My So Called Dizzy Life

My Chronicles of Vertigo, Nystagmus, Imbalance & Dizziness

My VNG, VEMP, & ECochG Testing

on July 9, 2012

Testing began at 7am on 6/28 and was performed by the same wonderful audiologist who had performed my hearing tests.  I was told it would take about 4 1/2 hours, but I must have been so good at the tests that they only took 3 1/2 hours.  I was told ahead of time that in the 2 days prior to my testing, I could not take any of the drugs prescribed to me for my condition (no Meclizine, no Clonazepam, no Gabapentin) because they could affect the outcome of the tests.  Yay.  Before I get into the nitty-gritty, please remember that parts of these tests were not 100% (or even 1%) pleasant, so I’m probably leaving out lots of details and I may have mixed some stuff up.  But you’ll get the gist.

I began with the VNG testing.  VNG stands for Videonystagmography, which is a series of tests that evaluate how your vestibular (balance) system is functioning.  For the entire test I was on an exam table, either sitting or laying down, and I was wearing these (kinda cool, circumstances aside) goggles that had infrared cameras that tracked my eye movements. It started off easy; I had to follow with my eyes moving red dots on this bar on the wall.  It was pretty ok and only gave me trouble when there were a whole bunch of dots moving really quickly.

There may have been some other stuff but what I remember most was the calorics portion of the testing.  In this part, I was laying back on the exam table, still wearing the infrared goggles but they were dark so I couldn’t see the room.  Even though I couldn’t see anything, I had to keep my eyes open throughout the test so that the audiologist could monitor the movements of my eyes.  The audiologist would put warm air into one of my inner ears (& and mean she pumped it in for what felt like minutes, but was probably less time).  I did not find this to be too pleasant.  After she shot the air in, she would ask me to count up by 2’s (all the way up to 100 and back down again), or count up by 3’s or 5’s.  I didn’t know there was going to be a math test!  She would ask me questions about how I was feeling, give me time to recover if I felt dizzy, and then she would move on to the next ear and repeat the same test.  After she completed the warm air test, she did the same thing with cool air.  Finally she quit with the math, and started asking me to name boys or girls names from A-Z.  Or states or cities from A-Z.   I have no idea if the math and word “games” were to distract me or assess my cognitive function during the testing.  I should have asked, but I was a bit preoccupied.

The audiologist seemed very intrigued by what was going on in my tests.  She said that I had a very strong left-beating nystagmus.  When she would test my right ear, she would ask me if I felt dizzy.  And I didn’t really; not any more dizzy than before the testing.  When she tested the left ear, I felt the dizziness.  I think it was with the cool air that I really felt it.  It brought on Vertigo, everything was spinning, and I felt like I was going to fall off of the exam table.  I didn’t read up on the testing ahead of time, so I really didn’t know what my test responses meant at the time.  But based on comments the audiologist made (including one where I believe she said she hadn’t seen anything like this in her 20 years at Kaiser), I had a feeling that it was possible that I was just a tad broken.  One of the nicest things she said was something like that the symptoms I was experiencing definitely weren’t in my head and there was something not working right.  Ha!  Take that ex-Evil Doctor who tried to tell me this was depression!

The next test was the ECochG test.  ECochG stands for Electrocochleography, which is a test that measures the electrical activity in the inner ear.  People who have symptoms such as hearing loss, tinnitus, dizziness, or pressure in their ears might be given this test to see if those symptoms are caused by abnormalities in the fluid levels of the cochlea.

First, I was seated in a comfortable reclining chair.  Not bad yet.  Then two small electrodes were placed on my forehead, which I believe were attached to a computer to measure my responses.  OK, still not too bad. Then a small electrode was inserted into one of my ear canals and placed against my eardrum, followed by a soft foam earplug placed at the entrance of my ear canal.  Kinda a weird feeling that makes your ear feel very full; an odd kind of pressure.  Not totally terrible, but not how I typically like to spend my mornings.  I was told to stay as relaxed as I could and try not to move.  I was even told that some people fall asleep during this test!  I didn’t fall asleep, but I did close my eyes and go to my internal zen garden.  Once the testing began there was this loud clicking sound in my ear.   This test was performed on one ear at a time (a Kaiser cost saving measure; they use the same $25 electrode in each ear).  I was told that typically this testing takes about 1 1/2 hours, but I really couldn’t say how long it took; I was in zen mode.

