Why alert patients during vestibular testing?

Accurate measurement of the Vestibular-ocular reflex (VOR) is crucial for diagnosing and managing neuro-vestibular disorders. While it might seem counterintuitive, alerting the patient is essential. Some clinicians skip this step when testing for vestibular nystagmus, which can lead to inaccurate results or missed diagnoses.
Vestibular nystagmus has two components: a slow component from the vestibular system and brainstem, and a fast component controlled by higher cortical processes. Continuous alerting maintains the generation of the fast phase component, ensuring accurate measurements.

Which tests should clinician alert the patient?

Any Vestibular Tests that are performed in the absence of vision.

• Spontaneous nystagmus measurements;
• Vision Denied Gaze Tests;
• Head Shake, Head Heave, Ocular Counter Roll;
• Mastoid Vibration Test;
• Caloric;
• Rotational Chair Testing;
• Positioning Tests for BPPV if clear nystagmus is not visible.

How to alert the patient?

The alerting task should be moderately challenging and match the test type (a patient doing a vision-denied gaze test will need a more complex alerting task than a patient during a caloric test). Clinicians should have a variety of tasks available to adapt to the patient's abilities. Avoid anxiety-inducing tasks and consider the patient's interests. Do they like to cook? Or do they take a particular interest in cars/animals/sports?

Examples of Alerting Tasks:

• Naming names that start with a specific letter;
• Listing animals from different continents;
• Identifying dog breeds starting with different letters;
• Recalling local street names;
• Describing a favorite recipe;
• Naming family members by age.

Non-verbal alerting

For language barriers, non-verbal tasks like molding shapes can be used.

In summary, using appropriate alerting tasks throughout vestibular testing enhances accuracy and simplifies interpretation.

_{*The content has undergone a slight revision by the Academia editorial team.}