If the room spins, your head feels light, or you feel unsteady on your feet, you deserve a clear answer — not guesswork. That off-balance feeling can be frightening, and it is easy to feel that no one can explain why it keeps happening. At Abhinav ENT Care Center in Hastinapuram, Hyderabad, we take your dizziness seriously and look for the real reason behind it.
Using a careful examination and advanced VNG (videonystagmography) testing on the equiCOG system, Dr. G Abhinav Kumar Reddy — an ENT specialist with around 13 years of experience who provides dedicated vertigo and balance (vestibular) evaluation — works to pinpoint what is happening in your balance system and explains it to you in plain language.
What is a VNG test, and what is equiCOG?
A VNG (videonystagmography) test is a safe, non-invasive way to check how well your inner-ear balance organs and their connections to your eyes and brain are working. There are no needles and no incisions. You simply wear lightweight goggles fitted with tiny infrared cameras while you follow moving dots, lie in a few different positions, and have gentle warm and cool air placed in each ear.
The reason we watch your eyes is that your balance organs and your eyes are linked by a natural reflex — the vestibulo-ocular reflex — which keeps your vision steady when you move your head. When one inner ear is not sending the right signals, it shows up as a specific pattern of eye movement called nystagmus: an involuntary, rhythmic flicker of the eyes. By recording these movements, we get an objective, measurable window into your balance system, rather than relying only on how you describe the dizziness.
equiCOG (Cranio-Oculo-Graphy) is the advanced VNG system we use at the clinic, made by Equidor Medtech LLP in Bengaluru. Unlike ordinary eye-only trackers, equiCOG records both your eye movements and your head movements at the same time, and plays them back together on a single synchronised timeline. This matters because a flicker of the eyes only tells the full story when we can see exactly how your head was moving at that moment, so this paired eye-and-head recording helps us read your inner-ear reflexes more completely and confidently.
It is important to be clear that equiCOG is diagnostic equipment. It measures and records how your balance system behaves; it does not treat or cure vertigo on its own. What it gives us is an accurate, objective foundation on which the right treatment can be planned — and every result is interpreted by your ENT specialist.
The equiCOG system at a glance
What it doesRecords eye and head movement together for complete VNG assessment
Eye recordingBoth eyes captured on direct video at 100 frames per second
Head trackingBuilt-in motion sensor (IMU) records head position at 100 fps
Synchronised playbackEye motion replayed alongside an animated head-position view on one timeline
Slow-motion reviewHigh-speed capture lets us replay tiny eye movements in slow motion
Pupil measurementAutomatic pupil detection and measurement in millimetres, plus blink detection
Field of view80° horizontal, 60° vertical — marker-free, with no reflective glass
Comfort & lightingElectronics-free magnetic visor; cameras kept out of your line of sight
Made byEquidor Medtech LLP, Bengaluru, India
These are the real, published capabilities of the equiCOG system we use for VNG testing. It is diagnostic equipment that helps us assess and record your balance function; it is not a treatment in itself, and results are always interpreted by your ENT specialist.
Why an accurate vertigo diagnosis matters
Dizziness is a symptom, not a diagnosis. The same spinning feeling can come from very different causes, and each one needs a different approach. Objective testing helps us stop guessing and start treating the right problem — and can protect you from months of trial and error.
Not all dizziness is the same
A common inner-ear crystal problem (BPPV), a weak inner ear, migraine-related dizziness and other conditions can all feel similar but are managed very differently. Testing helps tell them apart.
Eye and head tracked together
Every nystagmus recording is paired with a synchronised head-motion reference, so your eye movements are read in their true context rather than in isolation.
It pinpoints which ear is involved
By comparing how each ear responds during caloric testing, VNG can show whether one inner ear is weaker than the other, which often points directly to the source of the problem.
Objective, recorded results
equiCOG captures measurable, replayable recordings rather than impressions. This lets us document what we find and follow how your balance changes over time.
It guides the right treatment
A clear diagnosis lets Dr. Abhinav choose the correct next step — whether that is a repositioning manoeuvre, balance exercises, medication or lifestyle advice — and helps decide if onward referral is needed.
