II. Definition

  1. Vestibular Testing

III. Indication

  1. Paroxysmal Positional Vertigo Exam
    1. Vertigo evoked by position change
    2. No symptoms at rest

IV. Contraindications

  1. Elderly with significant carotid vascular disease

V. Procedure

  1. Patient starts in sitting position on exam table
    1. Facing forward with eyes open
  2. Rapidly lie patient backward
    1. Head turned 45 degrees to RIGHT
    2. Neck extended 20 degrees hanging over end of table
    3. Patient remains in this position for 30 seconds
  3. Sit patient up
  4. Rapidly lie patient backward
    1. Head turned 45 degrees to LEFT
    2. Neck extended 20 degrees hanging over end of table
    3. Patient remains in this position for 30 seconds
  5. Observe
    1. Nystagmus
    2. Vertiginous symptoms

VI. Interpretation: Positive

  1. Signs suggestive of Paroxysmal Positional Vertigo
    1. Vertigo
    2. Rotary Nystagmus
      1. Globe torques around central axis
      2. Counterclockwise or clockwise
    3. Latent period follows procedure before Nystagmus
    4. Response Fatigues or habituates on repetition

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