92542 Positional nystagmus test, minimum of 4 positions, with recording

Name of the Procedure:

Positional Nystagmus Test

Summary

The positional nystagmus test is a diagnostic procedure used to check for abnormal eye movements called nystagmus that occur when the patient's head is placed in different positions. It involves recording the eyes while the patient is moved through at least four different head and body positions.

Purpose

The test is used to diagnose disorders that affect the vestibular system (the inner ear and brain areas involved in balance). This can help identify conditions like benign paroxysmal positional vertigo (BPPV), Meniere's disease, or vestibular neuritis.

Indications

• Frequent dizziness or vertigo
• Balance problems
• Episodes of nystagmus noticed by a healthcare professional or described by the patient
• Unexplained nausea or motion sickness

Preparation

• Patients may be asked to avoid caffeine, alcohol, and certain medications for 24-48 hours before the test.
• Wear comfortable clothing and avoid eating heavy meals before the procedure.

Procedure Description

1. The patient sits in a comfortable chair and wears goggles equipped with video recording capabilities.
2. The healthcare provider instructs the patient to move their head and body into different positions, typically including:
   • Sitting upright
   • Lying flat on the back
   • Head turned to the right side while lying down
   • Head turned to the left side while lying down
3. During each position, the eye movements are recorded to observe any nystagmus.
4. The patient may feel momentary dizziness in different positions.

Duration

The procedure typically takes about 30 to 45 minutes.

Setting

This test is usually performed in an outpatient clinic or a specialized vestibular testing laboratory.

Personnel

• An ENT specialist or an audiologist often conducts the test.
• A nurse or medical assistant may assist with positioning and recording.

Risks and Complications

• Common: Temporary dizziness, mild discomfort
• Rare: Prolonged vertigo, nausea

Benefits

• Accurate diagnosis of vestibular disorders.
• Helps determine appropriate treatments for conditions like BPPV.
• Results can guide further management and improve quality of life.

Recovery

• Patients are usually able to return to normal activities immediately after the test.
• Avoid driving immediately after if feeling dizzy.
• Follow-up appointments may be needed to discuss results and treatment options.

Alternatives

• Electronystagmography (ENG) or Videonystagmography (VNG): Different methods to record eye movements.
• Magnetic Resonance Imaging (MRI): Used when a central nervous system issue is suspected.

Pros and cons of alternatives:

• ENG/VNG: Similar in purpose but might offer more detailed analysis.
• MRI: Non-invasive but more expensive and time-consuming, useful for detecting central causes of vertigo.

Patient Experience

During the procedure, the patient might experience brief periods of dizziness when moved into different positions. These sensations typically subside quickly. Post-procedure, most patients do not experience prolonged discomfort. Pain management is not usually necessary, but reassurance and instructions from the healthcare team can improve comfort.