generate barcode in c# asp.net Tests of Labyrinthine Function in Microsoft Office

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Tests of Labyrinthine Function
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The most rudimentary test of labyrinthine function is simply to have the patient shake his head from side-to-side in an attempt to
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elicit symptoms that simulate the dizziness that has been described and to observe the degree of postural instability during this maneuver Falling and marked intensi cation of the dizziness is almost always an indication of labyrinthine disease Also, nystagmus may be evoked, indicating a vestibular instability More informative is the rapid head impulse test, which is conducted by asking the patient to xate on a target and then for the examiner to quickly rotate the patient s head by 10 degrees (an explanation must be given to encourage the patient to relax the neck muscles and remain focused on the xation point) The eyes are observed for a slippage from the target; this is most evident by a quick saccadic return to the point of focus Ocular instability is elicited when the patient turns his head toward the side of the affected labyrinth This use of the vestibulo-ocular re ex is said by Halmagyi to be among the most dependable bedside tests of labyrinthine function Maneuvers designed to elicit positional vertigo by rapidly changing from a seated to a supine position with the head turned to one side bring about vertigo in a number of conditions but are speci cally intended to detect so-called benign positional vertigo and are described further on A number of other interesting but unvalidated tests that bring out instabilities in station and gait may be used to supplement the conventional tests for vestibular dysfunction The Unterberger maneuver requires the patient to march in place with eyes closed and arms outstretched Normally, less than 15 degrees or so of rotation is displayed; asymmetry of labyrinthine function is manifest as excessive rotation away from the diseased side A related test attributed to Fukada involves having the patient walk around a chair with eyes closed; an increasing or decreasing radius is indicative of an imbalance between the two sides of the labyrinthine apparatus Both of these tests, however, often show abnormalities with cerebellar disease as well, and the sensitivity of maneuvers such as these has been questioned We can only comment that they seem in our experience to demonstrate vestibulocerebellar lesions but are no more helpful than other less elaborate bedside investigations Irrigation of the ear canal alternately with cold and warm water (caloric or oculovestibular testing) may be used to disclose a reduction in labyrinthine function in the form of an impairment or loss of thermally induced nystagmus on the involved side In caloric testing, the patient s head is ideally tilted forward 30 degrees from the horizontal; this brings the horizontal semicircular canal into a vertical plane, the position of maximal sensitivity of this canal to thermal stimuli Each external auditory canal is irrigated for 30 s, rst with water at 30 C and then at 44 C (7 C below and above body temperature), with a pause of at least 5 min between each irrigation In normal persons, cold water induces a slight tonic deviation of the eyes to the side being irrigated, followed, after a latent period of about 20 s, by nystagmus to the opposite side (direction of the fast phase) Warm water induces nystagmus to the irrigated side (As noted in Chap 14, this is the basis for the mnemonic COWS : cold opposite, warm same, referring to the direction of compensatory nystagmus) In normal subjects, the nystagmus usually persists for 90 to 120 s, although the range is considerably larger Nausea and symptoms of excessive re ex vagal activity may occur in sensitive individuals Simultaneous irrigation of both canals with cold water causes a tonic downward deviation of the eyes, with nystagmus (quick component) upward Bilateral irrigation with warm water yields a tonic upward movement and nystagmus in the opposite direction Caloric testing will reliably answer whether the vestibular end organs react, and comparison of the responses from the two ears will
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