Understanding an Inner Ear Test

If you’re reading this, you know firsthand the impact of inner ear problems. They can cause dizziness, nausea, hearing difficulties, and discomfort in various situations. Whether you’ve experienced a quick and straightforward inner ear test or a more complicated and challenging one, this article aims to provide a comprehensive overview of different inner ear tests, their purposes, and whether they may be necessary. This valuable information could help you save time and money and avoid extreme discomfort during specific testing procedures. Let’s get started.

Why an Inner Ear Test?

The tests for the inner ear are typically focused on the cochlea (hearing) and the vestibular system (balance). When these organs malfunction, various conditions can arise. Identifying the type of testing needed to find effective relief is important. Generally, there are three different types of tests for the inner ear:

1. Hearing: This test determines if the organ that sends hearing signals into the brain is sending signals correctly. For example, it is used to diagnose Meniere’s disease.

2. Peripheral Vestibular: This test assesses whether the peripheral vestibular organ sends information into the brain. For example, it is used to diagnose vestibular neuritis, superior canal dehiscence, and fistula.

3: Central Vestibular: Is the information from the vestibular system consistent with other sensory signals that help maintain your balance?
Examples: post-concussion syndrome, cervicogenic vertigo, visually induced vertigo.

Common Symptoms That Suggest the Need for an Inner Ear Test

Some common symptoms that may indicate a need for an inner ear evaluation include:
– Persistent dizziness or vertigo
– Hearing loss or impairment
– Tinnitus (ringing in the ears)
– Balance problems or unsteadiness
– Ear pain or pressure

Types of Inner Ear Tests

Seven commonly used inner ear tests are described below audiometry, VEMP testing, VNG, MRI, caloric testing, rotary chair testing, and ECoG testing. These tests are all common in a clinical setting.

1: Audiometry

This is a basic hearing test that helps quantify hearing loss. It helps determine the magnitude of the loss and the frequencies affected. You may have this test run if you complain of balance issues, as the hearing and balance information travel into the brain via the 8th cranial nerve.

2. Vestibular Evoked Myogenic Potentials (VEMP)

This test determines how well the vestibular organ sends signals to the neck musculature. The neck and inner ear work together in a regular vestibular system to ensure accurate head movements and reactions to external stimuli. This test can help determine the nerves’ integrity from the vestibular organ into the brain. This is done by measuring the time and speed of muscle contraction in neck muscles after hearing sounds. This test is helpful for the diagnosis of peripheral vestibular conditions like neuritis and Meniere’s disease.

3. Videonystagmography (VNG)

This test for vestibular function uses infrared cameras to record the eyes performing different movements. It can be used as a peripheral test to detect BPPV and a central test to analyze integration between sensory systems. This is a popular test in concussion clinics as it allows for accurate and objective measurement of vestibular symmetry and the accuracy of saccades, pursuits, and OPK function.

4. Magnetic Resonance Imaging (MRI)

This test helps rule out life-threatening pathology of the inner ear, such as tumors or strokes. It is generally used as a first-line option to ensure nothing needs imminent surgery. It will not show functional lesions or connectivity issues between organ systems.

5. Caloric Testing

This involves putting cold water into one ear and observing for something called nystagmus. Cold water affects the firing rate of the vestibular nerve, which causes an imbalance from side to side, creating nystagmus. This is a peripheral test to see if the nerve sends signals into the brain. Caution: this test will typically make you very dizzy.

6. Rotary Chair Testing

This test also tends to exacerbate dizziness. It involves sitting in a chair while it spins and measuring how well the eyes track the environment. The eyes should bounce from one thing to the next in response to the vestibular stimulation. When they don’t, you can make conclusions based on the extent and location of vestibular damage.

7. Electrocochleography (ECoG)

Auditory brainstem response (ABR) testing is a noninvasive diagnostic tool that measures the electrical potentials generated in the inner ear and auditory nerve in response to sound stimuli. This test is particularly useful for diagnosing conditions such as Ménière’s disease, as it can help evaluate the function of the auditory pathways and identify any abnormalities in these pathways.

Preparing for an Inner Ear Test

Preparation for an inner ear test depends on the specific type of test you’ll undergo. General preparation tips include:

– Consult Your Doctor: Follow any specific instructions your healthcare provider provides. Make sure to fill out any intake forms beforehand, as they help save time and get the doctor up to speed more quickly.

– Avoid Certain Medications: Discontinue medications that could affect test results, as advised by your doctor. Some medicines are vestibular suppressants, which hinder the ability to detect abnormalities during testing

No Alcohol or Caffeine: Do not consume alcohol or caffeine 24 hours before the test. They affect electrolyte balance and nerve conductivity, which may skew the results.

– Bring support: If you’re dizzy the day of testing and perform testing, which makes it worse, having a pre-arranged ride home may be helpful.

What is the Testing Like?

Audiometry

You’ll wear headphones and listen to sounds at various pitches and volumes, indicating when you hear each sound.
People will seek an audiometry exam if they’ve experienced a loud noise like a gunshot, have a virus that attaches itself to the inner ear (neuritis), or experience sudden hearing loss in the case of Meniere’s disease.

VEMP

We will place electrodes on your neck and around your eyes to measure muscle responses to sound stimuli. People with BPPV, neuritis, and superior canal dehiscence may seek out a VEMP test for confirmation.

ENG/VNG

Small sensors or a camera-equipped mask will track your eye movements while you undergo various visual and balance tests. This test is beneficial for post-concussion post-concussion syndrome because it allows you to see if it is strictly a vestibular issue or if it is a combination of factors leading to dizziness.

MRI

You’ll lie down inside an MRI machine, which will capture detailed images of your inner ear using magnetic fields. People who suspect trauma, cancer, or damage to the structures of the inner ear will seek out an MRI to ensure they don’t need surgery.

Caloric Testing

Warm or cold water or air will be introduced into your ear canal, and your eye movements will be observed. This test helps determine the function and connectivity of the vestibular nerve to the brain. This occurs in peripheral disorders like Menirere’s disease and neuritis.

Rotary Chair Testing

The technician will seat you in a chair that rotates at controlled speeds and will analyze your eye movements. This test can determine the source of damage and can serve as both a central and peripheral test.

ECoG

A clinician will place electrodes near your ear canal to record electrical responses to sound stimuli. This test helps determine the connectivity from the vestibular system to the neck, which is commonly disrupted in many conditions, such as Meniere’s disease.

Conclusion

Inner ear testing can be essential to the healing journey, mainly if performed at the right time. The biggest mistake we see is that people need to understand if they need a central or peripheral test to determine the source of their dizziness. This will often lead to misdiagnosis and chasing therapy programs that are ultimately ineffective.