Electronystagmographic analysis of peripheral vertigo
Keywords:Electronystagmography, Vestibulo-ocular reflex, Peripheral vertigo, Nystagmus, Caloric testing, Claussen’s butterfly chart
Background: Examination of the vestibulo-ocular reflex is still the investigation of choice for evaluating the vestibular function to rule out peripheral causes. Aim and objectives were to compare the electronystagmographic changes of all peripheral forms of vertigo and to highlight its significance in the diagnosis and management of the same.
Methods: This is a prospective study done after obtaining ethical committee approval in a total of 100 patients attending the ENT OPD at Sri Muthukumaran Medical College Hospital & Research Institute with chief complaints of vertigo. Patients diagnosed with chronic suppurative otitis media, hypertensive patients, h/o seizures, recent cardiac illness or patients on cardiac investigations, psychotic disorders, documented CNS lesions, cervical spondylitis, h/o recent eye/ ear surgery are excluded from this study. ENG analysis includes occulomotor testing, positional testing and caloric stimulation. Evaluation of gait and balance is done followed by maneuver induced vertigo testing (dix hallpike and fistula test) along with PTA. Statistical analysis was done using independent sample t test and chi square test to check the hypothesis using statistical package for social studies SPSS version 17.
Results: The observations of ENG like spontaneous nystagmus and bi-thermal caloric test responses are represented on a claussens butterfly chart and the corresponding bar codes were obtained. The inferences for different forms of vertigo were studied.
Conclusions: ENG is now an accepted routine and basic investigation in the management of all patients suffering from equilibrium disorders. Management consists of diagnosing the underlying pathology and treatment of the same.
Scott and Brown's Otorhinolaryngology Head and Neck Surgery; 7th edition; 3103-244.
Biswas A. Clinical audio- vestibulometry for otologists and neurologists. In: Kirtane MV, Electronystagmography. Mumbai: Bhalani Publishing House. 2009;109-47.
3. Sanjay Kumar Gupta, Raj Kumar Mundra. Electronystagmography: A very useful diagnostic tool in cases of vertigo. Indian J Otolaryngol Head Neck Surg. 2015;67(4):370-4.
Stockwell CW. Rationale of the Bithermal Caloric Test ENG Report. ICS Medical Corporation. Clinical Testing of the Audiovestibulometry, 5th edition Pursuit System", ENG Report.
Korres SG, Balantsouras DG, Ferekidis E. Electronystagmographic findings in BPPV. Ann Otol Laryngol. 2004;113(4):313-8.
KoKM, Song MH, Kim JH, Shin DB. Persistant spontaneous nystagmus following a calolith repositioning procedure in horizontal SCC BPPV. Otolaryngol Head Neck Surg. 2014;140(3):250-2.
Dobie RA, Snyder JM, Donaldson JA. Electronystagmographic and audiological findings in patients with Meniere's disease. Acta Otolaryngol. 1982;94(1-2):19-27.
Zee DS. Ophthalmoscopy in examination of patients with vestibular disorders. Ann Neurol. 1978,3:373-4.
Barber HO, Stockwell CW. Manual of electronystagmography (2nd edition) St. Louis: C.V. Mosby Co.18. Init Evaluat Vert Am Fam Physic. 2006;73:244-51.
Jongkees LB, Phillipzoon AJ. Electronystagmography. Acta Otolaryngol. (Stockh). 1964,189:1-111.
Halmagyi GM, Cremer PD,Anderson J,Murofushi T, Curthoys IS. Isolated directional preponderance of caloric nystagmus.: I. Clinical significance.Am J Otol.2000 Jul;21(4):559-67.
Mezzalira R, Bittar RS, do Carmo Bilécki-Stipsky MM, Brugnera C, Grasel SS. Sensitivity of caloric test and video head impulse as screening test for chronic vestibular complaints. Clinic. 2017;72(8):469-73.
Braumgartner B, Taylor RS. Peripheral vertigo. In: Stat Pearls. Treasure Island (FL): Stat Pearls Publishing. 2020.
Choi JE, Kim YK, Cho YS, Lee K, Park HW, Yoo SH, et al. Morphological coorelation between caloric tests and vestibular hydrops n Meniere's disease using intravenous Gd enhanced inner ear MRI. PLo On. 2017;12(11):e0188301.
Somishetty SM, Das J. Neuroanatomy, Vestibulo ocular reflex. In: Stat Pearls. Treas Islan (FL). 2020.
Meneses E, Sampaio A, Venosa A, Tauli P, Dias M, Oliveria C. Vestibulo ocular reflex as predictor of cerebral brain death in comatose patients. Int Tinnit J. 2016;16(1):8-13.
Dhingra PL, Dhingra S. Diseases of ear nose and throat; 7th edition: 43-50.