Patient guide · Neuro-otology · 6 min read
Electronystagmography / videonystagmography, the objective vestibular battery for chronic vertigo and unexplained dizziness.
ENG (electrodes) and VNG (infrared goggles) record eye movements to objectively test the vestibular system. Includes caloric testing, positional testing, saccades, smooth pursuit and optokinetic responses. The gold-standard workup for chronic vertigo.
Key facts
- 01
Definition
An objective vestibular test battery using electro-oculography (ENG) or infrared video goggles (VNG) to record eye movements.
- 02
Includes caloric, positional, saccade, pursuit, OKN
A structured sequence of sub-tests that interrogate the peripheral and central vestibular pathways.
- 03
Reports vestibular hypofunction, direction preponderance
Quantifies asymmetry between the ears and any preponderant nystagmus direction.
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45–60 minute test
Longer than most audiology tests — plan the afternoon around it, not around it.
- 05
Complements Dix-Hallpike, vHIT and audiology
Sits within a wider vestibular work-up — it does not replace bedside or high-frequency tests.
- 06
Reported by audiologist / neuro-otologist
A specialist report — clinical context sharpens what the traces mean.
How it’s done
From preparation to report — what happens, in order.
A structured 45–60 minute battery, with a written report and plan from the audiologist or neuro-otologist.
- 01
Before
ENT / vertigo consultation
A clinical assessment first — history and bedside examination decide whether ENG/VNG is the right test.
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Before
No alcohol / sedatives 48 h
Alcohol and sedative medication suppress the vestibular response — avoid for 48 hours before.
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Before
No caffeine 4 h
Skip coffee, tea and energy drinks for 4 hours before the test.
- 04
On the day
Goggles or electrodes applied
Either infrared VNG goggles or small ENG electrodes around the eyes to record eye movements.
- 05
On the day
Bithermal caloric irrigation
Warm and cool water or air in each ear canal to stimulate the horizontal semicircular canal.
- 06
On the day
Positional and gaze tests
Head and body positions, saccades, smooth pursuit and optokinetic tracking recorded in sequence.
- 07
After
Written report with plan
A structured report from the audiologist or neuro-otologist with an interpretation and next-step plan.
Total time in the clinic: 45–60 minutes for the full vestibular battery.
What it shows
The patterns the vestibular battery reveals.
Read in context with the clinical history and audiogram, ENG/VNG maps the peripheral and central vestibular pathways and points to the site of the lesion.
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Unilateral vestibular hypofunction
A quantified caloric weakness on one side — the classic pattern of peripheral vestibulopathy.
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Bilateral vestibulopathy
Reduced or absent responses in both ears — often ototoxic, autoimmune or age-related.
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Central-vs-peripheral pattern
Saccade, pursuit and OKN abnormalities help separate a central from a peripheral cause.
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Positional nystagmus (BPPV)
Positional testing reproduces the diagnostic nystagmus of benign paroxysmal positional vertigo.
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Saccade abnormalities (cerebellar / brainstem)
Dysmetric or slow saccades point to central pathology — cerebellar or brainstem.
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Smooth-pursuit impairment
Broken or saccadic pursuit is a soft but useful central sign.
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OKN asymmetry
Optokinetic asymmetry supports a central or hemispheric lesion.
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Red flag: central positional nystagmus — MRI brain + neurology
Positional nystagmus with central features demands MRI brain and neurology review — never dismissed as BPPV.
Next steps
What follows the result.
The plan depends on the pattern — rehabilitation, a repositioning manoeuvre, medical treatment, imaging or a specialist referral. Here’s the map.
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Vestibular rehabilitation
Structured physiotherapy — the first-line treatment for most peripheral vestibular disorders.
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Epley for BPPV
A canalith-repositioning manoeuvre — often curative in a single session.
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Betahistine / diuretic for Ménière’s
Medical management of episodic vertigo with fluctuating hearing loss and tinnitus.
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MRI IAM for asymmetric SNHL
Cross-sectional imaging of the internal auditory meatus to exclude vestibular schwannoma.
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Migraine prophylaxis for vestibular migraine
Lifestyle plus prophylactic medication where the pattern fits vestibular migraine.
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ENT / neuro-otology referral
For complex, ambiguous or refractory presentations — a specialist opinion.
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Falls-prevention programme
For older patients with bilateral vestibulopathy — an integrated falls-risk plan.
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Structured follow-up
Serial testing and clinic review to track response and progression.
Red flags
When the result changes what happens next.
Certain patterns and clinical pictures demand escalation — MRI brain, MRI IAM, neurology or ENT review. These are the ones we don’t sit on.
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Central positional nystagmus
Positional nystagmus with central features — MRI brain and neurology, never dismissed as BPPV.
