Topic #3 - Are you performing the most efficient assessment based on the information from the case history and physical exam?

This newsletter series will explain how you can achieve vast time savings and yet gain more confidence in the diagnosis of the patient suffering from the most frequently diagnosed peripheral disorders. The goal of assessing the patient with vestibular symptoms is to determine if the disorder is unilateral or bilateral, what end organ is contributing to the disorder and the severity of the disorder, and assessing recovery after the onset of the disorder.

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Case History

Presence of vertigo (attacks of a spinning sensation), hearing loss, tinnitus, and a sensation of fullness in the affected ear. Episodes typically last ~ 2 hours. Hearing loss is intermittent, occurring mainly at the time of the attacks. Low pitched sounds are more difficult to hear. Loud sounds are uncomfortable. 

Physical Exam & Spontaneous
Nothing significant reported

Audiogram: Ipsilateral sensorineural hearing loss with involvement in the low frequencies

Impulse
Increased Gain may be observed -  Other causes for the eye leading the head (such as improper setup) have been ruled out.

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VEMP
cVEMP:
Reduction of amplitude on affected side:

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oVEMP:
Increased amplitude as compared to normals (about 5-6uV).

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Caloric
Unilateral Weakness may be observed

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What is the Diagnosis?

  1. Meniere’s Disease
  2. Superior Vestibular Neuritis
  3. Vestibular Migraine
  4. Inferior Vestibular Neuritis

Learn more
Diagnostic booklet – Describing the global trend in vestibular testing
Reimbursement for Vestibular Testing – US version – Current avg. reimbursement reported is $64
The Complete Test of the Vestibular Peripheral System - Ian S. Curthoys, PhD
A Video Head Impulse Test Pioneer: Dr. Leonardo Manzari
Analysis video

 

 
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