What we can assess during your evaluation
A VNG assessment is a set of small, painless tasks rather than a single test, and there are no needles or incisions at any stage. Not every patient needs all of them; Dr. Abhinav selects the parts most relevant to your symptoms. Here is what the different parts involve, in plain English.
Eye-tracking (saccade) test
You look quickly between targets while we measure how fast, accurately and well-timed your eyes jump to them.
Smooth pursuit test
You keep your head still and follow a slowly moving dot with your eyes, to check how smoothly your eyes and brain track movement.
Optokinetic test
You watch a moving full-field pattern while your head stays still; abnormal responses can point to a central, brain-pathway cause.
Gaze test
We check whether your eyes stay steady, or drift and flicker, when you look straight ahead or hold your gaze to one side.
Positional & Dix-Hallpike testing
We gently guide your head and body into different positions to see whether a change of position triggers dizziness — the key test for BPPV, a very common and treatable cause of vertigo.
Caloric test
Gentle warm and cool air is placed in each ear, one at a time, to compare the two sides and reveal whether one inner ear is weaker. Brief, short-lived dizziness during this part is normal.
Head-movement & provocation tests
Because equiCOG records your head as well as your eyes, we can study how your balance reflex responds to motion. Simple manoeuvres such as brief head-shaking can also bring out balance clues not visible while you sit still.
Pupillometry
The system automatically measures your pupils over time, adding an extra layer of information to your assessment.
Video Frenzel examination
A close-up video view magnifies your eyes on screen so subtle involuntary movements can be observed clearly during a tailored examination.
Conditions a VNG assessment helps evaluate
VNG does not diagnose by itself; it gives Dr. Abhinav objective information to help find the cause of dizziness, vertigo and imbalance, and to identify whether one or both inner ears are involved. The final interpretation is always made by the doctor after considering your full history and examination. It is commonly used when assessing:
- Benign paroxysmal positional vertigo (BPPV) — the brief spinning triggered by head or position changes
- Vestibular neuritis and labyrinthitis (inflammation affecting the balance nerve or inner ear)
- Suspected Ménière’s disease and other inner-ear disorders, often with hearing changes or ear fullness
- Unexplained, recurring dizziness or vertigo attacks
- A persistent sense of imbalance, unsteadiness or feeling off-balance on your feet
- Dizziness that may be linked to migraine
- Dizziness where we need to know whether one or both inner ears are involved
- Symptoms that may point to a central (brain-pathway) rather than inner-ear cause, helping decide if onward referral is needed
The common causes, and what each one feels like
Most vertigo comes down to a handful of causes, and they behave differently enough that the pattern itself is a strong clue — how long an attack lasts, what sets it off, and whether your hearing changes with it. Below is what each tends to feel like. They do overlap, and more than one can be present at once, so treat this as a way to describe your symptoms more clearly at your appointment rather than a way to diagnose yourself.
BPPV (benign paroxysmal positional vertigo)
- What it feels like
- Short, intense spinning set off by a change in head position — rolling over in bed, lying down, sitting up, looking up at a shelf or bending to pick something up. Each spell usually lasts seconds to under a minute, often with nausea, and between spells you feel normal.
- What is happening
- Tiny calcium crystals that normally sit in one part of the inner ear come loose and drift into one of the balance canals. Moving your head then makes them shift, and the canal sends a false signal of spinning to the brain.
- How it is assessed and treated
- Identified with positional tests that place the head in specific positions while your eye movements are recorded, which also shows which ear and which canal is involved. It is treated with canalith repositioning manoeuvres — guided head and body movements that move the crystals back out of the canal. This is the most treatable cause of vertigo, and relief is often quick.
Ménière’s disease
- What it feels like
- Attacks of spinning that last roughly twenty minutes to several hours, usually with hearing symptoms in the same ear — muffled or fluctuating hearing, ringing, and a blocked or full feeling. Attacks come unpredictably, and many people notice the ear feels full before one starts.
- What is happening
- Related to changes in the fluid and pressure inside the inner ear. The exact trigger is not fully understood, which is worth saying plainly rather than glossing over.
- How it is assessed and treated
- Diagnosed from the pattern of attacks together with hearing tests and balance testing. It is managed rather than cured: dietary and lifestyle measures, medication for attacks and sometimes preventive treatment. The aim is fewer and milder attacks and protecting hearing, and that plan is reviewed over time.
