Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral sti
CPT4 code
Name of the Procedure:
Basic Vestibular Evaluation
Includes Spontaneous Nystagmus Test with Eccentric Gaze Fixation Nystagmus, with Recording, Positional Nystagmus Test (Minimum of 4 Positions), with Recording, Optokinetic Nystagmus Test, Bidirectional Foveal and Peripheral Stimulation.
Summary
A basic vestibular evaluation is a series of tests designed to assess the function of the vestibular (balance) system. The procedure includes testing for spontaneous nystagmus, positional nystagmus in multiple positions, and optokinetic nystagmus, all while recording eye movements.
Purpose
The procedure helps diagnose issues related to balance and dizziness by evaluating how the inner ear and brain coordinate with eye movements. The goal is to identify abnormalities in the vestibular system that could be causing symptoms such as vertigo, dizziness, and imbalance.
Indications
- Symptoms of vertigo or dizziness
- Balance problems or unsteady gait
- Unexplained nausea and vomiting related to changes in head position
- History of head injury affecting balance
- Evaluation of known vestibular disorders
Preparation
- Patients may be advised to avoid certain medications, such as sedatives, for 24-48 hours before the procedure.
- It is generally recommended to avoid alcohol for at least 48 hours prior to the test.
- Patients should wear comfortable clothing and may need to fast for a few hours before the evaluation if advised by their healthcare provider.
Procedure Description
- Spontaneous Nystagmus Test: The patient is asked to sit still and focus on a target while the examiner observes and records any involuntary eye movements (nystagmus) that occur without moving the head.
- Eccentric Gaze Fixation Nystagmus Test: The patient is asked to fixate on a target placed in various eccentric positions (to the sides, up, and down), and any nystagmus is observed and recorded.
- Positional Nystagmus Test: The patient is moved into at least four different head and body positions (lying down, on each side, etc.) to observe and record any nystagmus that occurs due to changes in position.
- Optokinetic Nystagmus Test: The patient looks at a moving visual field (like a rotating drum with stripes) to elicit and record the optokinetic nystagmus response.
The tools used include video goggles or cameras to record eye movements, and other diagnostic equipment to track and measure nystagmus.
Duration
The entire procedure typically takes about 30 to 60 minutes.
Setting
The procedure is performed in an outpatient clinic or a specialized vestibular testing lab.
Personnel
The healthcare team may include:
- An audiologist or a specialist in balance disorders
- A trained technician to assist with the equipment
- Occasionally, an otolaryngologist (ENT specialist) may be involved.
Risks and Complications
- Most patients experience no significant risks.
- Rarely, the procedure may induce temporary dizziness or nausea.
- There is a minimal risk of falling if significant dizziness occurs during the test, but this is managed by the healthcare team.
Benefits
- Accurate diagnosis of vestibular disorders leading to targeted treatment.
- Improved understanding of the cause of balance and dizziness problems.
- Identification of proper therapeutic and rehabilitative measures.
Recovery
- Patients can generally return to normal activities immediately after the procedure.
- Some may feel mild dizziness or unsteadiness for a short period after the test.
- Follow-up appointments may be scheduled to discuss results and potential treatments.
Alternatives
- Clinical Balance Assessment: A different set of tests and physical exams performed by an audiologist or physical therapist.
- MRI or CT Scans: Imaging studies to rule out structural causes of dizziness.
- Vestibular Rehabilitation Therapy: Physical therapy focusing on improving balance and reducing dizziness.
Patient Experience
- The patient might feel mild discomfort or dizziness during positional changes or visual stimulus tests.
- Pain is generally not involved, and comfort measures include reassurance and the flexibility to stop the test if significant discomfort occurs.
- Most patients tolerate the procedure well and can discuss any concerns with the healthcare provider before, during, and after the evaluation.