Diagnostic tests for vertigo
Posted , 3 users are following.
Knowing that a friend was going to a balance clinic to have her vertigo investigated, several posters thought it would be useful if I started a thread detailing what happened, so here it is. I’m afraid it’s going to take up a lot of space but I hope it will be useful to some people. I’m going to do it as a series of comments to avoid it being one massive post.
These tests took place at the balance clinic in an ENT department of a London hospital. It may be different elsewhere.
I need to be clear at the outset that my friend is visually and hearing impaired and could not complete some of the tests.
0 likes, 15 replies
mistibluey
Posted
The first appointment was with the physio who took a medical history of any other conditions, allergies, all meds and asked a lot of questions about how and when the vertigo started. Did any other symptoms accompany it, anything make it worse or better. How many attacks, how frequent. Was there a pattern. Was it accompanied by any other symptoms such as vomiting, tinnitus, ear fullness, headaches. Were there any noticeable triggers?
She examined the outer part of ears for infection or inflammation.
Blood pressure sitting down, lying down and standing from sitting position.
Tests:
The first was the Dix Hallpike manoeuvre to test for BBPV. There are descriptions & videos of this test online.
Then she tested the cervical spine for range of movement.
To test balance my friend had to try to stand with feet touching each other and her arms crossed over her chest, first with eyes open and then with them closed. Then to try to walk in a straight line toe to heel.
I don’t know the name of the next test but it tests vestibular function. She had to sit in a chair with feet on a footrest so there was no contact with the floor, wearing goggles that completely cut out all light and headphones that cut out all sound too.
She had to sit quietly for a while and then was spun round in the chair first in one direction and then the other, rapidly. With not being able to see or hear anything, and with nothing touching the floor the brain only has the inner vestibular balance signals from the ears to tell it where you are in space.
She felt very dizzy as soon as the chair stopped spinning.
mistibluey
Posted
The next series of tests was with the audiologist.
First part was a standard hearing test. She had to press a button when she heard a beep. First one ear and then the other. Second part was where special headphones were put on that gave a loud hissing noise in one ear and she had to say when she heard a beep in the other ear. The shushing sound got progressively louder.
mistibluey
Posted
The third person that she saw was for Audio vestibular assessment:
Because of her poor sight not all of the tests could be performed; the tests that she could not do would have involved sitting while wearing goggles that cut all outside vision. She would have then had to follow the movements of a small white dot while her eye movements were videoed. I believe these tests are called video Frenzel tests.
The test she could do involved lying down on a couch with a very large screen at the foot end of it that could be the technician, and by me, but not by the patient. She had to lie down with goggles on. The goggles cut out light and also filmed eye movements, which could be seen on the large screen and also on a pc screen in front of the tech.
She had to lie flat and “look at the ceiling”, though she could not see it of course while the tech used a machine that blew cold and then warm air into each ear. There were 4 rounds in total. She had to keep her eyes wide open through each round but could relax them in between.
This test is supposed to trigger the vestibular system into a vertigo attack. I could see her eyes flickering on the screen but she said after that she was unaware of this herself. Some people feel ill or have vertigo afterwards, but she rested on the couch with no goggle on for a while and was fine when she sat up.
The technician said that the test produces vertigo in some people , but that they usually recover from it much faster than after a “normal” attack.
She was tired after all the tests but felt ok. Then, on the way home, she got a minor wooziness, rather than full vertigo but was soon ok again.
mistibluey
Posted
If anything was not clear please feel free to ask
Good luck and best wishes to everyone. M
JMJ mistibluey
Posted
Dear Misti,
Sounds like your friend had a very compreshensive set of tests. All of the standard "rule out" tests were there for BPPV. The audiogram will give them a LOT of data....There's a peculiar curve to the audiogram of an MD patient.
How did she EVER endure being spun around in the chair?? I would have thrown up everywhere! THAT sounds barbaric!!!
Wow. That was some vigorous testing. I hope and pray that they come up with some definite conclusions, and she can be put on a regimen that will keep her vertigo at bay. Vestibular rehab and balance retraining were very helpful for me, but with your friend's low vision, I wonder if they'd be able to offer her that route . It requires that you use your eyes, to override the messages being sent to the brain by the compromised ear. Still, she might benefit from balance re-training....It gave me a lot more confidence walking. I never imagined that I could build "balance muscles", but I did.
Sounds like your friend has given them everything they could possibly need to work with. How long before she receives a diagnosis and treatment plan?
Take good care,
J-
mistibluey JMJ
Posted
Thanks for replying
Although she has to wait to see a consultant for a diagnosis, the physio did say that she could rule out BPPV.
The NHS is under a lot of pressure at the moment so it could be up to 3 months before she sees the consultant.
JMJ mistibluey
Posted
Three months! She's been waiting for such a long time, already. I'm sorry she has to go through this. Her symptoms have always sounded so classic to me — I'm not surprised to hear that it isn't BPPV.
I hope she has some decent rescue meds to get her through until she can get on a good treatment regimen. I wonder if she'd be a good candidate for steroid injections.
What's going on with the NHS, that people are having such long waiting times? I've seen others posting about long wait times, as well. Is there unusual demand on the system these days? What's happening?
