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[edit | edit source]

They are objective.

Nystagmus[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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 25–60s, against the direction of rotation.

Examination of the fistula symptom[edit | edit source]

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.

Links[edit | edit source]

Source[edit | edit source]