??5. Basic examination methods of otoneurology. Symptoms of central and peripheral imbalances.

What are the parts of otoneurological examinations

• history

• ear drum examination

• hearing tests

• vestibular system tests

• vestibular provocation tests

What are the vestibular system tsts

• statokinetic tests

• nystagmus tests

What are the vestibular provocation tests

• optokinetic test

• caloric labyrinthine test

What are the statokinetic tests

• Romberg’s test

• blind walking test

• Unterberger stepping test

describe the Romberg’s test

• patient stands with feet parallel and closed together with eyes closed

• unsteadiness or a tendency to fall indicated vestibular dysfunction

describe blind walking test

only gross abnormality of gait are diagnostically important

describe unterberger stepping test

• stepping on the spot with eyes closed

• peripheral disorder patients show rotation of body axis to the side of lesion

• central disorder patients show an irregular deviation

• only deviation of more than 40 degrees are of diagnostic significance

What are the observatory tests for nystagmus

• electronystagmography

• frenzel glasses

What is electronystagmography

• periocular electrical field is recorded

• change in retinal potential is proportional to the amplitude, frequency and speed of nystagmus

What are frenzel glasses

remomve visual fixation and also magnify + illuminate the patients eyes

What are nystagmus provocation tests

• head shaking test

• Dix Hallpike maneuver

• Head impulse test

describe the head shaking test

• spontaneous nystagmus can be provoked by gentle, passive, horizontal shaking of the patients head

describe the dix hallpike maneuver

• rapidly moving patient from sitting position to supine with head turned 45 degrees to the right and slightly extended

• after 20-30 seconds, patient is returned to sitting position

• if no nystagmus, procedure is repeated on left side

What is the head impulse test

• Test the vestibulo-ocular reflex

• The examiner moves the head quickly and unpredictably to 10-15 degrees of neck rotation

• Normal response: eyes remain on the target after the examiner’s movement

What is caloric labyrinthine test

• cooling or warming of labyrinthine capsule by irrigation with warm or cold wawter for 30 seconds

• induces currents and slight change in volume of endolymph

• movement of endolymph will deflect the cupula

• samd effect as deflection of cupula by angular acceleration

• cold- induces nystagmus towards the opposite side

• wam- induces nystagmus towards same side

What is optokinetic test

• patient tracks moving object with eyes

• object then moves out of visual fielt

• patients eyes move back to position where it first saw the object- saccade movement

What are peripheral vestibular imbalances

• problem in inner ear- labyrinth or vestibular nerve

What are examples of