The history
Most of the diagnosis comes from the conversation. You will be asked what the dizziness feels like (spinning, rocking, light-headedness or unsteadiness), how long episodes last, what sets them off, whether hearing or vision is affected, and what else was happening when it started. Medication, migraine history, head injury, falls and how the symptoms affect daily life are all covered. Bringing a note of when episodes happen and what triggers them makes this part faster.
Screening for red flags
Before any physical testing, the clinician checks for signs that need medical assessment rather than rehabilitation: sudden severe headache, new hearing loss, double vision, speech or swallowing difficulty, limb weakness or numbness. If any are present you are referred on rather than treated.
Eye movement tests
The eyes are closely linked to the balance system. You will be asked to follow a target, to look quickly between two points, and to keep your eyes on a target while your head is moved. Involuntary eye flicking, called nystagmus, and the way the eyes cope with head movement tell the clinician a great deal about which side and which part of the system is involved.
Positional tests
The Dix-Hallpike and related tests move your head into positions that provoke BPPV if it is present, while the examiner watches your eyes. This may briefly bring on your vertigo, which is expected and passes within a minute. It identifies the affected ear and canal, and if BPPV is confirmed the repositioning manoeuvre follows immediately.
Balance and walking
Standing with feet together and eyes closed, standing on a soft surface, walking while turning the head, and turning quickly all show how well the balance system compensates and how much the visual and body-sense inputs are being relied on. Neck movement and muscle tension are checked because the neck contributes to the sense of head position.
What you get at the end
An explanation of what the assessment found, treatment on the day if BPPV is present, and otherwise a rehabilitation plan with home exercises and a review schedule. If the findings point to a condition needing medical management, such as Meniere's disease or vestibular migraine, you are told clearly and given a report for your GP.
At Omnia
Vestibular First at our Chiswick clinic, near Turnham Green station, follows this format. Wear comfortable clothing, bring a list of medication, and arrange for someone to travel with you if your dizziness is severe, since positional testing can leave you briefly unsteady.