What is a Videonystagmography (VNG) Test

A videonystagmography (VNG) test is a diagnostic procedure that assesses your inner ears and evaluates your eye movements. The goal is to determine if you have nystagmus, a vestibular disorder, or another condition affecting your balance and causing dizziness. In short, it aims to get to the root cause of your symptoms so you can get the appropriate treatment.

Woman with vertigo symptoms is on appointment of neurologist. Doctor making positional testing of patient with using VNG for determine type of dizziness and performing Epley maneuver

Frequent dizziness and vertigo can have a significant impact on your life. Feeling like the world is spinning around you or the ground is moving under your feet can make doing even the simplest tasks a challenge.

Does this sound familiar? With a VNG test, you may be able to discover the cause of your symptoms, which will allow you to get the treatment you need to ease them. Read on to find out if it’s right for you. 

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Overview

What Is Nystagmus?

Nystagmus, also called dancing eyes, is the involuntary movement of your eyes. They may move rapidly or slowly, up and down, side to side, or even around in a circular pattern. The condition can have many causes, such as:

  • Intoxication
  • Motion sickness
  • Genetics 
  • Head injuries
  • Multiple sclerosis
  • Stroke
  • Certain types of medications, such as those for seizures
  • Inner ear problems

Symptoms of Nystagmus

Treatment for nystagmus depends on the cause. Those born with it may benefit from glasses or contact lenses that provide clearer vision, which helps slow down eye movements. Those who developed the condition due to another issue may find nystagmus clears up once the underlying cause is treated.

What Is a Vestibular Disorder?

Your vestibular system, located in your inner ear, plays a critical role in your movement and balance. A vestibular disorder is any condition that affects proper inner ear function. Like nystagmus, vestibular disorders can have many causes. 

Poor circulation in the inner ear, infections, calcium deposits in your semicircular canals, and traumatic brain injuries can all affect the structures in the vestibular system. 

Symptoms of a vestibular disorder

  • Dizziness
  • Vertigo
  • Disorientation
  • Feeling off-balance
  • A lack of coordination
  • Blurry vision

Treatments for vestibular disorders depend on the root cause. They may include diet and lifestyle changes, medications, and a form of physical therapy called vestibular therapy.

Conditions Diagnosed

A VNG test can also be beneficial for diagnosing conditions such as:

Cybersickness

Cybersickness is similar to motion sickness, except you aren’t moving. Instead, the condition occurs when using electronic devices—your phone, your laptop, or multiple screens at once. It may also happen during a virtual meeting as someone else controls what’s happening on your computer screen. 

The primary cause of cybersickness is a continuously moving visual image. Symptoms include dizziness or balance problems, headaches, eye strain, and nausea.  Cybersickness treatment options include reducing screen time, taking frequent screen breaks, slowing how quickly you scroll, and microprism glasses. Medications that combat motion sickness may help if you can’t avoid situations that trigger the symptoms. 

Convergence Insufficiency

Your eyes are supposed to come together when looking at objects up close. Working as a team, they should make a series of adjustments to form a single image. Convergence insufficiency occurs when the two eyes have difficulty coming together (or converging) to look at nearby objects, resulting in blurred or double vision. Other symptoms include headaches, eye soreness, and difficulty concentrating. Treatments include vision therapy and microprism glasses. 

Meniere’s Disease

Meniere’s disease is an inner ear disorder that typically only affects one ear. It causes vertigo, tinnitus (ringing in your ear), and hearing loss. You may also feel as though your ear is clogged. There is no cure, but you can manage the symptoms with treatments such as motion sickness medications and reducing your sodium intake. In some cases, surgery can also help. 

Labyrinthitis 

Labyrinthitis develops as a result of an inner ear infection or swelling. When this happens, you may experience vertigo and balance issues. For some people, the condition may go away on its own. Those with an infection may need antibiotics. 

VNG Testing Details

You take a VNG test in a dark room while wearing special goggles. The goggles have a small camera that will record eye movements. The VNG test consists of three separate parts:

  1. Ocular testing. A technician assesses your ability to follow visual targets with your eyes.
  2. Positional testing. The technician moves your head and body into different positions to check for inappropriate eye movements which is a sign of nystagmus. 
  3. Caloric testing. The technician blows alternating warm and cool air—or water—into your ear. Again, this tests for nystagmus. It can also help determine if there’s damage to the nerves in one or both of your inner ears. 

Understanding Your Results

After completing the VNG test, a specialist will review the results to identify any abnormal eye movements or issues with your vestibular system. They will analyze each part of the test—ocular, positional, and caloric—to determine if there’s evidence of nystagmus, a vestibular disorder, or another underlying condition. The results will indicate if your symptoms are likely due to an inner ear disorder, a central nervous system issue, or another possible cause.

