Centre of Excellence

Neuro-otology and Vestibular Laboratory

Neuro-otology is a subspeciality of ENT. The Neuro-Otology and Vestibular Lab was established in the Department of ENT, Head and Neck Surgery in November 2020. It is a dedicated centre for managing patients suffering from vertigo and other diseases causing disequilibrium. Vertigo and dizziness are common presenting symptoms for clinicians of all specialties. It has a lifetime prevalence of around 20–30%. The diagnosis of vestibular disorders has seen tremendous advancement with the advent of new technology and equipment. There are over 40 common inner ear disorders, including those of the central nervous system, which can lead to vertigo. The comprehensive management of these disorders includes a detailed history, appropriate investigations, rational treatment and rehabilitation strategies. The first step to successful treatment is establishing a diagnosis. Vertigo and dizziness are symptoms like headaches, nausea or fevers that relate to specific pathologic conditions. Hence, the interpretation of history with clinical and diagnostic tests is important. The Neuro-Otology Clinic will function on Tuesdays, Thursdays and Saturdays from 10 a.m. to 1 p.m. in the ENT Department, Ist floor of the SRM Hospital. It will be jointly managed by suitably qualified professionals from the departments of ENT, Audiology and Neurology. Patients are scheduled based on the prior appointment only. The contact person is the nurse in charge of ENT OPD and the contact number is +9144 47432386.

Vestibular Laboratory

In order to evaluate the vestibular system and enable the clinician to arrive at a precise diagnosis, tests and investigations are usually done in the newly created vestibular lab. These tests are

Dynamic Visual Acuity (DVA)

It is the best test to diagnose vestibulotoxicity and peripheral vestibulopathy, usually caused by ototoxic drugs. It can also be used as a rehabilitation tool and to assess the outcome of rehabilitation.

Computerized Stabilometry (Posturography)

Stabilometry helps in the functional evaluation of the postural control system in its steady-state behaviour. It measures the outcome of vestibular rehabilitation by assessing the patient’s balance control and postural sway velocity.

Rhythmic Weight Shift (RWS)

To quantify the patient’s ability to rhythmically move their COG from left to right and forward to backward between two targets at different speeds.

Subjective Visual Vertical (SVV)

It is used to evaluate the otolith system responsible for the perception of verticality. It helps to diagnose various otolithic disorders, chronic dizziness and compensated vestibular disorders, differentiate peripheral vestibular disorders from central vestibular disorders and assess the effect of rehabilitation in vertigo patients. To quantify the patient’s ability to rhythmically move their COG from left to right and forward to backward between two targets at different speeds.

Craniocorpography (CCG)

It is an objective investigation to evaluate the vestibulospinal reflex. Romberg’s test, Tandem’s walking test, and Unterburger/Fukuda’s test are done.

Videonystagmography (VNG)

It is a non-invasive, accurate and reliable way of evaluating the vestibular and oculomotor systems. It evaluates peripheral and central vestibular functions through spontaneous nystagmus with and without optic fixation, gaze-evoked nystagmus, saccades, optokinetic tests, caloric tests, head shaking tests, smooth tracking with various frequencies, positional tests, valsalva and hyperventilation-induced nystagmus and skew deviation.

Video Head Impulse Test (vHIT) with VOR Suppression Test

The vHIT enables the testing of all six semi-circular canals at high frequency, as well as the saccade strategies (overt and covert). The important features are

• Quick test: In 10 minutes, all six semi-circular canals can be tested.
• Nine-axis motion sensors accurately measure head movement, allowing for simultaneous comparison of head and eye movements.
• Monocular high-frame rate camera with 200 fps to detect fast eye movements
• Lightweight goggle design to reduce slippage.
• Built-in lasers that provide stimulus for calibration and VOR testing.
• Fully integrated and computerised, with real-time recording of all parameters
• Videos of the eye movements can be viewed after the test.

Vestibular Rehabilitation Therapy (VRT)

VRT is used for treating vestibular disorders. The Cawthorne-Cookesy exercises, which are now over 60 years old, do not meet the requirement of vestibular compensation in many patients. It is important to identify the areas of dysfunction in order to tailor rehabilitation strategies. Rehabilitation needs to be progressive and adapt to the needs of the patient. It cannot be a “one size fits all” approach. Virtual reality-based rehabilitation is making rehab more real and able to expose the patient to real-life situations in the protected environment of the vestibular rehab clinic. Vertigo is a common multisensory syndrome. A thorough diagnostic assessment helps to establish the pathophysiology of the disorder. In recent times, the diagnosis of vertigo has undergone a paradigm shift due to new diagnostic possibilities. The introduction of modern vestibular test procedures in clinical practice has led to the assessment of all components of the vestibular organ. Combined with established methods, a frequency-specific assessment of the function of vestibular reflexes is possible. These developments have enabled the clinician to manage vertigo better through quicker evaluation with this diagnostic equipment and customise the rehabilitation therapy. The vestibular lab will function on all working days, from 10 a.m. to 1 p.m. It is located in the Department of ENT, Ist Floor, Hospital ‘B’ Block. Appointments are made with the nurse in charge of ENT OPD or by telephone at +914447432386.

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