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Common otology viva topics
Published in Joseph Manjaly, Peter Kullar, Advanced ENT Training, 2019
Spontaneous and gaze-evoked nystagmus: Assess in horizontal and vertical planes. Physiological when assessed beyond 30°, so do not assess beyond this degree. The corrective fast phase is away from the affected ear in an acute vestibular loss. Less commonly during an irritative lesion, the fast phase is seen towards the affected ear. It is important to comment that there will be no spontaneous nystagmus in positionally triggered dizziness presentations. Drugs and rare central causes of nystagmus exist including Arnold–Chiari malformations. Failure to suppress with fixation suggests a central origin and thus any assessment of peripheral nystagmus is aided by the use of Frenzel goggles.
Clinical management
Published in Alistair Burns, Michael A Horan, John E Clague, Gillian McLean, Geriatric Medicine for Old-Age Psychiatrists, 2005
Alistair Burns, Michael A Horan, John E Clague, Gillian McLean
Occasional patients have BPPV affecting the horizontal canal. This can be tested using the 'roll test'. The patient lies supine with the head slightly flexed. The head is turned 90� to one side and the eyes are observed for horizontal nystagmus. The test is then repeated, turning the head to the other side. As with the Semont manoeuvre, fixation may suppress the response: Frenzel goggles overcome this problem.
Proceedings of the 44th Annual Upper Midwest Neuro-Ophthalmology Group Meeting
Published in Neuro-Ophthalmology, 2023
Negar Moheb, Adam Baim, Collin McClelland, John. J. Chen
Following lunch, the afternoon sessions began with a presentation by Jorge Kattah, MD, OSF Healthcare Illinois Neurological Institute, about the effects of peripheral vestibulopathies on the angular vestibulo-ocular reflex (VOR) and suppression of spontaneous nystagmus by visual fixation. In this study, video Frenzel goggles were used to compare quantitative eye movement data from 19 healthy volunteers, six patients with peripheral vestibular lesions, and one patient with a chronic left medial vestibular nucleus haemorrhage. Healthy subjects displayed an expected increase in angular VOR gain at near (that is, increased velocity of eye movements relative to the velocity of head turn) while patients with peripheral vestibulopathies did not demonstrate increased gain with near targets. These patients did, however, demonstrate more effective suppression of nystagmus with convergence than divergence for 48 hours, after which suppression at near and distance became concordant. The single patient with a chronic vestibular nuclear lesion did not demonstrate increased angular VOR gain at near, similar to patients with acute peripheral lesions; however, this patient displayed longstanding failure to suppress nystagmus at near with improved suppression when viewing distance targets. Dr Kattah closed by discussing novel interactions between the VOR and near reflex that are suggested by these findings.
Atypical variants of posterior canal benign paroxysmal positional vertigo after canalith repositioning: a case report
Published in Hearing, Balance and Communication, 2019
A primary limitation to this study is the lack of videonystamography data, and while all assessments were completed with video frenzel goggles, quantifying the speed of nystagmus would have aided in the examination. Also, similar to other studies of BPPV, we are restricted by the inability to visualize the otoconia and endolymphatic flow within the inner ear. This forces us to rely on both our knowledge of vestibular anatomy and physiology and the physical signs and symptoms to form a diagnosis and determine treatment efficacy. As a result, it cannot be determined with complete certainty if the DS was the sole factor contributing to the resolution of APC-BPPV and UCPC-BPPV. The recommendation to sleep on the unaffected ear, as recommended by Vannucchi et al. [2], may also have contributed to the resolution of BPPV. Cambi et al. [29] found that 48 of 50 individuals evaluated for downbeating nystagmus of peripheral origin had resolution of their nystagmus after 1 week, regardless of receiving treatment. While unlikely, it is possible that we merely entertained the patient while the symptoms resolved naturally.
Cervical vestibular evoked myogenic potentials in patients with the first episode of posterior canal benign paroxysmal positional vertigo before and after repositioning
Published in Acta Oto-Laryngologica, 2021
Gülsüm Saruhan, Ahmet Gökçay, Figen Gökçay, Neşe Çelebisoy
The definite diagnosis of BPPV requires observation of the canal specific positional nystagmus during the positional maneuvers. Nystagmus is generally detected without special equipment. Frenzel goggles or video-oculography can be used in case the nystagmus is weak. Diagnostic criteria for benign paroxysmal positional vertigo for all canal types for both canalolithiasis and cupulolithiasis have been reviewed as a part of the International Classification of Vestibular Disorders [2]. Treatment depends on repositioning maneuvers which are highly effective especially on patients with canalolithiasis [7].