Next Steps and Follow-up

Once your results are available, your healthcare provider will discuss them with you in detail. If the VNG test shows signs of a vestibular disorder or another balance-related issue, your provider may recommend additional tests or referrals to specialists, such as an ENT (ear, nose, and throat) doctor or a neurologist. They may also suggest specific treatments, such as:

  • Vestibular Therapy: A form of physical therapy that focuses on improving balance and reducing dizziness.
  • Medication: Medications to manage symptoms like dizziness, vertigo, or nausea.
  • Lifestyle Changes: Dietary modifications, stress management, and other lifestyle adjustments that may reduce symptoms.

Your provider will work with you to develop a personalized plan that addresses your specific symptoms and improves your quality of life.

If the test does not reveal any abnormalities, further evaluations may still be recommended to rule out other potential causes such as Binocular Vision Dysfunction (BVD). 

Common Questions

1. What does a VNG test diagnose?

A VNG (videonystagmography) test diagnoses balance and inner ear disorders by assessing eye movements, specifically looking for nystagmus. It helps identify vestibular disorders, labyrinthitis, Meniere’s disease, and other conditions that affect balance and coordination. It can also assist in diagnosing conditions like cybersickness and convergence insufficiency.

2. Can a VNG test detect Meniere’s disease?

Yes, a VNG test can help detect Meniere’s disease. The test may show abnormal eye movements or other vestibular irregularities common in patients with Meniere’s disease. While VNG alone cannot confirm Meniere’s, it can provide essential clues that, along with other assessments, contribute to a diagnosis.

3. How do you prepare for a VNG test?

Preparation for a VNG test includes:

  • Avoiding Medications: Avoid taking certain medications (such as antihistamines, tranquilizers, or sleeping aids) at least 48 hours before the test, as they can affect results.
  • Limiting Caffeine and Alcohol: Refrain from consuming caffeine or alcohol for 24 hours before the test.
  • Fasting: Avoid eating or drinking anything for a few hours prior to the test.
  • Dressing Comfortably: Wear comfortable clothing, as the test involves head and body movement.

4. Can VNG detect MS?

While a VNG test cannot directly diagnose Multiple Sclerosis (MS), it can reveal signs of central nervous system dysfunction, which may prompt further neurological evaluation. Abnormal VNG results in conjunction with other symptoms could indicate a need for further tests, like MRI scans, which are more definitive for diagnosing MS.

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5. How long does a VNG test take?

A typical VNG test takes about 60 to 90 minutes to complete, depending on how many parts of the test are performed.

6. Is a VNG test painful?

In short, no, a VNG test isn’t painful though it can cause minor discomfort in some patients. The exam is relatively straightforward and usually takes about an hour to complete. You may need to make some preparations before the day of your test. 

For instance, you may need to stop taking certain medications or avoid alcohol and caffeine for at least 24 to 48 hours. If you typically wear contacts, you’ll want to wear your glasses to your appointment. You’ll receive more specific instructions when you schedule your VNG test. 

7. Are there any side effects after the test?

Most people feel fine after the test, though some may experience mild dizziness or nausea for a short time. These symptoms typically resolve within a few hours.

8. How accurate is the VNG test in diagnosing balance disorders?

The VNG test is highly effective in diagnosing vestibular disorders and nystagmus. However, if your symptoms are caused by other conditions, additional tests may be needed for an accurate diagnosis.

9. Can I drive after a VNG test?

It is recommended to bring someone with you to the test, as some patients may feel disoriented or dizzy afterward, making it unsafe to drive.

10. Will insurance cover my VNG test?

Most health insurance plans cover diagnostic tests like VNG, but it’s always a good idea to check with your provider to confirm coverage and any potential out-of-pocket costs.

11. When should you take a VNG test?

If you experience any of the symptoms discussed above—uncontrolled eye movements, dizziness, vertigo, difficulty focusing, poor balance—and they’re persistent, you might want to consider scheduling a VNG test.

12. What If a VNG test doesn’t help diagnose me?

While a VNG test can determine if you have nystagmus or a vestibular disorder, it may not always be able to pinpoint the exact issue. Another condition, such as binocular vision dysfunction (BVD), may be causing your symptoms. BVD is the inability of your eyes to work together to focus on a single object. 

As a result, your brain can’t merge what each eye sees into a single clear image.  If you aren’t able to get a diagnosis with a VNG test, you may require additional testing. The specialists at NeuroVisual Medicine can help. If you’re experiencing dizziness, vertigo, poor balance, and other disruptive or uncomfortable symptoms, we can help you get to the bottom of them and help you get the relief you need. 

For more information and to schedule your appointment, visit NeuroVisual Medicine today.

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