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VESTIBULAR SYSTEM
Urmila Rawat
Investigations of vestibular system involves two categories:
They are:
This law may not hold true in case of nystagmus of central region
PROCEDURE:
Patient is seated in front of the examiner/lie in supine position on
bed
Examiner keeps his finger 30cm away from patient’s eye in central
position
peripheral central
PERIPHERAL CENTRAL
LATENCY 2-20 s No latency
DURATION Less than 1 min More than 1 min
DIRECTION OF NYSTAGMUS Direction fixed towards the Direction changing
under most ear
FATIGUABILITY fatiguable nonfatiguable
ACCOMPANYING SYMPTOMS Severe vertigo none or slight
FISTULA TEST
PRINCIPLE:
Induce NYSTAGMUS
ABNORMALITY: POSITIVE
Erosion of horizontal semi-circular canal- cholesteatoma
Surgically created window in horizontal canal- fenestration
operation
Abnormal opening in oval window- poststapedectomy fistula
Abnormal opening in round window- rupture of round window
membrane
ALSO INDICATES THAT LABYRINTH IS STILL FUNCTIONAL
RUPTURE OF ROUND WINDOW MEMBRANE
FALSE NEGATIVE FISTULA TEST :
IN CHOLESTEATOMA: it covers the site of fistula
and it doesn’t allow pressure changes to be
transmitted to the labyrinth
IN LABYRINTH DEAD
FALSE POSITIVE FISTULA TEST :
Means +ve test without presence of fistula
It is seen in two conditions : 1.congenital syphilis
2.Meniere’s disease.
Congenital syphilis: stapes footplate is hypermobile
Meniere’s disease: due to fibrous bands connecting
utricular macula to the stapes
footplate.
ROMBERG TEST
PROCEDURE :
Patient is asked to stand with feet together and arms by side with eyes first
open and then closed.
With eyes open : patient can still compensates the balance
With eyes closed : patient cant compensate –Here VESTIBULAR SYSTEM is at
MORE DISADVANTAGE
Peripheral: Central:
Patient sways to instability
side of lesion
If patient perform this test without sway then SHARPENED ROMBERG TEST is
performed.
On Nystagmus
NYSTAGMUS IS
subsequent disappears
FATIGUABLE
repetition altogether
IN CENTRAL LESIONS Tumours of 4th ventricle
Cerebellum
Temporal lobe
Multiple sclerosis
Vertibrobasilar insufficiency
or
Raised intracranial tension
Nystagmus is produced immediately
as soon as the head is in critical
position
No latency
Duration: lasts as long as head is in
that critical position
Direction: changes
Fatiguability: nonfatiguable
TEST OF CEREBELLAR DYSFUNCTION
For cerebellar diseases – all cases of giddiness should be tested.