Take good care,
J-
mistibluey JMJ
Posted
Hi J
I’m sorry that I didn’t see your question about the NHS when you posted it weeks ago. The NHS has been seriously underfunded for many years now. She did get an appointment sooner than many poor souls on this forum; I think it was pure dumb luck - we have a system of e-booking in some places, and when I logged in for her I saw this single, solitary appointment that was being offered, just the one day and the one time. I think someone had just gone online and cancelled it.
If you Google (without the quotation marks) “this crisis in the worse in NHS history – our health service is at risk of irreparable damage” you should get a short but interesting article about the NHS in the UK version of the Huff Post.
My friend is still waiting for an appointment with the consultant. Yes, I think her symptoms do sound fairly classic for MD, but it is possible it’s something else. We will have to wait and see.
In the US I suppose you have the problem of what your insurance will pay for. I don’t know what someone with this condition does if they have no insurance and don't qualify for Medicare ( have I got than one right?).
JMJ mistibluey
Posted
Hi Misti,
Thanks for the key words...I will Google for the article about the NHS.
Yes, we always have problems around what insurance will or will not pay for. And each plan is different, and each year the plans change. I'm fortunate to have the insurance plan that I have, but even so, I have heflty co-pays. And a few times, I have had to appeal their denials of my claims, which requires an enormous amount of time, energy and paperwork.
You have to be 65 or older in order to qualify for Medicare. And even with Medicare, everyone needs to buy a "Medi-gap" plan that will cover part of what Medicare won't. Medicaid is available to very low income families, pregnant women, the elderly and the disabled.
The Affordable Care Act is soon to be repealed and replaced by this new administration. Or, that's what they say. We'll see. Sigh.
Thanks again. Take care.
J-
JMJ mistibluey
Posted
Hi Misti,
I just read the article you recommended: Wow. I had no idea what was going on with the NHS, and how fast that it all has happened. Thank you so very much for giving me the key words. The crux of the arguments don't sound that different from a lot that's going on here in the US.
How does something so basic as healthcare, get so exploited and abused by governmental and business forces? I would think that it would be in everyone's best interest to make a huge investment in the good health of the country. It just makes sense!
It's interesting. I can remember that in the US, during the 70's and 80's, the health care system seemed to be in good balance. Insurance prices were reasonable, typically well-funded by employers, and doctors and hospitals always accepted all of the major insurers. Additionally, a lot of free care was dispensed by hospitals — no one without insurance would be turned away in those days. And unpaid health care bills were not considered when it came to credit scores.
Something began to unravel in the 90's. Big Insurance and Big Pharma began to get Big Greed. In response, doctors offices and hospitals began adopting a more corporate/for-profit model of health care. And the race was on. Now, we're in a big mess.
It's hard to believe how quickly the power has shifted from the hands of physicians to the hands of insurance providers, in terms of treatment decisions. And the prices of many life-saving medications have now become out of reach of all but the wealthiest people. It's not good. The Affordable Health Act was an attempt to make it better, but I don't know what's going to happen now.
I think both countries are in a serious crisis when it comes to healthcare....when it comes to a lot of things, actually!
Will you be posting the results of your friend's follow up consultation, on this thread?
Thanks again!
Take good care,
J-
mistibluey JMJ
Posted
Yes, it's all about the money now. Some sections of the NHS may be sold off to American companies to run. The current administration is assuring the country that those sections will still be free at point of use, but it's the thin end of the wedge.
I'm not sure if anyone was really that interested in this thread as there were no comments but I will let you know when my friend finally gets a formal diagnosis.
Hope you continue to be well. Misti
JMJ mistibluey
Posted
So there's money to pay American companies to run the NHS but no money for the NHS to run the NHS. It must require a degree in business or economics to understand that equation. I confess: I don't get it.
I think it's great that you posted the process your friend went through. I'm sure there will be opportunities to refer people to your post, who are looking forward to their own consultations. Being able to read that, I think, would dispel some anxieties by providing key information. And I'm guessing other people have already read it and learned something, even though they may not be in need of the information at this time. I don't think information is ever a waste. And I do hope that you'll post your friend's results.
I'm doing okay. This awkward period of one good eye and one bad, is almost over! I haven't been able to drive because of the discrepancy, and I tried to drive with one eye...and I had NO depth perception....Not safe at all! I've had a few post-op complications, but there's a good chance that they'll resolve in 3 wks to 3 months. But this Monday, I'll be having the second eye done, and I'm hoping that life is going to get lots better (and brighter!)
Keep in touch. It's always so good to hear from you!
Take good care,
J
JMJ mistibluey
Posted
Hi Misti,
Hope you're doing well, and that your friend continues to feel much better! I hope the results of her consultation will be coming soon!
I was just going through my notifications. When I clicked on one that I apparently missed earlier last week, it said that the thread had been deleted. So, the alternative thread isn't the only one that's been deleted by the moderators. Very strange. I've never seen this before.
Take good care,
J-
mistibluey JMJ
Posted
She is still waiting to see a consultant to discuss the tests. The NHS is in trouble these days.
JMJ mistibluey
Posted
Hi Misti,
Thanks for letting me know. I'm so sorry she's still waiting! And I'm sorry that the NHS is in such bad shape. These are difficult times, that's for sure.
Keep in touch!
Take good care,
J-