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Examination methods 

Examination methods
Chapter:
Examination methods
Author(s):

Béla Büki

and Alexander A. Tarnutzer

DOI:
10.1093/med/9780199680627.003.0005
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date: 07 April 2020

Bedside testing (ocular motor and other neurological signs) during an acute attack of vertigo may yield invaluable information. The head impulse test (HIT) assesses the vestibulo-ocular reflex (VOR) in its physiological working range. The utricle and saccule may be stimulated by air-conducted and bone-conducted vibrations. The saccule has neural connections to the ipsilateral sternocleidomastoid muscle, and the utricle projects strongly to contralateral ocular muscles. By choosing the corresponding electrode montage to record myogenic electrical activity elicited by short vibrations, it is possible to test the saccular (vestibulo-collic) and the utricular (vestibulo-ocular) reflex separately. Endolymphatic hydrops can be detected by non-invasive electrocochleography (Ecochg), thereby aiding the differential diagnosis of Menière’s disease (MD), especially before considering ablating procedures such as intratympanic gentamicin instillation.

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