Question
During Dr. Barin's course, Getting the Most of ENG/VNG Testing, he discussed performing positional head tests at a 30 degree angle instead of in supine position. Why is this recommended? What is considered "normal limits" for the patient in an inclined head position?
Answer
The main purpose of the static position test is to examine the effect of gravity on the labyrinth. When the patient is placed flat in the supine position, none of the semicircular canals is fully in the plane of gravity. In the standard caloric position, the lateral (horizontal) canals are in the plane of gravity and when the head is turned right or left from this position, the effect is primarily mediated by the lateral canals. I do not see much benefit to placing all three canals partially in the plane of gravity. That is why we do the test primarily from the standard caloric test. It also makes positioning the patient easier. We do not have to move the patient when going from the position to the caloric test. Finally, we can directly compare our position test results in the "supine" position with the baseline shift in the caloric test (another way of saying spontaneous nystagmus).
I am not sure what you use as normal limits for the position test. We use 4 deg/sec in VNG and 6 deg/sec in ENG as the only normal limit. In other words, if the nystagmus slow-phase-velocity is greater than one of those limits in any head position, we consider the finding abnormal. Otherwise, we report the nystagmus but denote it as non-significant/normal. With that criterion, the exact position or number of different head positions tested will not alter the normal limit. Please refer to this article I wrote a couple of years ago that provides justification for the above normal limits: www.otometrics.com/insights_may_2008_std.pdf
Kamran Barin, Ph.D. is the Director of Balance Disorders Clinic at the Ohio State University Medical Center and Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Department of Speech and Hearing Science, and Biomedical Engineering Program. He received his Master's and Doctorate degrees in Electrical/Biomedical Engineering from the Ohio State University. He has taught national and international courses and seminars in different areas of vestibular assessment and rehabilitation. Kamran Barin is a consultant to Otometrics and provides courses and other educational material to the company.
Kamran Barin, PhD
Director of Balance Disorders Clinic at the Ohio State University Medical Center and Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Department of Speech and Hearing Science, and Biomedical Engineering Program
Kamran Barin, Ph.D. is the Director of Balance Disorders Clinic at the Ohio State University Medical Center and Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Department of Speech and Hearing Science, and Biomedical Engineering Program. He received his Master’s and Doctorate degrees in Electrical/Biomedical Engineering from the Ohio State University. He has taught national and international courses and seminars in different areas of vestibular assessment and rehabilitation. Kamran Barin is a consultant to Otometrics and provides courses and other educational material to the company
Related Courses
1https://www.audiologyonline.com/audiology-ceus/course/guide-to-bithermal-caloric-testing-815A Guide to Bithermal Caloric TestingThe purpose of this course is to provide an in-depth discussion of the caloric testing portion of the VNG/ENG test battery. Content will include descriptions of testing procedures, analysis and interpretation of results.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comA Guide to Bithermal Caloric TestingThe purpose of this course is to provide an in-depth discussion of the caloric testing portion of the VNG/ENG test battery. Content will include descriptions of testing procedures, analysis and interpretation of results.815OnlinePT60M
The purpose of this course is to provide an in-depth discussion of the caloric testing portion of the VNG/ENG test battery. Content will include descriptions of testing procedures, analysis and interpretation of results.
2https://www.audiologyonline.com/audiology-ceus/course/guide-to-bithermal-caloric-testing-36752A Guide to Bithermal Caloric TestingThe purpose of this course is to provide an in-depth discussion of the caloric testing portion of the VNG/ENG test battery. Content will include descriptions of testing procedures, analysis and interpretation of results.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comA Guide to Bithermal Caloric TestingThe purpose of this course is to provide an in-depth discussion of the caloric testing portion of the VNG/ENG test battery. Content will include descriptions of testing procedures, analysis and interpretation of results.36752OnlinePT60M
The purpose of this course is to provide an in-depth discussion of the caloric testing portion of the VNG/ENG test battery. Content will include descriptions of testing procedures, analysis and interpretation of results.
