Physical Examination of Vestibular system

History of Patient

Symptoms

1. Dizziness is a sense of disturbed relationship between oneself and one's environment.
2. Vertigo is defined as an illusion of movement.
3. Lightheadedness is defined as a feeling that fainting is about to occur.
4. Dysequilibrium is defined as the sensation of being off-balance.
5. Oscillopsia is a subjective experience of the motion of objects in the visual environment that is known to be stationary (Table 1).
   

Table:1; Symptoms and their causes
Symptoms	Possible Causes
Vertigo	Unilateral vestibular hypofunction Benign paroxysmal positional vertigo Unilateral lesion affecting vestibular nuclei
Lightheadedness	Orthostatic hypotension Hypoglycemia Anxiety Panic disorder
Dysequilibrium	Bilateral vestibular hypofunction Chronic unilateral vestibular hypofunction Loss of somatosensation of lower extremity Upper brainstem lesion Cerebellar and motor pathway lesion

Duration of Symptoms

• Determine how recently the patient has had acute attacks of vertigo, lightheadedness, dysequilibrium, or oscillopsia.
• Determine the symptoms are constant or episodic.
• If the symptom is episodic then determine the average duration of episodes in seconds, minutes, or hours.
• For example:
• Vertigo lasting seconds to minutes commonly suggest benign paroxysmal positional vertigo.
• Vertigo lasting minutes to hours suggest Méniére's disease.
• Vertigo lasting 4 days implies vestibular neuronitis and migraine-associated dizziness.
• Determine under what circumstances the patient experiences symptoms.

Special Tests

1. Visual Analogue Scale

• The use of VAS is an effective technique to obtain subjective intensity ratings of vertigo, lightheadedness, dysequilibrium, and oscillopsia (e.g., How intense are your symptoms).

2. Examination of Eye Movements

• The test includes:
• Observation for nystagmus,
• Head impulse test (HIT),
• Head-shaking induced nystagmus (HSN) test, Positional testing,
• Dynamic visual acuity (DVA) test. more

3. Examination of Gait and Balance

• Examination of gait and balance is important for the determination of the patient's functional status.
• Testing should address both static and dynamic balance.
• gait and balance tests cannot uniquely identify pathology within the vestibular system.
• Table 2, includes common balance tests and expected results.

4. Vestibular Function Tests

1. Semicircular Canals Tests
1. Electro-nystagmography (ENG)
1. Caloric Test
2. Rotational Chair Test
2. Otolith Tests
1. Vestibular-Evoked Myogenic potential (VEMP) Test
1. Cervical VEMP
2. Ocular VEMP
3. To read more about these tests, click here.