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Category: VNG Testing

Do you suffer with dizziness?

July 31, 2021
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| Categories: Balance Assessment Equipment, Balance Platform, VNG Testing

Do you or anyone you know suffer from dizziness?

Overview of basic diagnostic and treatment solutions

Do you or someone you know complain about dizziness, unsteadiness, or experiencing repeated falls?  That can be very frustrating and dangerous due to injuries resulting from a fall.  

There are many factors that can affect our balance.  The complex vestibular system includes our eyes (visual inputs), ears (vestibular inputs in the inner ear), and feet (proprioception inputs while walking). If any one of these three areas is off it can cause dizziness resulting in falls.  It's kind of like a three-legged stool, if one leg falls off, the stool tips over.  

The first course of action needs to be a visit to your primary physician/s for a detailed evaluation. The following questions are a valuable tool for the physician to receive a good history and determine the best next steps in forming an accurate diagnosis and treatment protocol.

  1. How many times have you fallen in the last year?
  2. Do you feel dizzy prior to a fall or more unaware of the imbalance?  
  3. Do you have dizziness when lying in bed on a specific side but not on other sides? Or when moving your head one way or another?
  4. Do you experience dizziness while standing up from a seated position? Or when going from a lying down position to sit up and then stand up?
  5. Is there any numbness in your lower legs and feet? (Neuropathy or diabetic neuropathy)
  6. Are there any medications taken that list dizziness as a side effect?
  7. Have you experienced any head trauma recently?  Been in an accident or hit your head during a fall?

In addition to the questions from the physician above, at Secure Health, Inc. we highly recommend the physician use our Better Balance Analyzer platform to determine your Fall Risk Assessment (FRA).  The patient stands on the platform with eyes closed for 20 seconds - 3 times. The results are then compared to our large normative database, based on age and gender.  Your results determine if you are at low risk, moderate risk or high risk of falling.

Based on the results from the primary’s evaluation and considering the results from the Better Balance Analyzer, a referral to either an Ear, Nose, and Throat (ENT) or Audiologist (AuD) will likely be recommended.    

Once at your referred specialist, they may want to do a test called ENG or VNG (electronystagmography or Videonystagmography).  ENG has been around for 100 years while VNG, the modern gold standard method, has been around for 30+ years.  The VNG is very accurate and efficient.  Both are widely accepted as viable tests worldwide, but VNG is far more accurate, consistent and easier to administer. 

The ENG uses electrodes placed around your eyes and head while the VNG uses goggles with cameras to track eye movements while the patient follows stimulus, either a dot or light bars.  Using these tests, your health care provider can diagnose and identify vestibular problems or central nervous system (CNS) problems.  Another stimulus used with ENG/VNG is ear irrigation using either air or water  The air or water is blown into the ear canal purposely causing dizziness with a caloric irrigator.  The tests are done to see how long or if the patient can make the dizziness go away on their own, if not then it is likely central nervous system related.  

By far, the most common balance disorder is called Benign Paroxysmal Positional Vertigo (BPPV).  With BPPV you will feel dizzy only when you position your head in a certain way or position.  BPPV is generally caused when the crystals in your inner ear are out of position.  

Thankfully, BPPV is very treatable.  The most common treatment is the Canalith Repositioning maneuver that moves the crystals back to their intended position.  This is a painless movement, putting your head in various positions to allow the ear crystals to reposition in the correct manner. Vestibular rehab therapy is likely to be recommended to you to help with your recovery.

The vestibular system is very complex with far more potential diagnosis than just BPPV.  It is very important to go to the correct specialist for accurate diagnosis and treatments.

I hope this has helped in some way.  I know it's not anything absolute, but at least it may offer you some input on causes. This information is not intended as any sort of diagnostic or medical advice other than general information. You should seek your own personal care from a qualified medical professional.

May you all have a prosperous and healthy 2021.  Feel free to contact me at 260.804.4041 or email [email protected]

Dan Scherer

CEO, Secure Health, Inc.

260.804.4041 / [email protected]

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Why Balance Assessment Platforms are Essential as the Prelude to VNG Testing

February 27, 2021
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| Categories: Balance Platform, Uncategorized, VNG Testing

Why Balance Assessment Platforms are Essential as the Prelude to VNG Testing

Balance Assessment Platforms Reduce Subjectivity

Recently on a training conference call, a question arose of why a balance assessment platform is necessary? Why not simply have the individual complete a balance assessment questionnaire and then proceed to VNG testing based on the answers? Or perhaps a Tinetti gait and balance assessment or at the very least a sit-stand test?

Balance assessment platforms are an essential component because they reduce subjectivity. They are a screening tool that utilizes an objective physical assessment and provides an individualized, computer-generated report. When a subject is analyzed as part of an annual wellness exam or at an event such as a health fair for seniors, the balance platform evaluation can provide the objective data that would indicate that an individual is at a higher risk of falling. At this point, a comprehensive balance questionnaire would be completed by the subject. Depending on the answers, a full battery of VNG testing may be recommended.

