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* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * THANK YOU! * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * EXAMINATION Otological examination (tuning fork) for hearing assessment including fistula test Cranial nerve examination Blood pressure and pulse Romberg’s test (balance test) Cerebullar function test Neck examination for carotid artery disease and range of motion Nystagmus – the only objective manifestation of vertigo Nystagmus It is defined as involuntary repetitive movement of eyes, having slow and fast phase Spontaneous nystagmus seen when eyes are in resting position Gaze evoked nystagmus Induced nystagmus by head shaking test or caloric test Positional nystagmus by Hallpike maneuver Positional nystagmus BPPV Central type Latent period 2 – 20 sec none Adaptation disappears in 50 sec persists Fatiguability disappears on repetition persists Vertigo always present typically absent Direction of nystagmus to undermost ear variable Incidence relatively common relatively uncommon Investigation Screening blood test: Include CBC-diff, ESR, TFT, lipid profile, syphilis screening and serology for autoimmune disease if indicated. P.T.A. to detect any hearing loss ABR if asymmetrical hearing loss present CT/MRI indicated if there is unexplained neurological finding or retrocochlear hearing loss ECG with rhythm strip Special Vertibular Investigation Electronystagmography ENG use to record eye movement and this is possible because of electric potential difference between Retina (-ve) and cornea (+ve) Caloric testIt is the only test in which both lateral SCC function can be examined separately Chiar testVOR comparing eye velocity to head velocity ( ie – chair) - any asymmetry of response indicate vestibular syst defect. Dynamic PosturographyIt assess equilibrium as whole, test is not diagnostic for specific disease entities but usefull in: Monitoring patient progress in vestibular reha