Vestibular Examination

Question 1

What is one of the most common complaints that brings adults to a physician?

Answer 1

Dizziness.

Question 2

What are the four common descriptions patients might use instead of ‘dizziness’?

Answer 2

• vertigo
• light-headedness
• dysequilibrium
• oscillopsia

Question 3

What does vertigo indicate?

Answer 3

Vestibular involvement, either peripheral or central.

Question 4

What is dysequilibrium?

Answer 4

A sensation of being off balance, which can be due to vestibular or non-vestibular causes.

Question 5

What is oscillopsia?

Answer 5

An illusion of unstable vision, where stationary objects appear to move, especially with head movement.

Question 6

What vestibular conditions might cause vertigo?

Answer 6

• BPPV
• Unilateral vestibular hypofunction (UVH)
• Vestibular migraine
• Meniere’s disease

Question 7

What non-vestibular conditions might cause light-headedness?

Answer 7

• orthostatic hypotension
• hypoglycemia
• anxiety
• panic disorder
• cardiac dysfunction
• VBI
• polypharmacy

Question 8

What are the four ‘D’s that may indicate neurological involvement?

Answer 8

• Dysarthria - difficult to pronounce words
• Dysphagia - trouble swallowing
• Diplopia - double vision
• Drop Attacks - loss of consciousness

Question 9

What is the Dizziness Handicap Inventory (DHI)?

Answer 9

A 25-item self-report questionnaire that quantifies the impact of dizziness on a patient’s daily life.

• 0-35 = mild
• 36-53 = moderate
• 54+ = severe

Question 10

Score range on the DHI

• mild impact = ?
• moderate = ?
• severe impact = ?

Answer 10

• mild impact = 0-35
• moderate = 36-53
• severe impact = 54 +

Question 11

What is the purpose of the cranial nerve screening in a vestibular exam?

Answer 11

To rule out central nervous system involvement.

Question 12

What is nystagmus?

Answer 12

Rapid, rhythmic, involuntary eye movements.

Question 13

How is nystagmus named?

Answer 13

By the direction of the fast phase relative to the patient.

Question 14

What does spontaneous nystagmus at rest indicate?

Answer 14

It can indicate a peripheral vestibular lesion, especially if horizontal.

Question 15

How can you observe nystagmus more effectively?

Answer 15

Using infrared video goggles that prevent fixation and allow observation of eye movements.

Question 16

What does direction-fixed nystagmus indicate?

Answer 16

Typically, a peripheral vestibular lesion.

• Direction-fixed = always beating the same direction, regardless of where the patient looks

Question 17

What does direction-changing nystagmus indicate?

Answer 17

A central vestibular pathology.

Direction-changing = changes direction while the patient is gazing forward, or while the patient looks around.

Question 18

What is the ‘H’ test used for in the oculomotor exam?

Answer 18

To test extraocular range of motion and observe for pathological nystagmus.

Question 19

What does abnormal smooth pursuit indicate?

Answer 19

It may indicate central dysfunction such as cerebellar or brainstem involvement.

Question 20

What is the purpose of the head impulse test (HIT)?

Answer 20

To examine the VOR at high acceleration and identify vestibular hypofunction.

Question 21

What does a positive head impulse test indicate?

Answer 21

Vestibular hypofunction on the side toward which the head is turned.

Question 22

What is the dynamic visual acuity test (DVAT)?

Answer 22

A test that compares static visual acuity with visual acuity during passive horizontal head movements.

Question 23

What does a greater than 3-line difference in dynamic versus static visual acuity suggest?

Answer 23

VOR loss and vestibular hypofunction.

Question 24

What is the significance of the Dix-Hallpike test in vestibular examination?

Answer 24

It is a positional test used to diagnose BPPV.

Question 25

What vestibular conditions might cause dysequilibrium?

Answer 25

Bilateral vestibular loss, chronic unilateral vestibular hypofunction, peripheral neuropathy, cerebellar/motor pathway involvement, LE weakness.

Question 26

What are some key symptoms of vestibular dysfunction?

Answer 26

Vertigo, tinnitus, pressure in the ears, difficulty concentrating, feeling disoriented, difficulty watching moving objects, blurred vision with movement.

Question 27

What is lateropulsion?

Answer 27

A tendency to lose balance laterally, often leaning or falling toward the side of vestibular weakness.

Question 28

What balance tests can be used in a vestibular examination?

Answer 28

* Modified CTSIB * Romberg * Sharpened Romberg * Single leg stance * 4 Square Step Test * Functional Reach Test * Fukuda Stepping Test

Question 29

.

Answer 29

.

Question 30

What is the Fukuda Stepping Test used for?

Answer 30

To assess vestibular weakness by monitoring body rotation while the patient steps in place with eyes closed.

Question 31

What does a rotation greater than 30 degrees during the Fukuda Stepping Test suggest?

Answer 31

* Possible vestibular weakness * Patients usually rotate/deviate to the side of the vestibular weakness

Question 32

What does the Dynamic Gait Index (DGI) assess?

Answer 32

The ability to modify gait during various walking tasks.

Question 33

What does a positive [Dix-Hallpike](https://www.youtube.com/watch?v=7wMvTUPaNPo) test indicate?

Answer 33

Benign Paroxysmal Positional Vertigo (BPPV).

Question 34

What does the [head impulse test](https://www.youtube.com/watch?v=DrA4ERU2aG8) (HIT) assess?

Answer 34

The function of the vestibulo-ocular reflex (VOR) at high accelerations.

Question 35

What does the Dynamic Visual Acuity Test (DVAT) assess?

Answer 35

The **difference** between static visual acuity and visual acuity during passive horizontal head movements.

Question 36

What might a greater than 3-line difference between static and dynamic visual acuity suggest?

Answer 36

VOR loss and vestibular hypofunction.

Question 37

What is the significance of a positive [Romberg test](https://www.physio-pedia.com/Romberg_Test) in a vestibular examination?

Answer 37

It indicates a loss of proprioception or vestibular dysfunction.

Question 38

What might vertical nystagmus indicate?

Answer 38

Central vestibular system pathology.

Question 39

What does direction-fixed nystagmus suggest?

Answer 39

A peripheral vestibular lesion.

Question 40

What does direction-changing nystagmus suggest?

Answer 40

A central vestibular pathology.

Question 41

What does the 'H' test assess in a vestibular examination?

Answer 41

Extraocular range of motion and observation for pathological nystagmus.

Question 42

What does a positive Head Impulse Test indicate?

Answer 42

Vestibular hypofunction on the side being tested.

Question 43

What is dynamic visual acuity?

Answer 43

The clarity of vision during head movement, testing the VOR function.

Question 44

What is the purpose of the Dix-Hallpike test?

Answer 44

To diagnose BPPV by identifying positional nystagmus.

Question 45

What is VOR gain?

Answer 45

The ratio of eye velocity to head velocity, ideally 1:1 for normal function.

Question 46

What are corrective saccades during the head impulse test indicative of?

Answer 46

Vestibular hypofunction on the side being tested.

Question 47

What is a common symptom of BPPV?

Answer 47

Vertigo triggered by specific head positions.

Question 48

What does a decline in dynamic visual acuity indicate?

Answer 48

A loss of VOR function and possible vestibular hypofunction.

Question 49

What is the role of the vestibular nuclei?

Answer 49

Integration of sensory information from the vestibular system and coordination of motor output.

Question 50

What does spontaneous nystagmus at rest suggest?

Answer 50

Acute peripheral unilateral vestibular lesion or hypofunction.

Question 51

What does the Fukuda Stepping Test assess?

Answer 51

Spatial orientation and vestibular weakness.