Medical Center MEDICA 2005

Affiliates Sofia, Vidin and
MC Academica 2008 - Pleven
Medica 2005 Medical Center
Home Activites Otoneurology



When should an otoneurological examination be conducted?

If you feel dizzy or have an imbalance, you can contact our neurologists. After a thorough neurological examination, blood test and ultrasound examination of the cerebral arteries, in case of suspected damage to the vestibular apparatus, you will be referred for an otoneurological examination.

When is Video Head Impulse Test (vHIT) needed and what is it?

In patients with acute vestibular syndrome (vertigo, nausea, unsteady gait, nystagmus) vHIT distinguishes peripheral vestibular deficiency (e.g. vestibular neuritis) from central pathology (stroke) with sensitivity and specificity of 100% (compared to MRI).

This test is indicated in patients with chronic vertigo and unsteady gait, which may result from bilateral vestibulopathy. The detection of unilateral peripheral-vestibular deficiency is useful in diagnosing and monitoring Meniere's disease or vestibular neuritis.

In this test, the investigator rotates the patient's head with high acceleration and small amplitude in the plane of the horizontal semicircular canal, while the patient looks straight ahead at a specific target. In a normal vestibulo-ocular reflex, a compensatory eye movement occurs in the direction opposite to the movements of the head, which allows fixation of the target (Fig. 1).

insufficient vestibulo-ocular reflex, the gaze passively follows the movement of the head, which is compensated by subsequent rapid eye movements towards the target (catching-up saccades). Catching-up saccades are indirect signs of a damaged vestibulo-ocular reflex. They can occur after the turning of the head (overt saccades) or during the rotation itself (covert saccades). Only overt saccades can be identified by clinical examination. Covert saccades are registered only with vHIT.

If dizziness is accompanied by auditory symptoms - a decrease in hearing or tinnitus, it is mandatory to conduct an audiogram.

What is an audiogram?

An audiogram is a graph that shows the results of a hearing test (Fig. 2).

Every time you hear sound in the headphones and press a button, the result is registered on the audiogram. The audiogram shows what level of hearing you have, compared to that of a normal hearing person. If a decrease in hearing is detected, the degree of decrease is precisely determined and the frequency of hearing loss is identified.

Otoneurological examination is painless and well tolerated by patients. Sometimes with vHIT there is a slight discomfort and symptoms similar to those of an acute vestibular attack, so it is good to have an attendant.

More information can be obtained on tel. 02/4444455.