What Happens During a Vestibular Assessment?

If you've been dealing with dizziness, vertigo or unsteadiness, booking an appointment can feel daunting, especially if you're worried the tests will make you feel worse. Knowing what to expect can make the first visit easier.

Physiotherapist examining a patient's neck and upper shoulders

This article explains what a vestibular physiotherapy assessment usually involves, why each part matters, and how to prepare. Every clinician's approach differs slightly, so treat this as a general guide.

What is a vestibular assessment?

A vestibular assessment is a physiotherapy examination of how your inner ear balance system, eyes, neck and body are working together. It has three main goals:

  1. to identify whether your symptoms are likely to come from the vestibular system
  2. to narrow down the likely cause, for example BPPV or reduced inner-ear function
  3. to recognise signs that need a medical opinion instead, and refer you appropriately

A physiotherapy assessment doesn't replace medical investigations such as hearing tests, scans or blood tests. Where these are needed, your physiotherapist can communicate with your GP.

Do I need a referral?

In Australia, you don't need a doctor's referral to see a physiotherapist privately. Some people have a GP referral under a GP chronic condition management plan, which may let Medicare cover part of the cost of a limited number of sessions, or a referral through an insurance or compensation claim. If your dizziness started recently and hasn't been checked by a doctor, it is worth seeing your GP as well. When should dizziness be checked by a doctor?

Before your appointment

It helps to:

  • note your symptoms: when they started, what triggers them, how long episodes last, and what makes them better or worse
  • bring a list of your medications, plus any relevant test results or specialist letters
  • wear comfortable clothing that lets you lie down and move easily
  • consider arranging a lift if your symptoms make driving unsafe, or if you're unsure how you'll feel after testing

What happens during the assessment

1. Talking through your symptoms

Your history is often the most informative part of the assessment. Your physiotherapist will ask about:

  • what the dizziness feels like (spinning, light-headed, unsteady, foggy)
  • how long episodes last: seconds, minutes, hours or constant
  • triggers such as rolling in bed, looking up, busy environments or screens
  • associated symptoms: hearing changes, ringing, headaches, neck pain, nausea
  • your general health, medications and any previous episodes
  • how symptoms affect work, driving, exercise and daily life

They will also screen for red-flag symptoms that need urgent medical assessment.

2. Eye-movement tests

Because the inner ear and eyes are closely linked, the way your eyes move tells a clinician a lot about your vestibular system. Tests may include:

  • watching for involuntary eye movements (nystagmus)
  • following a target with your eyes, and quickly shifting gaze between targets
  • a head impulse test, where the clinician makes small, quick head turns while you keep your eyes on a target, to check the reflex between the inner ear and the eyes

3. Positional tests

If your symptoms are triggered by head position, your physiotherapist may perform positional tests such as the Dix-Hallpike or supine roll test to check for BPPV. These can briefly bring on vertigo, which is expected and gives useful information.

4. Balance and walking

You may be asked to stand with your feet together or in different positions, with eyes open and closed, on firm and soft surfaces, and to walk while turning your head. This shows how well your body is compensating and where your balance is limited.

5. Neck screening

Your neck contributes to your sense of position and, in some people, may be linked to dizziness or headaches. A screen of neck movement also confirms that positional tests are safe for you.

What happens after the assessment?

Your physiotherapist should explain:

  • what they think is going on, in plain language
  • whether vestibular physiotherapy is likely to help, or whether you should see your GP or a specialist first
  • a plan, which may include a repositioning manoeuvre for BPPV, a tailored vestibular rehabilitation exercise program, advice on activity, and a review schedule

Some tests can leave you feeling briefly dizzy or tired. That usually settles, and your physiotherapist will check you are okay before you leave.

How long is the first appointment?

At Physio Focus Cronulla, initial vestibular appointments run for [XX] minutes.

Key points

  • A vestibular assessment checks how your inner ear, eyes, neck and balance work together.
  • It includes a detailed history, eye-movement tests, positional tests where relevant, and balance testing.
  • You don't need a referral to see a physiotherapist privately in Australia.
  • Some tests may briefly bring on symptoms, which is normal and informative.
  • If anything suggests a non-vestibular or serious cause, you should be referred for medical assessment.

This article is general information only and is not a substitute for individual medical advice.

References

  • healthdirect.gov.au/vertigo
  • healthdirect.gov.au (physiotherapy: no referral needed)
  • Services Australia (Medicare chronic condition management, allied health)
  • Tasmanian Health primary care dizziness guidelines (2024)
Harry - Gymea Physio