Vestibular neuritis and labyrinthitis
- What it feels like
- Sudden, severe, constant spinning that lasts hours to days rather than seconds — often with nausea and vomiting, and much worse with any head movement. It frequently follows a cold or viral illness. If hearing is affected too, it is usually called labyrinthitis rather than neuritis.
- What is happening
- Inflammation affecting the balance nerve or the inner ear itself, commonly after a viral infection, so one ear stops sending normal balance signals while the other carries on.
- How it is assessed and treated
- The first few days are about settling symptoms. After that, recovery comes mainly from vestibular rehabilitation — graded balance and gaze exercises that let the brain recalibrate to the changed signal. Balance testing can show a reduced response on one side, which helps confirm what happened and track recovery.
Vestibular migraine
- What it feels like
- Episodes of dizziness, rocking or unsteadiness that can last minutes, hours or longer — and often with no headache at the time, which is why it is so commonly missed. Many people notice sensitivity to light, sound or motion, and that busy visual patterns, scrolling or supermarket aisles make it worse.
- What is happening
- The same underlying mechanism as migraine, affecting the balance pathways rather than only causing head pain. A personal or family history of migraine is a useful clue.
- How it is assessed and treated
- There is no single test for it; it is recognised from the pattern, alongside balance testing that typically does not show the inner-ear findings seen in the conditions above. Management focuses on identifying triggers, sleep and lifestyle measures, and in some cases preventive medication — sometimes working alongside a neurologist.
If your pattern does not look like any of these, that is not unusual and it does not mean nothing is wrong. Dizziness can also come from blood pressure, medication, neck problems, anxiety or causes outside the ear entirely — part of the value of a proper assessment is ruling the inner ear in or out, so you are not treated for the wrong thing.
Treatment after your diagnosis
Testing is only useful if it leads to relief. Once we understand what is causing your dizziness, treatment can be directed precisely at it — which is exactly why testing comes first. Many causes of vertigo respond very well to simple, well-established treatments, and much can often be done in the clinic itself.
Dr. Abhinav will recommend the option, or combination of options, most suited to your specific condition, set clear expectations and review your progress over time. Where a cause outside the scope of ENT care is suspected, he will guide you to the appropriate next step. The goal is always to reduce your symptoms and help you feel steady and confident again.
Canalith-repositioning manoeuvres
For BPPV, gentle guided head-and-body movements (such as the Epley manoeuvre) help move displaced inner-ear crystals back into place, often bringing quick relief.
Vestibular rehabilitation exercises
A tailored set of balance and gaze-stability exercises helps your brain adapt and compensate, reducing dizziness and improving steadiness over time.
Medication
Where appropriate, medicines can help settle acute symptoms such as severe spinning or nausea, or address an underlying inner-ear condition, as advised by the doctor.
Lifestyle guidance
Practical advice on triggers, hydration, movement and daily habits that can support recovery and reduce how often dizziness affects you.
What a vertigo evaluation includes
People understandably want to know what a VNG test will cost before they book. The honest answer is that it depends on which parts of the assessment you actually need — a straightforward positional problem does not require the same testing as long-standing, unexplained imbalance — so rather than quote a figure that may not apply to you, here is exactly what a full evaluation involves. For current fees, please call the clinic; you will be told the cost before anything is carried out.
What matters more than the number is that the assessment is done once, properly. Repeated inconclusive visits, or treatment aimed at the wrong cause, cost far more in time and discomfort than an accurate diagnosis does.
- A full ENT consultation with Dr. G Abhinav Kumar Reddy, including your history and a clinical examination
- Ear examination to rule out causes such as wax, infection or a middle-ear problem before balance testing
- VNG (videonystagmography) testing on the equiCOG system, covering the parts of the assessment your symptoms call for
- Paired eye-and-head recording played back on one synchronised timeline, reviewed with you during the visit
- A plain-language explanation of what the findings mean — not just a printout
- A treatment plan, including any repositioning manoeuvre that can be carried out in the clinic on the day
- Clear guidance on follow-up, and onward referral only if it is genuinely needed
