in various directions. During the test you will be asked to keep your eyes on a fixed point on the wall. The camera in the goggles will record very small eye movements, which would otherwise not be visible.
Figure 1. A patient having a Video Head Impulse assessment
Duration: 30-40 minutes
Purpose:
These are a series of tests that measure your eye movements. The tests provide information about the function of your balance system, including the balance organ (inner ears) and nerve pathways to your brain.
Process:
You will wear video goggles while sitting in the dark on a rotational chair. For the first part of the test, you will be asked to follow a series of visual targets. During the second part of the test, the motorised chair you are sitting in will slowly rotate side-to-side and round in a circle for around 5 minutes.
Figure 2. A patient having Videonystagmography assessment
Duration: 1 hour
Purpose:
The aim of caloric testing is to check the function of your vestibular system. Warm and cool water is used to stimulate the inner ear, which induces involuntary eye movements (nystagmus). We can use the speed and direction of these eye movements to assess the function of the inner ear.
Process:
You will be asked to wear a pair of goggles and lie down on a couch with your head slightly tilted. An irrigator will deliver a stream of warm water (44°C) or cool water (30°C) into your ear canal for 30 seconds. This may make you feel a little dizzy, but the audiologist will be with you throughout, and the sensation usually passes after 2-3 minutes.
Duration: 30 minutes
Purpose:
VEMP testing assesses how certain muscles respond when sounds stimulate a specific part of your balance system.
Process:
While you sit in a chair, the audiologist will clean your skin with a wipe and scrub and four small sensors will be attached on your forehead and either around your eyes or around your neck. Headphones will then be placed over your ears, and you will hear loud clicking sounds for approximately 20 seconds per measurement. You do not need to respond to these sounds; you will be asked to remain still and relax, either looking upwards with your eyes or with your head turned to one side, The computer automatically records your responses.
Duration: 20 minutes
Purpose:
This test uses a computerised platform to measure your overall balance and posture.
Process:
You will be asked to wear a safety harness, take off your shoes and stand on a platform with a visual surround screen. At times, the platform may tilt, or the screen may move; you will be asked to close your eyes for some parts of the test. Your stability will be measured by the computer.
Duration: 30 minutes
Purpose:
This test is used to diagnose a specific condition called Benign Paroxysmal Positional (BPPV). BPPV is a common cause of dizziness and is caused by calcium crystals in the inner becoming dislodged and floating freely in the inner ear.
Process:
You will be asked to sit on a couch. The audiologist will position your head to one side and then while holding you, quickly lie you backwards. The audiologist will look at your eyes for specific eye movements and ask you if you are experiencing any dizziness/vertigo.
- British Academy of Audiology
- Tinnitus UK (formerly the British Tinnitus Association)
- Hearing Link
- The Hyperacusis Network
- Royal National Institute for Deaf People (RNID)
- UCL Ear Institute
- NHS
- University College London Hospitals
- Address: 235 Euston Road, London NW11 2BU
- Telephone: 020 3456 7890
UCLH cannot accept responsibility for information provided by other organisations.
We would be happy to answer any questions you have.
Telephone: 020 3456 5164
Switchboard: 020 3456 7890
Email: uclh.
Website: www.
Patient Advise and Liaison Service (PALS)
PALS is a patient-centred accessible service designed to provide a dedicated point of contact for patients, their families, and carers. If you are facing a concern or issue that you have been unable to resolve, PALS is here to offer support and assistance in finding a solution.
The PALS office is located in the main atrium of University College Hospitals
235 Euston Road
PALS are open:
Monday to Friday: 10:00 am – 16:00 pm
Telephone: 020 3447 3042
Email: uclh.
Royal National ENT & Eastman Dental Hospital
47-49 Huntley Street, London WC1E 6DG
Huntley Street is close to Euston, Warren Street and Goodge Street underground stations and there are bus stops nearby.
Services
Page last updated: 06 February 2025
Review due: 01 February 2027