Hostname: page-component-848d4c4894-p2v8j Total loading time: 0.001 Render date: 2024-05-14T21:51:24.924Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of techniques for identification of peripheral vestibular nystagmus

Published online by Cambridge University Press:  26 October 2012

P D B West ,
Z A Sheppard  and
E V King
P D B West*
Affiliation:
Department of Audiovestibular Medicine, Queen Alexandra Hospital, Portsmouth, UK
Z A Sheppard
Affiliation:
School of Health and Social Care, Bournemouth University, UK
E V King
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, Poole Hospital NHS Foundation Trust, UK Cancer Sciences Division, University of Southampton, UK
*
Address for correspondence: Dr P D B West, Department of Audiovestibular Medicine, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth PO6 3LY, UK Fax: +44 (0)2392 283238 E-mail: pdbwest@doctors.org.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine the best clinical method for identifying peripheral vestibular nystagmus, by comparing eye movement examination with optic fixation, and with fixation removed using Frenzel's glasses, infra-red video-Frenzel's goggles or an ophthalmoscope, with results of electronystagmography.

Method:

One hundred patients referred for electronystagmography from the audiovestibular medicine clinic at Queen Alexandra Hospital, Portsmouth, were examined immediately before undergoing electronystagmography.

Results:

Video-Frenzel's goggles were highly effective at detecting peripheral vestibular nystagmus, with a sensitivity of 85 per cent (95 per cent confidence interval, 62.1–96.8 per cent) and a specificity of 65 per cent (53.5–75.3 per cent), compared with electronystagmography. Ophthalmoscopy had comparable sensitivity to Frenzel's glasses (used in the dark), i.e. 26.3 per cent (9.1–51.2 per cent) compared with 31.6 per cent (12.6–56.6 per cent), respectively. Frenzel's glasses as normally used in ENT clinics (i.e. in dim lighting) were ineffective, with a sensitivity of just 10 per cent (1.2–31.7 per cent).

Conclusion:

Video-Frenzel's goggles should be used in all clinics with substantial numbers of balance-impaired patients. Traditional Frenzel's glasses have no place in clinical practice unless formal black-out facilities are available.

Keywords

VertigoDiagnosisNystagmusElectronystagmographyFrenzel's Glasses
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 12 , December 2012 , pp. 1209 - 1215
Copyright
Copyright © JLO (1984) Limited 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented in abridged, poster form at the British Society of Audiology Annual Conference, 8–10 September 2010, Manchester, UK

References

1Reker, U. Peripheral-vestibular spontaneous nystagmus. Analysis of reproducibility and methodologies. Arch Otorhinolaryngol 1980;226:225–237CrossRefGoogle Scholar
2Jeffcoat, B, Shelukhin, A, Fong, A, Mustain, W, Zhou, W. Alexander's Law revisited. J Neurophysiol 2008;100:154–9CrossRefGoogle ScholarPubMed
3Ben-David, Y, Hafner, H, Fradis, M, Krasnitz, G, Podoshin, L. Do Frenzel glasses have a place in the modern electronystagmography laboratory? Am J Otol 1996;17:89–92Google ScholarPubMed
4Strauss, P, Meyer zum Gottesberge, A. Caloric nystagmus: ENG in comparison with observation by Frenzel's glasses. Adv Otorhinolaryngol 1979;25:134–7Google ScholarPubMed
5Baba, S, Fukumoto, A, Aoyagi, M, Koizumi, Y, Ikezono, T, Yagi, T. A comparative study on the observation of spontaneous nystagmus with Frenzel glasses and an infrared CCD camera. Journal of the Nippon Medical School 2004;71:25–9CrossRefGoogle Scholar
6Mulch, G, Lewitzki, W. Spontaneous and positional nystagmus in healthy persons demonstrated only by electronystagmography: physiological spontaneous nystagmus or “functional scar”? Arch Otorhinolaryngol 1977;215:135–45CrossRefGoogle ScholarPubMed
7Guidetti, G, Monzani, D, Rovatti, V. Clinical examination of labyrinthine-defective patients out of the vertigo attack: sensitivity and specificity of three low-cost methods. Acta Otorhinolaryngol Ital 2006;26:96–101Google ScholarPubMed
8Sills, AW, Baloh, RW, Honrubia, V. Caloric testing 2. Results in normal subjects. Ann Otol Rhinol Laryngol Suppl 1977;86(suppl 43):7–23CrossRefGoogle ScholarPubMed
9British Society of Audiology: Recommended procedure: The caloric test. In: http://www.thebsa.org.uk/docs/RecPro/CTP.pdf [15 February 2012]Google Scholar
10Jongkees, LB, Maas, JP, Philipszoon, AJ. Clinical nystagmography. A detailed study of 341 patients with vertigo. Pract Otorhinolaryngol (Basel) 1962;24:65–93Google ScholarPubMed
11Bland, M.An Introduction to Medical Statistics, 3rd edn.Oxford: Oxford University Press, 2009Google Scholar
12Coates, AC. The diagnostic significance of spontaneous nystagmus as observed in the electronystagmographic examination. Acta Otolaryngol 1969;67:33–42CrossRefGoogle Scholar
13Department of Health. Provision of Adult Balance Services: A Good Practice Guide. London: Department of Health, 2009Google Scholar