However, abnormal findings are common among elderly patients with or without dizziness, and abnormal results may or may not correspond to the complaint of dizziness in this age group. Cerebral CT or MRI should be performed only if the history and physical examination suggest a cerebral lesion. Vestibular testing, including caloric testing, electronystagmography, rotational testing, and computerized posturography, can be considered in patients with history or physical examination findings suggestive of vestibular disease. Caloric testing assesses the symmetry of vestibular function. The ear that shows a shorter duration or lower frequency of nystagmus is presumed to be the diseased ear.
Rotational testing uses a series of well-controlled rotational stimuli to provoke nystagmus.
Electronystagmography, in which eye movements are recorded on an ECG-like tracing from electrodes placed around the eyes, is used to observe vestibular nystagmus during provocative testing. In computerized posturography, the patient stands on a platform that is imbedded with four sensors to monitor sway. Testing with the eyes closed or with a moving screen while the platform is synchronized to patient movement eliminates visual and proprioceptive information. This approach examines balance that is principally dependent on vestibular input. Other testing combinations examine visual and proprioceptive inputs to balance.