Vestibular Testing Methods — MCQs
In Fitzgerald-Hallpike caloric test, cold-water irrigation at 30 degrees centigrade in the left ear in a normal person will induce -
Hallpike test is done for
Vestibular evoked myogenic potential (VEMP) is a tool for evaluating which of the following?
Dix Hallpike maneuver is used to assess
All are true about vestibular neuritis EXCEPT:
In a patient with right vestibular neuronitis, what will be the finding on the head impulse test?
Caloric test assesses the function of ?
Which of the following includes tests used to assess vestibular function?
Chemical labyrinthectomy by transtympanic route is done in Meniere's disease using which drug?
Hallpike maneuver is done for:
Vestibular Testing Methods Indian Medical PG Practice Questions and MCQs
Question 1: In Fitzgerald-Hallpike caloric test, cold-water irrigation at 30 degrees centigrade in the left ear in a normal person will induce -
- A. Nystagmus to the left side
- B. Positional nystagmus
- C. Direction changing nystagmus
- D. Nystagmus to the right side (Correct Answer)
Explanation: ***Nystagmus to the right side*** - According to **COWS** (Cold Opposite, Warm Same) mnemonic, **cold-water irrigation** in the left ear inhibits the left horizontal semicircular canal. - This inhibition mimics a head turn to the right, causing nystagmus with the **fast phase to the opposite (right)** side. *Nystagmus to the left side* - This would occur with **warm-water irrigation** in the left ear, which excites the left horizontal semicircular canal. - Excitation would mimic a head turn to the left, causing nystagmus with the fast phase to the **same (left)** side. *Positional nystagmus* - This type of nystagmus is typically observed when the **head is moved into specific positions** and is indicative of benign paroxysmal positional vertigo (BPPV) or central lesions. - It is not the expected or primary response to a **caloric stimulus** in a normal individual. *Direction changing nystagmus* - This implies that the **direction of the nystagmus** changes depending on the gaze direction or with different stimuli, which can be a sign of a central vestibular lesion. - In a normal caloric test, the nystagmus direction following a specific stimulus (cold water in one ear) is **consistent**.
Question 2: Hallpike test is done for
- A. Vestibular function (Correct Answer)
- B. Cochlear function
- C. Audiometry
- D. Eustachian tube function
Explanation: ***Vestibular function*** - The **Dix-Hallpike maneuver** is a diagnostic test used to identify **benign paroxysmal positional vertigo (BPPV)**, a disorder of the vestibular system. - It involves specific head and body movements to provoke dizziness and **nystagmus**, indicating otolith displacement in the semicircular canals. *Cochlear function* - **Cochlear function** relates to hearing, which is evaluated by tests like **audiometry** or **otoacoustic emissions**. - The Hallpike test does not assess the ability to perceive sound or the health of the cochlea. *Audiometry* - **Audiometry** is a hearing test that measures a person's ability to hear sounds at different frequencies and intensities, assessing the **degree and type of hearing loss**. - It is unrelated to assessing vertigo or balance disorders caused by semicircular canal pathology. *Eustachian tube function* - **Eustachian tube function** is assessed by tests like **tympanometry** or the **Valsalva maneuver**, which evaluate middle ear pressure equalization. - The Hallpike test does not assess Eustachian tube patency or function.
Question 3: Vestibular evoked myogenic potential (VEMP) is a tool for evaluating which of the following?
- A. Superior vestibular nerve disorders
- B. Cochlear nerve lesions
- C. Auditory nerve function
- D. Inferior vestibular nerve disorders (Correct Answer)
Explanation: ***Inferior vestibular nerve disorders*** - **VEMP** uses **loud acoustic stimuli** or **bone vibration** to activate the **saccule**, with the response pathway: saccule → inferior vestibular nerve → vestibular nucleus → vestibulospinal tract → muscle response. - **Cervical VEMP (cVEMP)** is recorded from the **sternocleidomastoid muscle**, while **ocular VEMP (oVEMP)** is recorded from **extraocular muscles**; absent or delayed responses indicate **saccular or inferior vestibular nerve dysfunction**. *Superior vestibular nerve disorders* - The **superior vestibular nerve** innervates the **utricle** and **semicircular canals**, which are assessed by **head impulse test** and **caloric testing**, not VEMP. - **VEMP** is the only clinical test specifically assessing **otolith (saccule) function** and does not evaluate semicircular canal pathways. *Cochlear nerve lesions* - **Cochlear nerve** assessment requires **pure tone audiometry**, **auditory brainstem response (ABR)**, and **otoacoustic emissions**. - **VEMP** evaluates vestibular pathways through **muscle reflexes**, not auditory nerve conduction or cochlear function. *Auditory nerve function* - **VEMP** is a vestibular test that evaluates **otolith organs** and their neural pathways, not auditory function. - While VEMP uses **acoustic stimuli** to trigger the response, it measures **vestibulospinal or vestibulo-ocular reflexes**, not hearing or auditory nerve conduction.