When subjects only complete a balance assessment questionnaire, it relies on the answers they give being accurate and consistent. But that isn't always the case. The individual may answer differently depending on what the situation that day is. As an example, when asked, "Do you feel lightheaded? Dizzy? Do you have neuropathy? What medications are you taking?" The answers to these questions may be dependent based on how they feel on that particular day. When a balance assessment platform test is administered, the subjects are not likely to inadvertently circumvent the software analysis, it will record their data without the subjectivity of their answers.

Subjective tests such as the Tinetti gait and balance assessment and sit-stand test are reliant on a human assessment of the subject. This can result in drastically different results based on observations by one individual compared with another.

What is the general overview for Falls Risk Assessment (FRA)?

Balance Assessment Platform Secure Health Inc

Better Balance Analyzer balance assessment platform measures fall risk

The subject is asked to stand on the balance plate without shoes to undergo a series of tests with their eyes open and eyes closed on both a smooth and perturbed surface. Depending on the sway factor and other indicators, the balance assessment software will produce a percentage based on normative data based on age and so forth. This is part of the Falls Risk Assesment (FRA). If the subject's results indicate a low risk of fall, they can be reevaluated at a future date. If a moderate or high risk of fall is indicated, then a referral for further testing may be warranted. The computerized assessment is the bridge between a subject who may be at risk of falling but hasn't yet been referred for a complete battery of VNG testing.

For more details on Fall Risk Assessment, please refer to Balance Assessment Platforms.

If you have questions, please contact Secure Health, Inc.  We look forward to hearing from you.

Lana Scherer
Marketing Director, Secure Health, Inc.
[email protected]

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Patient Compliance

July 29, 2020
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| Categories: Patient Compliance, Patient Preparation, VNG Testing

Patient Compliance VNG Testing

Help patients successfully prepare for VNG tests

Preparation and patient compliance are vital elements for completing a successful series of VNG tests. Many practices distribute pre-appointment paperwork with information such as timing for the following:

--Medications to temporarily discontinue

--Medications to continue

--What to wear: comfortable clothes, flat shoes

--Eye prep, such as not wearing eye makeup or contact lenses

--When to avoid eating food and drinking caffeine or alcohol prior to testing

--What to expect regarding induced dizziness, the possibility of not driving oneself home

The preparation sheets are a helpful reference for patients who have no experience with vestibular disorders or VNG testing. There is quite an extensive list of do's and don'ts, which can be quite overwhelming.

To further improve patient compliance, practices who distribute papers and/or web information with Q and A's of what is actually involved with the VNG testing can go that much further to assist their patients. Most people are already feeling nervous about a doctor visit, especially when they are undergoing tests that they have no idea of what is involved. I know I was completely caught off guard when I learned that a full battery of VNG tests involves a series of eighteen tests and that it would take up to 30 or 45 minutes.

The information doesn't have to be clinical or complex, just keep it simple such as:

What to Expect for Your VNG Testing

Overall Objective

The overall objective of your VNG testing is to stimulate and visually record your eye movements under various circumstances. This is very likely to make you feel dizzy. Be prepared for dizziness and even the possibility of feeling nauseous or even throwing up in some cases. Both are common reactions during VNG testing. Your technician will help you as much as possible.

First Phase of VNG Testing

--The first portion of the tests, you will be asked to wear head gear consisting of goggles that have built in camera/s

--One eye will be shielded with a cover and the other one will be video recorded

--Keep your eyes wide open so the camera can record the movements of your pupil

--You will be asked to look at a dot on a monitor and follow the dot with your eyes

--Don't try to anticipate the pattern of the movements of the dot

--Each eye will repeat the same testing sequences and will be video recorded, one eye at a time*

--Please let your technician know if you are experiencing any adverse reactions to the testing procedures

*Unless your practice has a binocular VNG, in which case the eyes will be recorded at the same time

Second phase: Caloric Irrigator Tests

--A medical device called a caloric irrigator will be used for the second phase of testing

--A caloric irrigator is used to evoke your inner ear response to a stimulus

--You will be asked to wear headgear: goggles with the camera/s and lie down on an exam table

--A lighted tip connected to the caloric device will blow warm and cool air into your inner ear

--Keep your eyes wide open so the camera can record the movements of your pupil

--The camera/s will record the movements of your eyes, one at a time

--Expect a sequence of caloric testing, including physically changing movements while lying on the exam table

--You may need to lie on the exam table for a few minutes once testing is complete in order to recover from the dizziness you may experience

--Do not attempt to sit up, stand up, walk or drive unless you do not feel dizzy

--Please let your technician know if you are experiencing any adverse reactions to the testing procedures

For practices who are using ENG or older, outdated VNG testing equipment, consider upgrading to premium VNG devices and caloric irrigators manufactured by Difra Instrumentation. Difra's software is designed to reduce the time consuming aspects of testing. Difra software eliminates the need to mark up tests during during the testing procedures and therefore allows technicians to accurately test more patients with less labor for the tech and less time for the patient as well. For more information about Difra products, please contact Secure Health or review the product information contained on this web site.

If you have questions or just want to talk about this post or you have any other questions, please contact Secure Health, Inc.  We look forward to hearing from you.

Lana Scherer
Marketing Director, Secure Health, Inc.
260-418-6835 / [email protected]

Secure Health, Inc. is the exclusive US agent for Difra Instrumentation, a world's leading manufacturer of diagnostic balance disorder technology for more than 48 years.

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