Correlation between clinical diagnosis and claussens butterfly chart patterns in patients with vertigo
Keywords:Butterfly chart, Electronystagmography, Vertigo
Background: Neurotology forms the grey area between otologists and neurologists. Vertigo is also a complex symptom that often has multiple pathologies leading to the presentation. Electronystagmography is a complex investigation that cannot be comprehended by many other doctors. The Claussens butterfly chart offers a simple pictoral representation of the caloric test that can be easily and immediately Understood by patients and other doctors.
Methods: 50 patients presenting to the Neurotology OPD with complaints of vertigo were subjected to this investigation and the butterfly chart derived. The correlation between the clinical diagnosis and the butterfly chart patterns studied.
Results: The sensitivity and specificity of the butterfly code for central lesions is 75% and 73% respectively. The sensitivity and specificity of the butterfly code for peripheral lesions is 64.3% and 50% respectively.
Conclusions: The butterfly chart is a very simple and useful investigation that can help classify the etiology of vertigo as central or peripheral and thus help in treatment. It is also the only investigation that is helpful to localize the side of lesion in vertigo of any etiology.
Kruschinski C, Kersting M, Breull A, Kochen MM, Koschack J, Hummers-Pradier E. -Frequency of dizziness-related diagnoses and prescriptions in a general practice database. Z Evid Fortbild Qual Gesundhwes. 2008;102(5):313-9.
IAN (Indian Academy of Neurology) Guidelines on vertigo, 2nd Edition.
Neuhauser HK. Epidemiology of vertigo. Curr Opin Neurol. 2007;20:40–6.
Froehling DA, Silverstein MD, Mohr DN, Beatty CW. Does This Dizzy Patient Have a Serious Form of Vertigo? JAMA. 1994;271(5):385-8.
Jacobson GP, McCaslin DL, Piker EG, Gruenwald J, Grantham S, Tegel L. Insensitivity of the "Romberg test of standing balance on firm and compliant support surfaces" to the results of caloric and VEMP tests. Ear Hear. 2011;32(6):e1-5.
Gurumani S. Prospective Study of Vertigo – Causes, Incidence, Audiometric Findings & Caloric Tests. Int J Medical Applied Sci. 2013;2(3):1.
Bakr MS, Saleh EM - Electronystagmography: how helpful is it? J Laryngol Otol. 2000;114(3):178-83.
Cass SP. Best Practices for the Evaluation and Management of Dizziness – Insighta in practice, Clin Topics Otoneurol. 2005.
Dipjyoti B, Bhattacharjee A, Purkaystha P, Rathor A. A clinical study on vertigo with special reference to audiovestibular tests. Int J Sci Res. 2013;2(7):370-5.
Arriaga MA, Chen DA, Cenci KA - Rotational chair (ROTO) instead of electronystagmography (ENG) as the primary vestibular test. Otolaryngol Head Neck Surg. 2005;133(3):329-33.
Büki B, Simon L, Garab S, Lundberg YW, Jünger H, Straumann D. Sitting-up Vertigo and Trunk Retropulsion in Patients With Benign Positional Vertigo but Without Positional Nystagmus. J Neurol Neurosurg Psychiatr. 2011;82:98-104
Felipe L, Carvalho SA, Labanca L, Tavares MC, Gonçalves DU. Validity of the monothermal caloric testing when compared to bithermal stimulation - Pró-Fono Revista de Atualização Científica. 2010;22(1):1.
Korres S, Riga M, Papacharalampous G, Chimona T, Danielidis V, Korres G. Xenellis ENT Department, Hippokration Hospital, University of Athens, Greece. - Relative diagnostic importance of electronystagmography and magnetic resonance imaging in vestibular disorders. J Laryngol Otol. 2009;123(8):851-6.
Ganança MM, Caovilla HH, Ganança FF. Electronystagmography versus videonystagmography. Braz J Otorhinolaryngol. 2010;76(3):399-403.
Singh BK, Bapna AS, Chhangani DL. Interpretation of ENG by Claussens Butterfly Chart. Indian J Otolaryngol. 1987;39(4):145-9.
Mehra YN. Eletronystagmography: A study of caloric tests in normal subjects. J Laryngol Otol. 1964;78:520-9.
Strupp M, Brandt T. Diagnosis and Treatment of Vertigo and Dizziness. Dtsch Arztebl Int 2008;105(10):173–80.
Burman D, Goswami, Majumdar PK. A study on peripheral vertigo in a kolkata based hospital - Indian J Otolaryngol Head Neck Surg. 2002;54(2):101-4.