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ENG Blunders

Ignored torsional nystagmus in patient with OPM.

Timothy C. Hain, MD Page last modified: August 30, 2010

see also: Blunders

Chicago dizziness and hearing is an unusual practice where we see a large # of patients with complex dizziness problems. It is our position that the individuals who interpret tests related to dizziness, should not only know about the common inner ear problems, but also the less common central problems. In other words, they should know some neurology. Here is an example of a blunder made by an audiologist who did not recognize a central cause of dizziness.

In oculopalatal myoclonus, the eyes bob in association with unsteadiness and bobbing of the soft palate. This is a central syndrome, cause by damage to the triangle of Guillain Molleret. Anyone that tests patients with dizziness, should know about OPM, and the characteristic ocular signs.

In the case from which a few snippets are taken below, the AuD audiologist made multiple blunders.

Case summary:

A patient underwent cerebellar surgery, and developed mysterious unsteadiness following the surgery. In the office, the physician who saw the patient (Dr. Hain), noticed that the palate moved and the eyes were twisting, and made the diagnosis of oculopalatal myoclonus.

Two vestibular tests were done.

ENG testing was as follows:

Wrong ENG

No HSN

Wrong way vibration

 

Rotatory chair testing showed very long time constants:

Long TC r-chair

One can figure out what happened by correlating together all of the data. This patient had cerebellar surgery, and thus her dizziness is more likely than not due to her surgery. The physician that saw her found torsional nystagmus. Torsional nystagmus is a very clear indication of a central lesion.

The audiologist made two mistakes here -- they should have read the chart, and they should also have noticed the nystagmus.

There was a second mistake made, likely a technical error in doing the caloric. Perhaps there was wax, or the irrigator was not in proper position. The ENG suggested a 50% (large) caloric asymmetry. However, this was not corroborated by HSN, vibration, or rotatory chair results. The audiologist should have concluded that a technical error was likely, as things didn't fit together.

 

 

 

Copyright August 3, 2016 , Timothy C. Hain, M.D. All rights reserved. Last saved on August 3, 2016