Alternative names 


Electronystagmography records involuntary eye movements. The test is used to determine whether ear nerve damage is the cause of dizziness or vertigo. Damage to the nerve of the inner ear is one of the more common causes of vertigo.

How the test is performed
Metal electrodes (similar to those used with ECG, but smaller) are placed to the side, above, and below each eye. They may be attached by adhesive or by a band around the head. A “ground” electrode is attached to the forehead. These electrodes record eye movements relative to the position of the ground electrode.

A standard caloric stimulation test is performed, with cold or hot water instilled into the ear canal. Each ear is tested separately. The duration and velocity (speed) of eye movements that occur when the inner ear is stimulated are recorded by the electrodes.

The test takes about 90 minutes. It is performed by an audiologist and interpreted by an ENT specialist.

How to prepare for the test
No preparation is necessary. Check with your health care provider if you are taking any medications.

For infants and children:
The physical and psychological preparation you can provide for this or any test or procedure depends on your child’s age, interests, previous experience, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child’s age:

  • Infant test or procedure preparation (birth to 1 year)  
  • Toddler test or procedure preparation (1 to 3 years)  
  • Preschooler test or procedure preparation (3 to 6 years)  
  • Schoolage test or procedure preparation (6 to 12 years)  
  • Adolescent test or procedure preparation (12 to 18 years)

How the test will feel
There is minimal discomfort. Some people find cold water in the ear uncomfortable. Brief vertigo may occur during the test.

Why the test is performed
This test is used to determine if ear nerve damage is a cause of dizziness or vertigo. Damage to the vestibular portion of the acoustic nerve (the nerve of the inner ear) is one of the more common causes of vertigo.

Electronystagmography is performed to evaluate the acoustic nerve, which provides hearing and helps with balance. This test may be recommended when the person is experiencing dizziness or vertigo, when there is impaired hearing, with suspected toxicity from certain antibiotics, and when psychologic causes of vertigo are suspected.

Electronystagmography provides exact measurements of eye movements rather than the objective observation of standard caloric stimulation. It can record behind closed eyelids or with the head in a variety of positions.

Normal Values
Distinct involuntary eye movements should occur after instillation of cold or hot water into the ear canal.

What abnormal results mean

If the expected eye movements do not occur, there may be some damage to the nerve of the inner ear.

Any disease or injury that damages the acoustic nerve can cause vertigo. This may include:

  • Congenital disorders  
  • Trauma  
  • Rubella  
  • Blood vessel disorders with hemorrhage (bleeding), clots, or atherosclerosis of the blood supply of the ear  
  • Cholesteatoma and other ear tumors  
  • Some poisons  
  • Medications that are toxic to the ear nerves, including aminoglycoside antibiotics, some antimalarial drugs, loop diuretics, and salicylates

Additional conditions under which the test may be performed:

  • Acoustic neuroma  
  • Benign positional vertigo  
  • Labyrinthitis  
  • Meniere’s disease

What the risks are
A risk is associated with the caloric stimulation part of the test. Excessive water pressure can injure a previously damaged eardrum, but this rarely occurs. Caloric stimulation should not be performed if the eardrum is perforated because of the risk of causing ear infection.

Special considerations
This test is an adjunct to a caloric stimulation test.

Johns Hopkins patient information

Last revised: December 7, 2012
by Mamikon Bozoyan, M.D.

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