Balance Comprehensive Assessment

Quick, targeted checks of your balance system to identify problems and recommend next steps.

What is a comprehensive balance assessment for?

A balance screening is a straightforward first step for anyone experiencing dizziness or unsteadiness. It provides an overview of how the balance system is working and highlights whether more detailed testing may be helpful.

Symptoms checked:

Common triggers such as dizziness, unsteadiness, or vertigo in everyday situations, helping to identify whether further testing is needed.

Why it matters:

Even mild balance problems can affect safety, independence, and quality of life. Early screening gives clarity and peace of mind.

How it’s assessed:

A series of short, non-invasive checks of ear health, eye movements, and coordination provide a clear overview of balance function.

Next steps:

Results are explained clearly, with tailored recommendations. If further investigation is needed, options for more detailed assessments are discussed.

What is included in a comprehensive Balance assessment?

Medical History
Video Otoscopy
3D Tympanometry

A more advanced check of middle ear function using gentle changes in air pressure. This helps identify problems such as fluid, stiffness, or blockages that could affect hearing and balance. The addition of testing the response of these responses at multiple frequencies allows for a more detailed assessment for subtle differences in function.
Pure Tone Audiometry (Hearing Test)

This is the standard hearing test used to measure how well different tones can be heard at various volumes. You listen to a series of beeps through headphones and press a button whenever you hear a sound. The results show whether your hearing is within the expected range or if there are any areas of hearing loss.

Hearing and vestibular function both originate from the same organ in the ear, so changes in your hearing can be very useful in formulating an accurate diagnosis.
Vestibular Evoked Myogenic Potentials (VEMP)

cVEMPs (Cervical Vestibular Evoked Myogenic Potentials)
This test measures the response of a neck muscle to sound, helping assess part of the balance system known as the saccule and the nerve pathways that connect it to the brain. Stick-on sensors are placed on the skin, and you’ll be asked to gently turn or lift your head while listening to short sounds through earphones.

oVEMPs (Ocular Vestibular Evoked Myogenic Potentials)
This test records tiny responses from the eye muscles to sound or vibration, giving information about another part of the balance system called the utricle. Sensors are placed just below the eyes, and you may be asked to look upwards while the responses are measured.

Threshold and Multi-frequency VEMPs
In more detailed testing, VEMPs can be measured at different sound levels and frequencies. This provides a clearer picture of balance organ function and can help identify specific patterns linked to different conditions.
Six Canal Video Head Impulse Test (vHIT)

Small, quick head movements are used while tracking the eyes with special goggles. This measures how well the balance organs in each ear are working.

During the test you will be required to relax your neck and let the clinician move your head for you, whilst you remain looking at a visual target in front of you. The goggles can be quite tight, but only need to be worn for approximately 5 minutes.

All six semi-circular canals are assessed, allowed for a detailed look at the function of the inner ear balance organs and nerve pathways.
Diagnostic Videonystagmography (VNG)

Eye movements are recorded using goggle-mounted cameras while they following simple visual targets. This provides information on how the brain, eyes and inner ears are working together to maintain balance.

A diagnostic VNG assessment includes advanced testing methods to provide a deep-dive into the complex systems involved in maintaining balance including:
-Gaze testing
-Smooth pursuit
-Random saccade testing
-Headshake nystagmus test
-Saccadometry
-Ocular Counter Roll
-Optokinetic Test
Positioning Assessments

Specific head and body positions are used during the assessment, with eye movements carefully observed during and after each position. Special goggles are worn to record eye movements accurately, as this provides vital information for diagnosis. Different manoeuvres may be performed depending on the type of BPPV suspected. The tests are safe but do require a reasonable level of mobility, such as being able to move quickly from sitting to lying back.
Canalith Repositioning Maneuvers

If BPPV is identified, treatment can often be provided straight away. Specific maneuvers are chosen depending on which balance canal is affected. As with the positioning assessments, the maneuvers require a reasonable level of mobility, such rolling over and sitting up from a reclined position. The repositioning maneuvers are highly effective, and many patients experience relief after just one session.
Bithermal Caloric Irrigation

This test helps us understand how well each inner ear is working. During the test, we gently warm and cool the ear canals using either air or water while you wear special goggles to record your eye movements.

The change in temperature makes the fluid inside the balance part of the ear move, which briefly causes dizziness. This is a normal and expected part of the test, and your clinician will explain everything beforehand so you know exactly what to expect.

By comparing the responses from each ear, we can see if one side is weaker than the other. This provides valuable information about how your balance system is functioning and whether one ear may be contributing to your symptoms.
Functional Balance Assessment

While many balance tests look at how your inner ear responds in a clinic setting, functional assessments help us understand how this translates into everyday activities.

The Gaze Stability Test (GST) and Dynamic Visual Acuity (DVA) measure how well your eyes and balance system work together when your head is moving. For example, you may be asked to read letters on a screen while turning your head side to side.

These tests are helpful because they show how your balance system performs in more “real-world” situations—like walking, turning your head, or crossing a busy street—allowing us to tailor treatment and rehabilitation more effectively to your daily life.
Debrief of Findings

At the end of the assessment, the clinician explains the results and what they mean for your symptoms. If treatment has been carried out, the response is reviewed and further steps are discussed. Clear written information is provided for your records, and with your consent a copy can be sent securely to your GP or specialist. Advice is also given on what to expect over the following days, and whether any follow-up appointments may be helpful.

Comprehensive

Clear answers and reassurance for unexplained dizziness or unsteadiness.

If you have been experiencing ongoing balance problems, recurring dizziness, or more complex symptoms, our Comprehensive Balance Assessment offers the most detailed investigation available. This assessment explores the full function of your balance system, helping to identify or rule out specific causes and providing clear recommendations for treatment or onward referral.

Book Comprehensive

Comprehensive Balance

£630

Our most in-depth assessment for persistent or unexplained dizziness or imbalance. It combines advanced diagnostic tests to evaluate your ear and balance function in detail.

This thorough approach provides clear answers and practical next steps—whether tailored rehabilitation, medical referral, or simple reassurance.

Flexible Assessment Options

We will only ever recommend or perform tests which are in your best interests. If further investigation is recommended, your screening can be upgraded to a Diagnostic or Comprehensive assessment at a later date. You’ll only pay the difference in cost, making it easy to take the next step without repeating tests unnecessarily.

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