Vestibular Event Monitor Provides Accurate Vertigo Diagnosis

Royal Prince Alfred Hospitals that record spontaneous and positional nystagmus eye movements may rapidly and accurately diagnose vertigo, claims a new study.

Researchers at the University of Sydney (US; Australia) and Royal Prince Alfred Hospital (RPA; Sydney, Australia) conducted a study to test a new system that could facilitate the diagnosis of vestibular disorders by capture of uncontrolled eye movements (known as ictal nystagmus). To do so, they developed miniature video-oculography goggles, consisting of lightweight swimming goggles inlaid with two infrared (IR) lights in the left ocular and attached to an audio/video recorder, thus enabling vision-denied recording of the uncontrolled left ictal nystagmus that accompany vertigo.

The study included 117 consenting patients with ictal video recordings and a final unblinded clinical diagnosis of Ménière disease (MD), vestibular migraine (VM), or benign paroxysmal positional vertigo (BPPV). The patients were taught to self-record spontaneous and positional nystagmus at home during spontaneous and positional vertigo. The video recordings included four positional components - sitting upright for 10 seconds; lying in supine position for 30 seconds; lying on the right side for 30 seconds; and lying on the left side for 30 seconds. Patients were also instructed to verbally report head orientation while recording.

The results showed the diagnostic accuracy of the goggles was highly effective in separating BPPV patients from those with other forms of positional vertigo, with a sensitivity of 100% and a specificity of 78%. It also showed diagnostic accuracy in patients with MD, characterized by high-velocity spontaneous horizontal nystagmus (95% sensitivity, 82% specificity) and in VM (93% sensitivity, 24% sensitivity). This spontaneous nystagmus was absent or minimal in all seven patients with BPPV. The study was published on May 15, 2019, in Neurology.

“Recurrent vertigo has ictal characteristics that assist with identification of the underlying inner ear balance disorder, and in the future we will be able to profile these disorders and separate them by their ictal nystagmus patterns,” said senior author Miriam Welgampola, PhD, of US and RPA. “Providing people with a pair of goggles that they can easily use at home to record eye movement has the potential to help with vertigo diagnosis, not only by a neurologist in clinic but also by physicians in an emergency room and physicians diagnosing patients remotely as well.”

The vestibular system includes the parts of the inner ear and brain that process the sensory information involved with controlling balance and eye movements. Commonly diagnosed vestibular disorders include BPPV, MN, labyrinthitis and vestibular neuritis, perilymph fistula, and secondary endolymphatic hydrops. Other problems related to vestibular dysfunction include vestibular migraine and complications from autoimmune disorders and allergies.

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University of Sydney
Royal Prince Alfred Hospital