Balance

Balance testing

During an assessment of your balance which lasts generally for 75 minutes we will start by asking you some questions about your balance problems. This will help us to decide which tests are necessary to assess your balance.

The tests that need to be performed will be discussed with you in more detail during the appointment. Some the test we use will be designed to cause you to become dizzy, this is deliberate to gain information we need to help you, you will be kept safe at all time during this.

Tests can include but are not limited to:

Hearing tests	A test of hearing ability. Some balance problems affect the hearing also.
Tympanometry	A test of the movement of the middle ear
Tests of standing balance	A test to see how the eyes, balance organs, muscles and joints are working together.
Dix-Hallpike manoeuvre	Involves moving of the head and whole body from sitting to lying down whilst the eye movements are observed
The roll test	Involves rapid head movement to the right and then to the left whilst the eye movements are observed.
Video Head Impulse test	A test to examine the reflex that exists between the eye and balance organ known as the vestibular ocular reflex.
Videonstagmography	Goggles with camera are worn so your eye movements can be observed in response to watching different targets.
Caloric tests	This test allows each balance organ to be tested separately and then compared. Goggles are worn so the movement of the eyes can be monitored. Air is gently blown into each ear to stimulate the balance organ, which may give a sensation of the room spinning for a short time. Warm and cool air can be used.
Vestibular evoked myogenic potentials (CVEMP and OVEMP)	Provides information about the saccule and utricle, two organs found in the balance organ.
Static positional tests	Your head and body are moved into different positions. These include lying flat, inclined, onto the right side and onto the left side. Goggles are worn that allow us to monitor the eye movements.

Balance rehabilitation

Balance rehabilitation or vestibular rehabilitation is designed to gradually promote central new nervous system compensation (via neuroplasticity) with a wide range of vestibular and balance issues.

Neuroplasticity is the nervous systems ability to adapt and change its structure based on different stimuli.

This can involve sets of exercises, education, breathing and relaxation exercises and counselling. These are tailored to you, your situation and your balance needs by your clinician. These exercises will be delivered holistically to target your specific needs with specific targets. The physical exercise may involve of series of head, eye and neck movements with the aim to re-education and retrain the balance system, (which consists of the eyes, ears and body) to deal with any issues that arise.

This does take time and initially it can irritate your balance system, but the exercises are developed over time to help the re-education.

The aim of vestibular rehabilitation is to help people who have vestibular and balance issues to become fully functional in every aspect of their day to day lives and manage their condition for as long as needed. This will be done with a variety of methods to help

reduce dizziness symptoms
support gaze stability
improve balance and gait
improve quality of life
build confidence and independence
reduce avoidance
reduce risk of falls
understanding triggers
pacing and factors in areas of your life that may affect your symptoms.

Useful websites

Contact us

audiology@uhb.nhs.uk
0121 371 7100
07939 988 871 (SMS text service)
The Queen Elizabeth Hospital Audiology Centre
Ground floor
Nuffield House
Mindelsohn Way
Edgbaston
Birmingham
B15 2TH

Last reviewed: 28 October 2026