If nystagmus does not occur after cold or warm water is instilled or there is a difference between the responses of each ear or between cold and warm water response, there may be some damage to the nerve of the inner ear, which controls balance. If nystagmus does not occur even after ice cold water is instilled, permanent damage to the nerve has probably occurred.

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

• congenital disorders (present at birth)
• trauma
• rubella
• blood vessel disorders with hemorrhage (bleeding)
• clots
• atherosclerosis of the blood supply of the ear
• cholesteatoma and other ear tumors
• some poisons
• ototoxic (toxic to the ear nerves) medications, including aminoglycoside antibiotics, some antimalarial drugs, loop diuretics, and salicylates

Additional conditions for which the test may be performed:

• acoustic neuroma
• benign positional vertigo
• labyrinthitis
• Meniere's disease