Vestibular Assessment

  • VEMP (Vestibular Evoked Myogenic Potentials)
  • v-HIT (Video – Head Impulse Test)
  • VNG (Videonystagmography)
Vestibular Evoked Myogenic Potentials
VEMP test is a test to evaluate Otoliths Functioning.  
c VEMP (Cervical VEMP)
c VEMP assess the functioning of Saccule and the inferior part of the Vestibular Nerve. The reflex is known as Vestibulocollic reflex . Loud sounds cause a strong movement of Oval Window. This movement simulates the saccule mechanically due to its close proximity to the oval window. This stimulates an action potential and reflexly stimulates neck muscles. This is recorded as a VEMP response.  
O VEMP (Occular VEMP)
o VEMP evaluates the functioning of Utricle and Superior part of the Vestibular Nerve. The sound evoked Occular VEMP evaluates the ipsilateral utricle and the ipsilateral superior vestibular nerve but the response is picked up from the contralateral inferior oblique muscle below the eye.  
v-HIT (Video – Head Impulse Test)
Video Head Impulse test evaluates the status of the three semicircular canals on each side at high frequencies of vestibular stimulation. This test works on testing the Vestibulo ocular Reflex (VOR) of all 3 Semicircular canals.  
VNG is a test to evaluate the Occulomotor system and Vestibular system. This test aims to identify the origin of Vertigo (Central or Peripheral)
VNG includes the following subtests
Occulomotor function tests (saccade, smooth pursuit, and optokinetic). This part tests the oculomotor system, which is the neural network that controls eye movements.
  • Saccades are voluntary and reflexive rapid eye movements of varying amplitude that abruptly change a point of fixation and may be used to bring a target object into the center line of sight.
  • Smooth pursuit refers to tracking eye movements that enable stable gaze to be sustained on a moving object or on a stationary target when the head is moving slowly.
  • Optokinetic nystagmus or optokinetic tracking refers to a normal reflexive response of the eyes when confronted with large-scale movement in the visual field.
  • Gaze stabilization tests (gaze, spontaneous nystagmus, and static position). This assesses angular vestibulo-ocular reflex contribution to gaze stability.
  • Positional tests (e.g. Dix-Hallpike test, epley’s test). This test assesses if the dizziness is related to BPPV.
  • Subjective visual vertical and horizontal (SVV/SVH) assessments evaluate an individual’s verticality to various spatial axes. The subjective visual vertical (SVV) test investigates the function of utricle. Important tool in diagnosing Vestibular lesions of Unilateral Peripheral Origin
The Electrocochleography test is an objective measure of the electrical potentials generated in the inner ear as a result of sound stimulation. This test is most often used to determine if the inner ear (cochlea) has an excessive amount of fluid pressure. This test is used to confirm the presence of Meniere’s Disease by calculating the SP/AP ratio.

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