The last test was the VEMP, which stands for Vestibular Evoked Myogenic Potential, which tests the saccule (a part of the inner ear responsible for sensing up & down movement) and also checks the nerve to see if they are working correctly.

The audiologist placed three electrodes on my neck and chest (& first she “cleaned” the area with something that felt like sandpaper); the electrodes were attached to a computer to measure my responses to the test.  I was lying on the exam table for this test. I would have to raise my neck off of the table (like a neck sit-up) for at least 30 seconds.  I had to hold it in this awkward position that really tenses up your neck, while my head was turned to the side (I would alternate sides to test different ears.  And all the while there was this loud clicking sound in my ear (I think the audiologist inserted some sort of headphone like-thing in my ear).  They described it as sounding like a woodpecker, but I just remember that it was loud and my neck hurt.  I would be given breaks in between each ear to recover from my neck fatigue.  This test was pretty short, as I only had to test each ear a few times.

So, just when I thought I was done, I had one other test to go.  Back to the VNG   (Videonystagmography) testing.  The audiologist had called the doctor to confirm that this next test should be done, as she had rarely has had to perform it.  It only had to be performed on my right ear because I guess that was the “special” one.  Like before when warm and cool air was put into my ear canals, this time the audiologist was going to put ice water into my right ear.  This is called an ice water caloric.  And I mean ICE water (she actually had to go hunt down ice cubes for this test).  Again, I wore the infrared goggles so that she could monitor my eye movements during the test.  Based on the earlier tests, I figured that this would be uncomfortable, but bearable.  Nope.  This test is something that I believe that they use to torture people in Guantanamo.  You know that “brain freeze” feeling you get when you drink something that is too cold?  Yeah, well imagine that but 1000 times worse and being pumped inside your head, inside your ear canal.  The audiologist probably didn’t pump the ice water in for more than a minute but it felt like hours.  My teeth were chattering from the cold, I was yelling and crying, “Why does this hurt so much?”  The response was because it was ice water.  I kept having to be reminded to keep my eyes open, which is hard to do when it feels like ice-cold swords are stabbing you in the ear.  Finally the test came to an end, and she had me turn my head to drain the water out into a towel.   I know my reaction was pretty intense and that she felt bad about it; she told me it was hard to watch and she wished she didn’t have to put me through that.

So, all that pain must have meant something, right?  The audiologist and I talked after that test.  She explained that my right vestibular system wasn’t functioning.  She must have known early on in my testing that things didn’t look right.  She made many phone calls for me and managed to get my Vestibular Physical Therapy appointment pushed up to that very same day, so that I could start retraining my brain to compensate without its right vestibular system.

Since having the torturous ice-water test, I’ve tried to read up on it.  It appears that they only use ice-cold water if there has been no response in the other caloric tests.  They use this test to confirm complete vestibular loss.  I had asked the audiologist for a copy of my results.  I was given 16 pages of graphs and test results that must mean something to a trained professional, but that look like gibberish to me.  There was one page with a summary of the results.  The audiologist summarized my calorics tests, “Response obtained from left ear with no response from the right ear, resulting in a 100% right unilateral weakness.”  Her final impression on the report was “These responses indicate a non-functioning right vestibular system.”

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2 responses to “My VNG, VEMP, & ECochG Testing

  1. Jaime Hoban says:

    I just had most of these tests done too (except the ice-cold Water of Death, thank God!), and they didn’t really give me my results yet, so I am super nervous. The warm/cold air in my left ear did not make me dizzy, so I guess I have a problem :( I’m sorry you had to go through all of it, I can understand… does the physical therapy help at all for you?

    • Emily says:

      Hi Jaime,
      Thanks for stopping by my blog. I hope you find out your results soon…waiting is always so torturous. And I really hope that the results point you in the direction of a treatment/therapy that will help.
      I definitely believe that physical therapy helps! It’s hard to notice your daily progress (or even your weekly progress) but looking back, I could see that months later I had improved. Looking back a year later, I can see that I’ve improved. Progress can be FRUSTRATINGLY slow. Sometimes you’re not making progress (one step forward, two steps back). But with persistence and determination there IS progress.
      Stay in touch. If you need to talk after getting your results, shoot me an email (MySoCalledDizzyLife@gmail.com).
      Best,
      Emily

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