2. Vertigo
• “Illusion” or “Hallucination” of movement.
Abnormal sense of motion
between patient & surrounding
PLUS
Loss of balance
3. • Patient often complain of DIZZINESS/GIDDINESS
which is a vague term & mayn’t always mean
vertigo.
• Most dizzy patients can be placed in to one of four
categories:
1. True Vertigo (50%)
2. Pre- syncope
3. Dysequillibrium
4. Vague lightheadedness
4. True Vertigo
•Loss of balance
PLUS
Abnormal sense of
motion between patient
& surrounding
15. Evaluation of a patient with vertigo
1. Clinical tests
2. Laboratory tests
16. Clinical tests of vestibular function
1. Spontaneous Nystagmus
• Nystagmus- Involuntary,
rhythmic, oscillatory
movements of eyes.
• Procedure--
• May be horizontal,
vertical or rotatory
• Direction of nystagmus—
direction of fast component
17. • Nystagmus of peripheral
origin:
Suppressed by- Looking at a
fixed point
Enhanced by- Darkness or
Frenzel glasses (+20 D), both
of which abolish optic
fixation
Frenzel Glasses
19. • Normally, the test is NEGATIVE
• POSITIVE--- Erosion of horizontal semicircular
canal(Cholesteatoma), Abnormal opening in
oval window(Poststapedectomy fistula) or
round window (Rupture of round window
membrane)
• FALSE NEGATIVE--- When cholesteatoma
covers the fistula
• FALSE POSITIVE--- Congenital Syphilis &
Meniere’s disease (25% cases)
20. 3. Romberg Test
• Peripheral lesion-
Patient sways to the
side of lesion
• Central lesion-
Patient doesn’t sway
21. • Sharpened Rhomberg test
If the Rhomberg test is
normal, this test is performed.
Inability to perform this test
indicates vestibular
impairment.
26. LAB TESTS OF VESTIBULAR FUNCTION
• A. caloric test
• 1. modified kobrak test
• 2. fitzgerald-hallpike test
• 3. cold air caloric test
• B. Electronystagmograph
• C. optokinetic test
• D. rotation test
• E. galvinic test
• F. posturography
27. Caloric test
• Test of lateral semicircular canal
• Induce nystagmus by thermal stimulation
• Each labyrinth can be tested separately
28. Modified kobrak test
• Ear is irrigated with icewater for 60 s
• First with 5 ml then with 10,20 and 40
• If no response to 40 ml ,it indicates dead
labyrinth
29. Fitzgerald-hallpike test
• ears are irrigated for 40 s alternately with
water at 30 and 44 degree celcious
• Time taken is recorded in calorigram
• If no nystagmus, repeated at 20 degree
celcious for 4 min
• Depending on response of caloric test
• a.canal paresis
• b.directional preponderance
30. • A.canal paresis
• indicates response illicted from particular
canal is less than that of opposite side
• depressed function of ipslateral
labyrinth,vestibular nerve or vestibular nuclei
31. b. Directional perponderance
• Duration of nystagmus irrispective to rt or left
is considered.
• Right beating nystagmus is caused by LC and
RW
• Left beating nystagmus is caused by RC and
LW
• TOTAL RESPONSE = RW+RC+LW+LC
32. FORMULA FOR RB AND LB
NYSTAGMUS
• Right beating nystagmus=(LC+RW)/TR X100%
• Left beating nystagmus=(RC+LW)/TR X100%
• IF nystagmus >25 to 30% in one ear than
other ,then it is called directional
perponderance
33. • DP=RT BEATING – LEFT BEATING/TR
• RVR(relative vestibular reduction)=(RC+RW-
LC-LW)/TR
• RVR normally is <25%
• RVR > 40 % seen in vestibular neuritis
34. • 3. cold air caloric test
• Done when there is perforation of tympanic
membrane
• Dundas grant tube
• Ethyl chloride is used to cool air
36. C. OPTOKINETIC TEST
• EYE movement ellicted by tracking of moving
field
• POSITIVE IN brainstem and cerebral lesion
37. E. Rotational test
• Patient seated in Brany’s revolving chair
• Rotated 10 turns in 20 second
• Normally nystagmus is for 25 to 40 second
• Used for pt with congenital anomalies where
calorie test is not possible
•
38.
39. F. GALVANIC TEST
• VESTIBULAR TEST
• Differentiate from end organ lession from
vestibular nerve
• 1 mA current passed in one ear
• Normally person sways towards anodal
current
41. VESTIBULAR NEURITIS
• A type of peripheral vestibular disorder
• A common cause of spontaneous vertigo
• Definition
– disorder in which there is sudden,
– spontaneous, isolated, total or subtotal loss of
afferent vestibular input from one labyrinth
42. • Etiology
– Viral infection of vestibular nerve
• Selective neuron loss in vestibular ganglia
– Virus
• Herpes Simplex virus type 1 (latent infection)
43. • Clinical manisfeststions
– Acute spontaneous vertigo
– Nausea, Vomitting
– Postural imbalance
– SYMPTOMS ARE TYPICALLY AGGRAVATED BY HEAD
MOVEMENT AND MINIMIZED BY KEEPING HEAD
STILL AND EYES CLOSED
– Symptoms gradually subside over the following
days
44. • In acute phase
– Spontaneous horizontal torsional nystagmus
• Unidirectional
• Quick phase towards unaffected side
• Suppressed by visual fixation
45. • Patients charcteristically rotate towards the
affected side when attempting to march on
the spot with their eyes closed
– POSITIVE FUKUDA / UNTENBERGER TEST