3https://www.audiologyonline.com/audiology-ceus/course/addressing-fall-risk-pt-ot-38144Addressing Fall Risk: PT, OT, and Audiology Assessment and Intervention, presented in partnership with Salus UniversityMultidisciplinary assessment and intervention of individuals at risk of falls is crucial in identifying functional and diagnostic factors as well as effective rehabilitation and prevention of future falls. This series identifies areas of collaboration and supportive information-sharing strategies between professions who commonly see individuals who fall and are likely to be injured due to a fall.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comAddressing Fall Risk: PT, OT, and Audiology Assessment and Intervention, presented in partnership with Salus UniversityMultidisciplinary assessment and intervention of individuals at risk of falls is crucial in identifying functional and diagnostic factors as well as effective rehabilitation and prevention of future falls. This series identifies areas of collaboration and supportive information-sharing strategies between professions who commonly see individuals who fall and are likely to be injured due to a fall.38144OnlinePT180M
Multidisciplinary assessment and intervention of individuals at risk of falls is crucial in identifying functional and diagnostic factors as well as effective rehabilitation and prevention of future falls. This series identifies areas of collaboration and supportive information-sharing strategies between professions who commonly see individuals who fall and are likely to be injured due to a fall.
4https://www.audiologyonline.com/audiology-ceus/course/contemporary-concepts-in-pediatric-vestibular-35586Contemporary Concepts in Pediatric Vestibular Assessment and Management, presented in partnership with Seminars in HearingThis 5-part webinar series is focused on the growing evidence of the need for pediatric vestibular evaluation, as well as the availability of successful treatment options for children. Guest editors, Dr. Devin McCaslin and Dr. Jennifer Christy along with a team of leading experts will present on select articles from a recent issue of the journal Seminars in Hearing (Issue 03 · Volume 39 · 2018).auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comContemporary Concepts in Pediatric Vestibular Assessment and Management, presented in partnership with Seminars in HearingThis 5-part webinar series is focused on the growing evidence of the need for pediatric vestibular evaluation, as well as the availability of successful treatment options for children. Guest editors, Dr. Devin McCaslin and Dr. Jennifer Christy along with a team of leading experts will present on select articles from a recent issue of the journal Seminars in Hearing (Issue 03 · Volume 39 · 2018).35586OnlinePT300M
Presented by Sharon Cushing, MD, FRCSC, Katheryn Bachmann, PhD, Violette Lavender, AuD, Jennifer B. Christy, PhD, PT, Steven M. Doettl, AuD, PhD, Devin L. McCaslin, PhD, Kristen L. Janky, PhD, Amanda I. Rodriguez, PhD, AuD
AudiologyOnline
Presenters
Sharon Cushing, MD, FRCSCKatheryn Bachmann, PhDViolette Lavender, AuDJennifer B. Christy, PhD, PTSteven M. Doettl, AuD, PhDDevin L. McCaslin, PhDKristen L. Janky, PhDAmanda I. Rodriguez, PhD, AuD
This 5-part webinar series is focused on the growing evidence of the need for pediatric vestibular evaluation, as well as the availability of successful treatment options for children. Guest editors, Dr. Devin McCaslin and Dr. Jennifer Christy along with a team of leading experts will present on select articles from a recent issue of the journal Seminars in Hearing (Issue 03 · Volume 39 · 2018).
5https://www.audiologyonline.com/audiology-ceus/course/improving-ehdi-with-caeps-clinical-31492Improving EHDI with CAEPs: Clinical Assessment of the Cortical Auditory Evoked Potential in Children with Hearing LossThis course will provide an overview of cortical auditory evoked potentials, current research, benefits and limitations to using CAEPs in a busy clinic, and several case studies.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comImproving EHDI with CAEPs: Clinical Assessment of the Cortical Auditory Evoked Potential in Children with Hearing LossThis course will provide an overview of cortical auditory evoked potentials, current research, benefits and limitations to using CAEPs in a busy clinic, and several case studies.31492OnlinePT60M
'Very pragmatic presentation regarding the clinical applications of cortical auditory evoked potentials and the value in using this procedure for the assessment of infants and children'Read Reviews
This course will provide an overview of cortical auditory evoked potentials, current research, benefits and limitations to using CAEPs in a busy clinic, and several case studies.