Abstract

Background: Vertigo is a symptom of vestibular dysfunction with a sensation of motion. It is one of the common presenting complaints in primary care institutions and emergency departments. Diagnosis of the underlying disease demands that the complaint of vertigo be analyzed correctly, the nature of the disturbance of function being determined first and then its anatomic localization. Vestibulonystagmography (VNG) has been recommended as a dependable investigation of vertigo & has been used at many big health institutions.

Aims and Objectives: To evaluate the role of Video Nystagmography (VNG) in the diagnosis of vertigo, & To assess the benefit of VNG in confirmation of canalolith repositioning in patients with BPPV after Epley’s maneuver.

Methods: A Prospective Observational Study was conducted among patients of peripheral Vertigo attending ENT OPD at Government SMHS Hospital Srinagar. A total of 110 patients were included in the study. The patients were followed up on 7^th day, 14^th day and at 3 Months. Among patients of BPPV, Epley Manuere was performed at first visit and 7^th day follow up & its impact was assessed at 7^th day and 14^th day respectively. At 3 months both Dix Hallpike & VNG were performed.

Results & Discussion: Out of the five tests of VNG, four tests (which include Saccadic Test, Gaze Test, Optokinetic Test and Caloric Test) were Normal in all the 110 patients. The Position Test was Positive in 72.73% of patients which indicates that 72.73% patients had either BPPV or Vestibular Neuritis. Dix Hallpike test was positive in 75 cases (68%) & 35 patients (31.8%) had a negative result. The 75 BPPV patients were provided with Epley Maneuver & followed up on 7^th & 14^th day. 53 patients had a negative Dix hallpike test at 1st Follow-up Examination (Day 7), while as 22 had a positive Dix hallpike test. These 22 cases were further subjected to Epley Maneuver & followed for another week. On 2^nd Follow-up Examination (Day 14), these 22 patients were subjected to assessment through Dix hallpike test & all had a negative result. Thus finally all such patients were symptom-free on 14^th  Day. On 3^rd  Follow-up Examination (at 3 Months), all the 110 patients were assessed through Dix hallpike & VNG; and both the tests were normal in all the 110 patients. Video Nystagmography (VNG) can differentiate between a central and peripheral vestibular lesion, and if peripheral it can decipher between unilateral and bilateral vestibular loss.

Conclusion: The VNG differentiated very efficiently between different diagnosis along with the side involved & Epley Maneuver was found very useful as a non-pharmacological management tool for BPPV. This benefit of Epley Maneuver in patients of BPPV can be confirmed with VNG on follow up examination.  It was concluded that Video nystagmography (VNG) is a simple, reliable and objective diagnostic tool for the evaluation of patients presenting with Vertigo & it can differentiate between a central and peripheral vestibular lesion, and if peripheral it can decipher between unilateral and bilateral vestibular loss.

Keywords: Vertigo, Diagnosis, Video Nystagmography, Epley Maneuver.