LM315 - It Is Not All in Your Head Advanced Vestibular Testing Should Include the Neck

Abstract: Audiologists play a critical role in identifying cervicogenic dizziness (CGD), yet cervical testing is often overlooked in vestibular evaluations. The Smooth Pursuit Neck Torsion Test (SPNT) and Cervical Gaze Test (CGT) offer objective, accessible tools to assess cervical contributions to dizziness. This session highlights research, pathophysiology, symptom patterns, and clinical utility of CGD testing. Attendees will gain practical strategies for identifying appropriate patients, bedside and advanced diagnostics for evaluation tools for SPNT and CGT, and a multidisciplinary approach to improving outcomes. Cervical assessments enhance diagnostic confidence and facilitate a more comprehensive and efficient evaluation of patients with dizziness.

Summary: Cervicogenic dizziness (CGD) has historically been a controversial diagnosis, with many clinicians questioning its validity due to overlapping symptoms with vestibular and central causes of imbalance. However, growing evidence, including objective measures such as the Smooth Pursuit Neck Torsion Test (SPNT) and Cervical Gaze Test (CGT), increasingly supports that CGD is a distinct clinical entity with measurable diagnostic criteria.
This session will review the proposed pathophysiology of CGD, including disrupted cervical afferent input to the vestibular nuclei and mismatched proprioceptive, visual and vestibular signaling. Symptom patterns such as dizziness exacerbated by head movement, neck pain, and imbalance will be described, with emphasis on differential diagnosis from vestibular and central causes.
Appropriate populations for CGD testing will be reviewed. Common candidates include patients with whiplash injuries, concussion, cervical arthritis, or persistent dizziness not explained by standard vestibular findings. Guidance will be provided on when to include CGD testing and how results can guide management.
Diagnostic strategies will be presented in two tiers: bedside assessments including the head-neck differentiation tests, and equipment-based options including the SPNT and CGT. The role of these tests in strengthening clinical confidence, refining differential diagnosis, development of individualized training and rehabilitation strategies and supporting patient education will be discussed. A detailed case study will demonstrate how CGD testing influenced diagnosis, clinical decision making and treatment planning, including collaboration and management of CGD by a manually trained physical therapist will also be presented.

Brief Summary of Clinical Takeaways: The clinical takeaway from this session is that incorporating cervical assessments, such as the Smooth Pursuit Neck Torsion Test, into vestibular evaluations empowers audiologists to identify cervicogenic dizziness, refine differential diagnoses, and improve patient outcomes through targeted, interdisciplinary care.

Assumptions: Attendees should have prior experience with bedside vestibular tests (e.g., Dix-Hallpike, Head Impulse Test), understanding of differential diagnosis for dizziness (e.g., BPPV, vestibular neuritis, central causes) and familiarity with VNG testing.