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26 The Most Common Audiovestibular Laboratory Tests, and the Specific Conditions in Which They May Assist in Making or Supporting the DiagnosisVN = vestibular neuritis; VM = vestibular migraine; VP = vestibular paroxysmia; vHIT = video head impulse test; VNG = video-nystagmography; ENG = electronystagmography; VOG = video-oculography; VEMPs = vestibular evoked myogenic potentials; SCDS = superior canal dehiscence syndrome; BPPV = benign pa...Text
27 The Most Common Vestibular Conditions Categorized by Timing and Triggers, with Specific Historical Features that Should be Sought for Each (Adapted from Approach to the Ocular Motor and Vestibular History and Examination)Adapted from https://collections.lib.utah.edu/ark:/87278/s64x9bq1Text
28 The Most Common Vestibular Conditions Categorized by Timing and Triggers, with Specific Ocular Motor and Vestibular Features that Should be Sought for EachHINTS+ = Head Impulse, Nystagmus, Test of Skew, ‘Plus' bedside assessment of auditory function; HIT = head impulse test; NP = nerve palsy; BPPV = benign paroxysmal positional vertigo; SCDS = superior canal dehiscence syndrome; BVL = bilateral vestibular loss; PPPD = persistent postural perceptual ...Text
29 Right Dix Hallpike TestThe Dix-Hallpike tests for benign paroxysmal positional vertigo (BPPV). A test is positive when a patient reports vertigo, dizziness, or sensation of movement or falling with nystagmus present. When the head is in this position, it allows the posterior canal to be aligned with the gravitational vect...Text
30 Right Half Hallpike TestThe Half Hallpike Test compliments the Dix Hallpike Test and is traditionally used to assist with the diagnosis of posterior canal-benign paroxysmal positional vertigo (BC-BPPV), cupulolithiasis, as it may produce a greater degree of deflection under the action of gravity without latency when the ot...Text
31 Rotary Chair Testing𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Rotary chair testing includes rotation around a vertical axis, and evaluates the horizontal semicircular canal vestibulo-ocular reflex (VOR). The patient sits in a mechanized chair with the head secured in a neutral posi...Text
32 Secondary Stroke PreventionA brief overview of secondary stroke prevention. (TIA = Transient Ischemic Attack)Text
33 Semicircular PathwaysOnce the semicircular canal fibers leave the peripheral labyrinth, they synapse in the ipsilateral vestibular nucleus, and then ascend to the ocular motor nuclei. This enables the vestibulo-ocular reflex to respond to head movements in the plane of any canal or combination of canals.Text
34 Short Canal Repositioning Maneuver for Anterior Canal BPPVThe Short Canal Repositioning Maneuver is used to treat anterior canal BPPV. 1. The patient's head is rotated 45-degrees towards the affected side. 2. The patient's maintains head in a 45-degree position and enters a head hanging position (40 degrees below the horizontal). 3. The patient then mainta...Text
35 Side-lying Test for Right BPPVThe side-lying test is an alternative for the Dix Hallpike Test as it reduces the need for cervical extension. The interpretation of a positive test is the same as the Dix Hallpike Test.Text
36 Square Wave Maneuver for Apogeotropic Horizontal Canal BPPVThe square wave maneuver is designed to treat individuals with horizontal canal cupulolithaisis and is commonly used when individuals have cervical restrictions and the affected side is not well identified at baseline. 1. The patient begins in the supine position with the head 20 to 30 degrees above...Text
37 Summary of the Most Common Audio-Vestibular TestingChart describing common audio-vestibular testing.Text
38 Supine Head-Hanging TestThe supine head-hanging test is more sensitive for AC-BPPV, but it does not differentiate laterality, as both canals are stimulated at the same time [1-3]. When the individual returns to a seated position, the otoconia should hypothetically move closer to the utricle, which continues their ampullofu...Text
39 Supine Roll Test/Pagnini-McClure TestThe supine roll test or the Pagnini-McClure Test is used to assess for horizontal canal benign paroxysmal positional vertigo. A test is positive when a patient reports vertigo, dizziness, or sensation of movement or falling with nystagmus present. Apogetropic nystagmus is indicative of cupulolithias...Text
40 Test of LatencyThe Test of Latency is used to identify which side is involved for patients with horizontal canal BPPV and is used in conjunction with the Supine Roll Test. For canalithiasis, lateralization is considered the side with a shorter latency time. For cupulolithasis, lateralization is considered the side...Text
41 Vertical Vergence and Fusional AmplitudeEssential information on vertical fusional vergences.Text
42 Vestibular Evoked Myogenic Potentials (VEMPs)𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Vestibular-evoked myogenic potentials (VEMP) are electromyographic potential reflex tests that reflect the function of the saccule in cervical VEMP and the utricle in ocular VEMP.1 In the cervical VEMP an inhibitory refle...Text
43 Video Head Impulse Testing𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: The video head impulse test (vHIT) is a clinical assessment technique used to assess the function of the semicircular canals-the angular acceleration detectors-which initiate the vestibulo-ocular reflex (VOR). The HIT and...Text
44 What is the Cause of My Patient's Hearing Loss?This is a flowsheet differentiating multiple causes of hearing loss. The onset and chronicity of hearing loss is a critical starting point in understanding whether urgent action is needed, such as in the setting of suspected stroke or sudden sensorineural hearing loss. For hearing loss that has been...Text
45 Yacovino Maneuver or the Deep Head Hanging Maneuver for Anterior Canal Benign Paroxysmal Positional VertigoThe Yacovino maneuver is used to treat anterior canal benign paroxysmal positional vertigo (AC-BPPV) and does not require the clinician to distinguish which side is involved. Additionally, when the patient completes cervical flexion, the motion may cause otoconial debris to enter the posterior semi...Text
46 Zuma Maneuver for Right Horizontal Canal Cupulolithiasis (Apogeotropic Nystagmus)The Zuma Maneuver is used to treat horizontal canal cupulolithiasis (apogeotropic nystagmus). 1. The patient begins in a seated position. 2. The patient transitions quickly to lying position on their affected side, with their head in neutral, and maintains this position for three minutes. 3. The pat...Text
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