How Vestibular Testing Can Help When MRI and CT Scans Don’t

Feeling dizzy can be scary—like the room is spinning or you’re unsteady and unsure of your next step. So you go to the doctor and explain what’s going on. They suggest getting an MRI or CT scan to figure out what might be causing it.

But then the results come back… and everything looks totally normal.

That can be super frustrating. You’re still dealing with all these symptoms, but the tests say there’s nothing wrong. It makes you feel stuck—not knowing what’s actually causing how you feel.

MRIs and CT scans are great for spotting big problems in the brain—like injuries, tumors, or bleeding. But here’s the thing: they can’t tell you how well your inner ear and balance system are actually working.

So even if those scans look totally normal, you could still be dealing with an issue that affects your balance. That’s where vestibular testing comes in—it checks how your balance system is functioning, not just how it looks. In fact, vestibular tests are more accurate and sensitive in identifying stroke patients than even an MRI! This is because the vestibular tests can identify any changes in the balance system functioning while MRI will pick it up only when the structures are damaged (which can be upto 48 hours after the symptoms start!)

Know More About Vertigo

• NeuroEquilibrium Vestibular Assessment Platform
• Virtual Reality Based Vestibular Rehabilitation
• Top 3 Essential Vertigo Tests

When Scans Show Nothing, But Symptoms Persist

Your MRI and CT scan results look normal, but that doesn’t mean your symptoms are just in your head. These scans are like super-detailed photos of your brain and skull. They’re great at spotting big problems like tumors, strokes, or broken bones.

But not all health issues show up in pictures. Some problems affect how your brain or inner ear works, even if everything looks fine on the scan.

It’s like having a phone that looks brand new on the outside but won’t turn on. It seems perfect, but something inside isn’t working right. That’s what can happen with vertigo. Your balance system might not be working properly, even if the scan shows everything is okay.

That’s why doctors need to look deeper than just the scans. They need to check how your body is working, not just how it looks.

What Scans Cannot Decipher

Some medical conditions cause dizziness, imbalance, and vertigo symptoms that do not show up on CT scans or MRI results. A brain scan cannot detect balance-related problems because these issues often originate outside the brain tissue, in the inner ear or the balance nerve system. Here are some common examples:

Benign Paroxysmal Positional Vertigo (BPPV)

Small crystals in your inner ear can move to the wrong position during this event. When you change your body’s position, like turning in bed or looking upward, it can lead to dizziness. BPPV remains undetectable by scanning devices, as these tests cannot identify the tiny ear crystals.

Vestibular Neuritis

The inflammation of the balance nerve (also known as the vestibular nerve) usually occurs after viral infections. Dizziness from this condition emerges suddenly and becomes extremely intense until it lasts several days. A scan would not detect nerve irritation, although it does not indicate nerve breakage.

Ménière’s Disease

The accumulation of fluid inside the ear leads to vertigo symptoms, together with ear ringing and reduced hearing capacity. The balance disturbance from swelling normally shows up separately from standard MRI or CT findings.

Vestibular Migraine

Some migraine experiences do not result in headache symptoms since they instead affect your sense of balance. Vestibular migraines create a combination of dizziness, sensitivity to light and sound, and a general unwell feeling. Brain examination scans usually miss this condition because they focus on brain reactions instead of physical abnormalities.

When someone has vertigo but their MRI and CT scans come back normal, it usually means the problem isn’t something structural in the brain—like a tumor or injury. Instead, it’s likely something functional, often coming from the inner ear, vestibular system, or the vestibular nerve—which all help control your balance.

Since regular scans can’t detect these kinds of issues, that’s where vestibular testing comes in.

What Is Vestibular Testing?

Vestibular testing represents a series of tests that assess inner ear and balance system operational status. People who experience dizziness or lightheadedness or feel off balance can benefit significantly from these tests, even though standard imaging methods such as MRIs and CTs are normal.

The big difference is this:

• MRI and CT scans analyze the structures of your brain. But conditions like stroke may take upto 48 hours to show up on an MRI. This crucial window is where the changes are reversible. That is why Vestibular tests like VNG need to be performed at the earliest to ensure missing problems which can be life-threatening.
• Vestibular tests determine operational performance levels to evaluate system capabilities despite normal outward appearances.

The evaluation system used for vestibular testing detects problems that standard imaging methods fail to identify. 

