Article

Vertigo Testing - How Is It Done?

Written by Dr Rajesh Bhardwaj

Topic: Digestive WellnessPublished March 7, 2020

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Vertigo, Dizziness, Giddiness, Imbalance are complex related symptoms that can trouble the patient as well as confound and confuse the clinician trying to make sense of it.
Vertigo is typically the sensation that the world around you is spinning or sometimes that the world around you is steady but you are spinning around.
The imbalance is usually a different symptom in which there is a sense of swaying to one side, loss of confidence in walking, especially on unsteady surfaces or at night.
There are many causes of true vertigo - from BPPV (Benign Paroxysmal Positional Vertigo), Meniere's Disease, Vestibular Neuritis, Labyrinthitis, Migraine associated Vertigo, Drug-induced Vertigo etc.
One of the most critical aspects in diagnosing a patient with Vertigo is to take a thorough history of the Vertigo itself- When does it occur, what precipitates it, how long does it last, what makes it better, is there accompanying nausea/ vomiting, is it accompanied with headache/s etc - each one leading to a specific cause and diagnosis.
For an accurate diagnosis, the patient is then subjected to a series of complex tests that assist the clinician in reaching a conclusion.
The following tests are carried out
Craniocorpography - checking for VestibuloSpinal reflexr
Advanced VNG- Vestibularnystagmography - The equipment evaluates peripheral and central vestibular functions using 10 protocols. It is the most advanced technology for oculomotor & positional testsr
Caloric Test - now a thermal test - we are not using water caloricr
Visual Head Impulse Test - testing the semicircular canalsr
Subjective Visual Vertical - for abnormal subjective tiltr
Dynamic Visual acuity - It assesses the ability of the subject to maintain the image on the fovea of the retina during head movement, an important function of Vestibulo Ocular Reflex (VOR).
Once the tests are carried out a cloud-based platform checks the results against laid out Algorithms to reach a tentative diagnosis.
This is then vetted by a trained team of a Senior ENT Specialist trained on Vertigo management as well as a Neurologist.
A final diagnosis is arrived at and a course of action which could include medication, as well as rehabilitative manoeuvres and exercises, are explained.
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About the Author

Dr (Major) R k Bhardwaj joined the armed forces medical college (afmc), Poona in 1978, and graduated as an MBBS in Oct 1982. From 1982 to 1997 he served in various capacities in the army medical corps including tours of duty at Siachen glacier and at Jaffna in Sri Lanka where he was intimately involved in the triage, management, and evacuation of battle casualties.
In 1987 he completed his diploma in ENT(DLO) from IGMC (mayo hospital) at Nagpur. From 1988 to 1990 he completed his ms in ENT from afmc at Poona where he was awarded the silver medal for standing first in ent in afmc. He was awarded the 'chief of army staff commendation card' for meritorious duty. From 1991 to 1993 he worked
as an ent specialist at Chandigarh where he performed a large number of ent surgeries and endoscopic procedures. In 1993 he was posted to army hospital (r&r hospital) the largest and most prestigious military medical establishment. He honed his surgical and diagnostic skills and was made a recognized postgraduate guide of the Delhi University.
In 1997 he left the army and has since then been in active practice. Apart from being attached to various prestigious hospitals of south Delhi including Sitaram Bhartiya institute, max med centre, Indian spinal injuries centre (Vasant Kunj) he has a well-equipped ent centre at Vasant vihar where he practices every evening.
Dr Bhardwaj is actively involved in his association affairs where he has been the editor of the news journal apart from being a member of the executive for many years. He was the secretary of the association in 2001-2002 and was the president of the All India association, Delhi branch from 2004 to 2005.
Dr Bhardwaj was the health consultant with the media group tv today network which includes "Aaj Tak and headlines today'. Presently he was health consultant with star news and was involved in bringing out the weekly health program called - 'Apna khayal rakhiyega'. Dr Bhardwaj was the doctor on a panel with the Shri ram school, Vasant vihar and has carried out the annual medical examinations at the heritage school and bloom public school. He contributes articles for the parenting magazine. the specialist at Chandigarh where he performed a large number of ent surgeries and endoscopic procedures.
In 1993 he was posted to army hospital (r&r hospital) the largest and most prestigious military medical establishment. He honed his surgical and diagnostic skills and was made a recognized postgraduate guide of the Delhi University.

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