VIBRATION TEST FOR DIZZINESS
C. Hain, MD
Page last modified:
June 4, 2011
The vibration test is a recent development in clinical vestibular assessment.
It has been made possible by the wide availability of video Frenzel goggles,
which are devices which allow one to observe a subjects eyes in complete darkness.
It was noted that vibration over the head or neck may elicit a vigorous nystagmus,
and furthermore, the nystagmus is frequently direction specific.
|Device used for vibration test (cost -- about $25). This is a Sunbeam/Oster shower massager.
A source of vibration, such as a hand-held shower massager is firmly applied to the mastoid,
anterior or posterior neck of a subject. Others have used a "TheraSpa Turbo Brookstone" (White et al, 2007) You can use other vibrators instead -- it is not very critical except we advise against battery powered devices.
||Method of vibration test. A shower massager is applied firmly to the lower edge of the sternocleidomastoid. The lower frequency setting is used (60 hz).
Generally we apply vibration to the lower edge of the sternocleidomastoid as we want to avoid the carotid artery area, but the exact location is not at all critical as long as the sternocleidomastoid is located and the pressure is firm. The eyes are observed with a device
such as a video-Frenzel goggle system. No light can be allowed. The subject
is sitting upright, without instruction other than to look straight ahead.
|Vibration induced nystagmus. This patient has a 60% left weakness. There is a 3 deg/sec right-beating spontaneous nystagmus, which increases to about 10 deg/sec when vibration is applied to either sternocleidomastoid with a device that produces a 60 cycle pulse (a shower massager).
A positive response is a horizontal nystagmus that beats in the same direction,
for vibration on both sides of the neck. Nystagmus that beats in different directions
according to the side of vibration, as well as nystagmus that is vectored other
than horizontally, is considered either normal or simply of unknown significance.
An example of the vibration test is shown here (movie, 7 meg). This individual has a complete unilateral vestibular loss secondary to removal of an acoustic neuroma on the right side 30 years prior. There is a strong nystagmus beating to the left, for vibration on either side. The subject cannot see because of the goggles which occlude vision. The vibration source is a conventional shower massager as shown above.
The vibration test nystagmus (as far as we know) persists forever. Here is an example of a patient post-acoustic removal 1 year prior to testing (image courtesy of Dr. Dario Yacovino). Vibbration is stronger than Head-shaking nystagmus. Of course, there is no caloric nystagmus (bottom right):
Variant vibration tests:
- Vibration over the posterior neck (suboccipital)-- this method has been reported useful in diagnosis of Superior Canal Dehiscence syndrome (White et al, 2007). These authors reported that a downbeating nystagmus is elicited.
- Vibration over the anterior neck -- this is the standard location
- Vibration over the mastoids. -- this location elicits nystagmus as well as the anterior neck, but due to bone conduction and proximity to the ear, might be less localizing. More study is needed.
There is a suprisingly large literature documenting the utility of neck vibration in diagnosis of dizziness. There is also a large basic science literature documenting the deleterious effects of vibration on posture.
In essence, vibration of the neck is a moderately reliable method of localizing the side of a unilateral vestibular lesion. In complete darkness, vibration induces a nystagmus that resembles that seen acutely, prior to compensation. Vibration induced nystagmus persists over decades, unlike spontaneous nystagmus.
Vibration of the posterior neck may also be useful in diagnosis of SCD. In this case, it reportedly induces a downbeating nystagmus (White et al, 2007). This observation is so far not well established.
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October 6, 2013
, Timothy C. Hain, M.D.
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October 6, 2013