Types of Vestibular Tests

Doctors conduct multiple tests to determine which components of the balance system fail to function correctly. The tests examine distinct elements between your inner ear and brain pathways and body equilibrium. Several standard tests exist for balance system evaluation.

Videonystagmography (VNG)

The test requires you to wear special infra-red goggles during recording of your eye movements. You will need to view moving lights while the doctor positions you in different postures.

>The test matters because it reveals how your eyes respond to balance system activation since your inner ear functions closely with eye movement. Through this test, doctors can identify BPPV as well as other disorders affecting the inner ear.

Vestibular Evoked Myogenic Potentials (VEMP)

A sound test measures the responses of inner ear components. Throughout the procedure, you will hear clicking noises that sensors will use to monitor your neck or eye muscle responses.

>The test aids in identifying ear damage that occurs during Ménière’s Disease or other balance disorders.

Video Head Impulse Test (vHIT)

During the examination, you will be wearing specialized goggles to track eye movements as the doctor performs small quick head impulses. 

>The test verifies proper functioning of your vestibular reflexes which integrate eye and balance system coordination. The test works effectively to detect Vestibular Neuritis alongside other similar disorders.

Dynamic Posturography

You will step onto a unique platform surface as it executes slight movements. The testing process requires your eyes to be shut or you to perform specific tasks while your balance is being measured.

>By performing this exam, your healthcare provider can determine how well your body synchronizes eyes with feet and ears for balance maintenance. People who experience both general body imbalance and prolonged issues with dizziness can benefit from this test.

Dynamic Visual Acuity

The test evaluates any deterioration in visual acuity during head movement.

>The test establishes how your balance systems operate in moving environments.

What to Expect During Vestibular Testing

If you’re feeling nervous about a vestibular test, don’t worry—it’s totally safe and non-invasive. That means no needles, no surgery, and nothing painful. Doctors use this test to figure out what’s really causing your dizziness or balance issues.

How to Get Ready

Before the test, your doctor might ask you to stop taking any meds that could affect your balance. It’s a good idea to eat something light and skip eye makeup that day—some parts of the test involve tracking your eye movements closely.

What the Test Feels Like

The test itself is pretty chill. You might wear special goggles, move your head in certain ways, follow lights on a screen, or stand on a moving platform. It usually takes about 1–2 hours. You might feel a bit dizzy during parts of it, but that feeling goes away quickly.

Why Early Vestibular Testing Matters

Getting a vestibular test early helps doctors figure out what’s going on, so you can start the proper treatment sooner.

Catching the problem early means your symptoms are easier to manage and way less likely to turn into something long-term. It can seriously improve your day-to-day life.

Vestibular testing can save you from going through a bunch of random medical tests or trying out meds that don’t help. Instead of guessing, doctors can get to the root of the issue and suggest treatments like balance therapy or vestibular rehab, which are made to help with dizziness and balance problems directly.

When to See a Specialist

A specialist should be consulted when you experience dizziness or unsteadiness, together with negative basic scan results.

The first step should be consulting with either a neurologist, an ENT specialist, or a vestibular specialist who handles balance disorders. These specialists possess the training required to analyze both your brain and ear structures and verify their functional condition.

When should you seek help?

• A medical consultation is needed if your balance issues become more serious, sudden, or if they keep recurring.
• A visit to a specialist is necessary when dizziness persists beyond three days.
• Your need for medical help exists when walking or maintaining balance has been an issue for you.
• A visit to a healthcare provider should be considered when dizziness interferes with your everyday activities.

Further imaging is necessary for evaluation, even though one routine brain scan has already been performed, when any of these warning signs appear:

• Sudden hearing loss
• Slurred speech
• Trouble seeing or speaking
• Weakness or numbness in your arms or legs
• Loss of consciousness

Medical evaluation is needed right away to check for possible severe medical conditions that these symptoms signify.

Conclusion

Getting normal results from an MRI or CT scan can be a relief but if you’re still feeling dizzy or off balance, don’t ignore it. That could be your inner ear or balance system acting up, and regular scans just won’t pick that up.

That’s where vestibular testing comes in. It looks at how your balance system actually functions, helping doctors find the real cause and give you the right treatment.

At NeuroEquilibrium, we offer full vestibular evaluations and support from balance experts—with visuals and guidance to make the process easier. You can reach out to us today and take the first step toward feeling better.

FAQs