Examination of the balance system

In addition to the vestibule, proprioception ( cerebellum ) and vision are also involved in balance - that's why balance disorders are difficult to assess.

Spontaneous and provoked vestibular phenomena
They are objective.

Nystagmus
Nystagmus are rhythmic movements of the bulbs in a certain plane and direction with a fast and slow component:


 * the slow component is the response to vestibular stimulation ,
 * the fast component is compensation from the CNS ,
 * direction of nystagmus – given according to the fast component – ​​rightward, leftward, up, down,
 * planes of nystagmus – horizontal, vertical, rotatory and diagonal.
 * Intensity of nystagmus – 3 degrees:
 * Grade I – nystagmus occurs when looking to one side, to which it then points,
 * II. degree - it can also be observed when viewed directly,
 * III. degree - it can also be observed when looking at the opposite side to the direction of the nystagmus.
 * we further evaluate – frequency, amplitude and angular velocity,
 * positional nystagmus – can be provoked by slowly moving the head into a certain position,
 * positioning nystagmus – provoked by rapid change of position, onset with latency,
 * vertical, diagonal, rotary or multidirectional is always central.

Standing according to Romberg

 * lie down, eyes closed.
 * head first straight, then with a turn to both sides.
 * the affected person leans or falls in the direction of the slow component of the nystagmus (behind the diseased ear).
 * we can scan optically and evaluate with posturography.

Deviations of the arms according to Hautant

 * forearm, close eyes, watch for half a minute,
 * in a peripheral disorder, both hands deviate in the direction of the slow component of the nystagmus.

Experimental examination of the vestibular system

 * in experiments we imitate the irritation or attenuation of the apparatus,
 * we mainly monitor nystagmus, but we can also monitor Romberg and Hautant.

Caloric examination

 * the patient is lying down, the head is tilted forward by 30° (verticalize the lateral semicircular canal),
 * through the glasses we watch the eyes,
 * we use water at 30 °C and 44 °C (ie ± 7 °C from body temperature),
 * first we examine both ears gradually (first one, then the other) with cold and then both with warm water,
 * on the stopwatch, we measure the latency to the onset of nystagmus,
 * cold water into the ear canal dampens (heat strengthens) the response of the lateral semicircular canal,
 * we induce 2 nystagmus – one in the contralateral direction (extinction) and the other in the homolateral direction (irritation),
 * nystagmus occurs in this way even in a healthy person.


 * Evaluation of results:
 * bilateral hyporeflexia – the duration of nystagmus is below the physical value.
 * bilateral hyperreflexia – the duration of nystagmus is above the physical value.
 * lateral difference in excitability – difference in times, pathological reduction in excitability of one side.
 * directional dominance  – the difference in the size of the deviation, the sum of the values ​​in one direction is noticeably higher than in the other.
 * vestibular areflexia – does not cause nystagmus.

Investigation of rotations

 * we stimulate both labyrinths at the same time, on a swivel chair, head tilted forward 30°, eyes closed,
 * we rotate 1 revolution in 6 s, stop suddenly and read the nystagmus,
 * physiologically, nystagmus lasts 25–60 s, against the direction of rotation.

Examination of the fistula symptom

 * in the presence of a labyrinthine fistula (it is most often in the semicircular canal),
 * blow the balloon into the ear, increase the pressure and if there is a whistle, nystagmus will occur.

Related Articles

 * Vestibular apparatus
 * Dizziness
 * Vestibular syndrome


 * Differential diagnosis of vertigo and tinnitus/PGS (VPL)
 * Vertigo/PGS (VPL)