Question 4: Dix Hallpike maneuver is used to assess
- A. Diagnose benign paroxysmal positional vertigo (BPPV) (Correct Answer)
- B. Assess patency of Eustachian tube
- C. Differentiate cochlear and retrocochlear deafness
- D. Assess neonatal hearing loss
Explanation: ***Diagnose benign paroxysmal positional vertigo (BPPV)*** - The **Dix-Hallpike maneuver** is the gold standard diagnostic test for **BPPV**, specifically posterior canal BPPV, the most common type of BPPV. - The test involves moving the patient from sitting to supine position with the head turned 45° and extended 20° below horizontal. - A **positive test** elicits characteristic **rotatory nystagmus** with a **latency of 1-5 seconds**, **duration <60 seconds**, and **fatigability** on repeated testing. - The nystagmus characteristics (latency, fatigability, direction) help distinguish **peripheral BPPV** from rare central positional vertigo. *Assess patency of Eustachian tube* - **Eustachian tube patency** is assessed using **Valsalva maneuver**, **Toynbee test**, or **tympanometry**, which measure pressure equalization in the middle ear. - The Dix-Hallpike maneuver involves head positioning to provoke vertigo, not middle ear pressure testing. *Differentiate cochlear and retrocochlear deafness* - **Cochlear vs retrocochlear deafness** differentiation requires audiological tests: **pure tone audiometry**, **speech discrimination**, **auditory brainstem response (ABR)**, and **otoacoustic emissions (OAEs)**. - The Dix-Hallpike maneuver tests the vestibular system (balance), not the cochlear system (hearing). *Assess neonatal hearing loss* - **Neonatal hearing screening** uses **automated otoacoustic emissions (OAEs)** and **automated auditory brainstem response (AABR)**. - The Dix-Hallpike maneuver is a positional vertigo test requiring patient cooperation and has no role in hearing assessment at any age.
Question 5: All are true about vestibular neuritis EXCEPT:
- A. Horizontal nystagmus
- B. Positive head thrust
- C. Vertical nystagmus (Correct Answer)
- D. Normal hearing
Explanation: ***Vertical nystagmus*** - **Vestibular neuritis** primarily affects the **horizontal semicircular canal** and superior vestibular nerve, leading to **horizontal or rotational nystagmus**, not vertical. - **Vertical nystagmus** is often indicative of a **central lesion** rather than a peripheral vestibular disorder like neuritis. *Horizontal nystagmus* - This is a characteristic finding in **vestibular neuritis**, where the **nystagmus is usually horizontal or rotatory** and beats away from the affected side. - The nystagmus typically **increases in intensity** when looking in the direction of the fast phase. *Positive head thrust* - A **positive head thrust test** (or **head impulse test**) is a hallmark of **peripheral vestibular dysfunction**, including vestibular neuritis. - It demonstrates a **saccadic corrective eye movement** when the head is quickly turned towards the affected side, indicating impaired vestibulo-ocular reflex. *Normal hearing* - **Vestibular neuritis** specifically involves inflammation of the **vestibular nerve**, sparing the cochlear nerve. - Therefore, patients with vestibular neuritis typically **maintain normal hearing**, differentiating it from labyrinthitis.
Question 6: In a patient with right vestibular neuronitis, what will be the finding on the head impulse test?
- A. Head turned to right, corrective saccade to the left (Correct Answer)
- B. Head turned to left, corrective saccade to the right
- C. Head turned to right, no corrective saccade
- D. Head turned to left, no corrective saccade
Explanation: ***Head turned to right, corrective saccade to the left*** - In **right vestibular neuronitis**, the right vestibular apparatus is impaired, affecting the **vestibulo-ocular reflex (VOR)** on that side. - During the head impulse test, when the head is rapidly turned **to the right** (toward the affected side), the impaired VOR cannot maintain eye fixation on the target. - The eyes initially move **with the head** (to the right), then a visible **corrective saccade** (catch-up saccade) brings them **back to the left** to refixate on the target. - This corrective saccade is the **hallmark positive finding** in head impulse test for right vestibular dysfunction. *Head turned to left, corrective saccade to the right* - This would indicate a **left vestibular lesion**, not right vestibular neuronitis. - When turning the head to the left with left vestibular dysfunction, a corrective saccade to the right would be observed. *Head turned to right, no corrective saccade* - This would indicate **normal VOR function** on the right side. - A normal response shows no corrective saccade because the eyes maintain fixation throughout the head turn. - This is the **opposite** of what is expected in right vestibular neuronitis. *Head turned to left, no corrective saccade* - This indicates normal VOR function on the left side. - In right vestibular neuronitis, turning the head to the left (away from the affected side) typically shows **normal VOR** with no corrective saccade needed.
Question 7: Caloric test assesses the function of ?