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Cerebellar stroke
Acute vertigo with central oculomotor signs — a stroke mimic that must not be missed.
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Vestibular schwannoma
A benign VIIIth nerve tumour — asymmetric vestibular findings prompt MRI IAM.
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Ototoxic drug injury
Aminoglycoside or platinum-related bilateral vestibulopathy — history is the key.
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Bilateral vestibulopathy
Loss of vestibular function in both ears — high falls risk and oscillopsia.
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Persistent postural-perceptual dizziness
A functional chronic dizziness syndrome — recognised, treatable, and often missed.
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Superior canal dehiscence
Sound- or pressure-induced vertigo — high-resolution temporal bone CT confirms.
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Autoimmune inner-ear disease
Progressive bilateral hearing and vestibular loss — early immunosuppression may preserve function.
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Vestibular paroxysmia
Brief, recurrent vertigo from neurovascular compression — carbamazepine often diagnostic.
Sources
The guidelines that shape this guide.
Reviewed by Pulse Atlas Editorial Board (). Published 2026-07-30. Next review 2027-07-30.
A quiet reminder
This is a patient guide — not a substitute for clinical advice.
If your symptoms are new, sudden or worsening, speak to your ENT specialist or GP.
- 01 Reference
British Society of Audiology. Recommended procedures — vestibular assessment.
British Society of Audiology. Recommended procedures — vestibular assessment. - 02 Reference
Bárány Society. Classification of vestibular disorders.
Bárány Society. Classification of vestibular disorders. - 03 Reference
American Academy of Otolaryngology. Clinical practice guidelines — vertigo and vestibular disorders.
American Academy of Otolaryngology. Clinical practice guidelines — vertigo and vestibular disorders. - 04 Reference
NICE CKS. Vertigo — assessment and management.
NICE CKS. Vertigo — assessment and management.
Frequently asked
Everything we get asked about ENG / VNG testing.
Quick answers on what the test feels like, how long it takes, how it fits with vHIT and audiology, and what an abnormal result means.
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What is ENG / VNG?
ENG (electronystagmography) and VNG (videonystagmography) are two ways of recording eye movements to test the vestibular system objectively. ENG uses small electrodes around the eyes; VNG uses infrared goggles. The test battery is the same — caloric, positional and oculomotor sub-tests.
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Is the caloric test uncomfortable?
Caloric irrigation temporarily provokes the sensation of vertigo — that is exactly the point. It is short-lived, done one ear at a time, and settles within minutes.
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How long does the test take?
Typically 45 to 60 minutes for the full battery. Plan not to drive straight after — the caloric portion can leave you briefly unsteady.
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Do I need to stop my medication?
Alcohol and sedative medication should be avoided for 48 hours; caffeine for 4 hours. Do not stop prescribed medication without your doctor’s advice — mention what you take when you book.
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What is the difference between ENG/VNG and vHIT?
ENG/VNG dominantly tests low-frequency horizontal canal function (caloric) plus oculomotor and positional systems. vHIT tests high-frequency canal function of all six semicircular canals. They answer different questions and are often used together.
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What happens if the test is abnormal?
The report guides the next step — vestibular rehabilitation, an Epley manoeuvre for BPPV, MRI IAM for asymmetric findings, or an ENT / neuro-otology opinion for central or complex patterns.
Related tests
Looking for a different test?
-
Caloric test
Bithermal caloric irrigation — the horizontal-canal cornerstone of the vestibular battery.
Learn more -
Dix-Hallpike manoeuvre
The bedside positional test for posterior-canal BPPV.
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Dynamic visual acuity
A functional test of vestibulo-ocular reflex — high-yield for bilateral vestibulopathy.
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In practice, in London
What electronystagmography videonystagmography looks like on the ground in London
With electronystagmography videonystagmography, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. The NHS route for electronystagmography videonystagmography is thorough, but the queue is real. Most patients we speak with have been told to expect anywhere from a handful of weeks to several months, depending on their local trust and how the referral is graded. Going private in London usually collapses that window to a matter of days — often the same week if the diary allows. It isn’t about jumping a queue so much as buying time back while you still have the flexibility to plan around it.
Once you’re in the private system for electronystagmography videonystagmography, the pace picks up noticeably. Consultant slots run to time, imaging is usually available in the same building or a short walk away, and the report comes back typed and detailed. It’s the coordination that tends to feel different — one person on the other end of the phone, not a switchboard. For electronystagmography videonystagmography specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
Fit matters more than people expect. For electronystagmography videonystagmography, the right consultant depends on what you actually need — a second opinion, a definitive diagnosis, a bridge into treatment, or reassurance that nothing’s being missed. We match on that, not on who has the biggest brochure. If a test isn’t the right next step, we’ll say so before you book anything.