Testing

By Marcello Cherchi, MD PhD

In order to arrive at a correct diagnosis, or a differential list of plausible diagnoses, practitioners use several tools.

1. Bedside physical examination

   1. ✅ Physical examination for otoneurology
   2. ✅ Bedside infrared video oculography
   3. ✅ Tests of the rotational vestibulo-ocular reflex
      1. ✅ Dynamic visual acuity testing
      2. ✅ Ophthalmoscope test
      3. ✅ Bedside head impulse testing
   4. ✅ Otoscopy (handheld, monocular)
   5. ✅ Bedside hearing tests (finger rub, whisper, Weber, Rinne)
   6. ✅ Romberg test
   7. ✅ Fukuda-Unterberger stepping test
   8. ✅ Vertebral artery testing
   9. ✅ Spontaneous retinal venous pulsations

2. Instrumented testing that requires more sophisticated equipment

   1. ✅ Why do we do testing at all?  Confidence and uncertainty.

   2. ✅ Binocular otomicroscopy

   3. Audiometric testing

      1. ✅ Audiometry
      2. ✅ Tympanometry
      3. ✅ Otoacoustic emissions (OAEs)
      4. ✅ Auditory evoked brainstem responses (ABRs)
      5. ✅ Electrocochleography (ECoG)

   4. Vestibular testing

      1. Tests that look at eye movements
         1. ✅ Why do we pay so much attention to eye movements?
         2. ✅ Magnetic scleral search coils
         3. ✅ Electronystagmography (ENG)
         4. ✅ Videonystagmography (VNG)
         5. ✅ Caloric testing
         6. ✅ Video head impulse testing (vHIT) and its variants
         7. ✅ Rotatory chair testing (RCT)
         8. ✅ Retinal imaging
         9. ✅ Measurement of ocular torsion

      2. Vestibular evoked myogenic potentials (VEMPs)

         1. ✅ General comments on vestibular evoked myogenic potentials
         2. ✅ Cervical vestibular evoked myogenic potentials (cVEMPs)
         3. ✅ Ocular vestibular evoked myogenic potentials (oVEMPs)

      3. ✅ Computerized dynamic posturography

      4. ✅ Tests limited to research settings

   5. Cardiovascular testing

      1. ✅ Tilt table testing (TTT)
      2. ✅ Cardiac monitoring

   6. ✅ Imaging in otoneurology

      1. ✅ MRI of the brain and internal auditory canals
      2. ✅ Temporal bone CT

3. ✅ Telehealth