- A. Posterior semicircular canal
- B. Cochlea
- C. Anterior semicircular canal
- D. Horizontal semicircular canal (Correct Answer)
Explanation: ***Horizontal semicircular canal*** - The **caloric test** primarily assesses the function of the **horizontal (lateral) semicircular canal** by inducing temperature changes that stimulate or inhibit endolymph flow. - This test evaluates the **vestibulo-ocular reflex (VOR)**, which is crucial for maintaining gaze stability during head movements. *Posterior semicircular canal* - The **posterior semicircular canal** is mainly assessed by tests like the **Dix-Hallpike maneuver**, particularly for diagnosing **benign paroxysmal positional vertigo (BPPV)**. - It is responsible for detecting **head rotations in the sagittal plane**. *Cochlea* - The **cochlea** is the part of the inner ear responsible for **hearing**, converting sound vibrations into electrical signals. - Its function is assessed by **audiometry**, not the caloric test. *Anterior semicircular canal* - The **anterior (superior) semicircular canal** detects **head rotations in the sagittal plane**, similar to the posterior canal but in a different orientation. - While it contributes to overall vestibular function, the caloric test's thermal convection currents are most effective at stimulating the horizontally oriented canal.
Question 8: Which of the following includes tests used to assess vestibular function?
- A. Caloric test and Hallpike maneuver
- B. Hallpike maneuver and Fistula test
- C. Caloric test and Fistula test
- D. Caloric test, Hallpike maneuver, and Fistula test (Correct Answer)
Explanation: ***Caloric test, Hallpike maneuver, and Fistula test*** - This option includes **all three major bedside tests** for comprehensive vestibular assessment. - The **caloric test** evaluates the function of the **horizontal semicircular canal** and its central connections by introducing warm or cold water/air into the ear canal. - The **Hallpike maneuver** (Dix-Hallpike) is used to diagnose **benign paroxysmal positional vertigo (BPPV)** by assessing for nystagmus triggered by specific head positions. - The **Fistula test** assesses for a **perilymph fistula** by observing nystagmus or vertigo in response to pressure changes in the external ear canal. *Caloric test and Hallpike maneuver* - While both tests are valid for vestibular assessment, this option is **incomplete** as it omits the Fistula test, which is important for detecting perilymphatic fistulas. *Hallpike maneuver and Fistula test* - This combination is **incomplete** as it omits the caloric test, which is the gold standard for evaluating horizontal semicircular canal function and central vestibular pathways. *Caloric test and Fistula test* - This option is **incomplete** as it fails to include the Hallpike maneuver, a critical test for diagnosing **BPPV**, one of the most common causes of vertigo.
Question 9: Chemical labyrinthectomy by transtympanic route is done in Meniere's disease using which drug?
- A. Amikacin
- B. Amoxycillin
- C. Cyclosporine
- D. Gentamicin (Correct Answer)
Explanation: ***Gentamicin*** - **Gentamicin** is an **aminoglycoside antibiotic** that is commonly used for chemical labyrinthectomy due to its **ototoxic** properties, particularly its selective toxicity to **vestibular hair cells** at lower doses. - When administered transtympanically, it achieves high concentrations in the **inner ear fluid**, effectively ablating the vestibular function and reducing severe vertigo in **Meniere's disease**. *Amikacin* - **Amikacin** is also an **aminoglycoside antibiotic** with ototoxic potential, but it is typically reserved for severe bacterial infections and is not the primary drug of choice for **chemical labyrinthectomy** in Meniere's disease. - While it can cause hearing loss, **gentamicin** has a more established and preferential effect on the **vestibular system** at therapeutic doses for Meniere's. *Amoxycillin* - **Amoxycillin** is a common **beta-lactam antibiotic** used for bacterial infections, and it does not possess **ototoxic** properties that would make it suitable for chemical labyrinthectomy. - It is primarily known for its antibacterial action and has no role in the management of vertigo in **Meniere's disease** via transtympanic administration. *Cyclosporine* - **Cyclosporine** is an **immunosuppressant drug** used to prevent organ rejection and treat autoimmune conditions; it does not have properties for chemical ablation of the labyrinth. - While some autoimmune components are sometimes considered in Meniere's disease, cyclosporine is not used for **transtympanic chemical labyrinthectomy**.
Question 10: Hallpike maneuver is done for:
- A. Vestibular function (Correct Answer)
- B. Cochlear function
- C. Audiometry
- D. Corneal test
Explanation: ***Vestibular function*** - The **Dix-Hallpike maneuver** is a diagnostic test used to identify **benign paroxysmal positional vertigo (BPPV)**, which is a common cause of dizziness originating from the **vestibular system**. - It involves specific head and body movements to provoke dizziness and observe characteristic eye movements (**nystagmus**) indicative of otolith displacement within the semicircular canals. *Cochlear function* - **Cochlear function** relates to hearing and sound perception, which is assessed by tests like **audiometry** or otoacoustic emissions. - The Hallpike maneuver does not directly evaluate the function of the **cochlea**. *Audiometry* - **Audiometry** is a test used to assess a person's **hearing sensitivity** by measuring their ability to hear sounds of different frequencies and intensities. - It is distinct from the Hallpike maneuver, which focuses on **balance** and **vestibular dysfunction**. *Corneal test* - The **corneal reflex test** evaluates the integrity of the **trigeminal (CN V)** and **facial (CN VII)** nerves by observing an involuntary blink response to corneal stimulation. - This test is unrelated to vertigo or the **vestibular system**, which the Hallpike maneuver addresses.
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