VNG (Videonystagmography) test battery

Consists of a series of tests used to assess the balance functions of the inner ear and central nervous system. The main tests included in the VNG test battery are:

Tests Used in the Evaluation of Balance:

1. Gaze Test: This test is performed to assess whether the eyes are focused on a specific point and whether there is any deviation from this point. In this way, the presence of nystagmus (involuntary eye movements) is investigated. 2. Spontaneous Nystagmus Test: This is a test to assess whether the patient has involuntary, rhythmic oscillations in eye movements (nystagmus). This test is performed by observing the patient’s eyes in a free gaze state, without focusing on any target. To assess eye movements more precisely, a light can be shone on the eyes in a dark room or a special video goggle (Videonystagmography – VNG) can be used to record the eye movements. 3. Smooth Pursuit Test: Assesses the ability of the eyes to follow a slow-moving object. Central nervous system disorders can affect this test. 4. Saccadic Test: Assesses the ability of the eyes to move quickly from one point to another. This test provides information about central nervous system functions. 5. Optokinetic Test: This test assesses the repetitive movements that the eyes make automatically in response to a moving visual pattern. This provides information about central and peripheral vestibular system function. 6. Head Shake Test: Eye movements are monitored during rapid shaking of the head. This test can reveal asymmetry of the vestibular system. 7. Positional Tests: Eye movements are evaluated in different head positions. The presence of nystagmus in certain head positions may indicate a problem in the inner ear. Especially Dix-Hallpike, Supine Head Roll, Deep Head Hanging tests have an important place in the evaluation of benign paroxysmal positional vertigo, commonly known as crystal shift.

• Dix-Hallpike Testi

• Supine Head Roll Test

• Deep Head Hanging Test

8. Caloric Test: In this test, cold and hot air or water are applied to the external auditory canal respectively. These stimuli produce fluid movement in the inner ear and this movement produces nystagmus in the eyes. The caloric test is used to compare the function of the vestibular system in both ears. 9.VEMP (Vestibular Evoked Myogenic Potentials) Test: It is a non-invasive test used to evaluate the function of the inner ear and vestibular system. It is especially used to evaluate the saccule (a structure in the inner ear that senses balance) and vestibulospinal tracts.

Purpose of VEMP Testing:

• Saccule Function: The saccule is sensitive to head movements and gravity. VEMP testing is used to measure the function of this structure and the vestibular nerves connected to it.
• Vestibulospinal Reflex: This reflex allows various muscles of the body to respond automatically to maintain balance. VEMP testing evaluates this reflex pathway.

Types of VEMP Testing:

1. cVEMP (Cervical VEMP): Measures the contraction responses of the sternocleidomastoid muscle (neck muscle). It evaluates saccule and inferior vestibular nerve function.
2. oVEMP (Ocular VEMP): Measures the responses of the lower eye muscles. It evaluates the function of the utricle (another structure in the inner ear that senses balance) and the superior vestibular nerve.

The VNG test battery allows assessment of the vestibular system (balance system) and eye movement control. Test results provide important information in determining the causes of symptoms such as dizziness, imbalance and vertigo. 10. Saccadometry Test Saccadometry is an advanced oculomotor test and provides a functional assessment of the different brain regions and circuits involved in the generation of saccadic eye movements. Saccades are traditionally analyzed by three different properties, including latency, amplitude and velocity. Saccadometry is a cognitive test that adds new analysis data to these traditional analysis parameters of saccades, performing phase data analysis that provides more information for lesion localization, looking at fatigability and error measurement with longer test duration. This in-depth examination with the Prosaccade and Anti-Saccade tests provides clinically applicable solutions to gain insight into neurological disorders such as concussion, head trauma, neurodegenerative diseases, movement disorders, depression and attention deficit disorders. These more advanced tests provide information that is not always detected in traditional saccade testing. 11. vOCR – Ocular Counter Roll Test The vOCR test is a clinical test used to assess otolith function using a torsional eye tracking algorithm. It allows you to evaluate otoliths and their central connections. What is Ocular Counter Roll (OCR)? OCR is a small angular movement of the eyes in the opposite direction of the head tilt when the head is tilted laterally (sideways). For example, when the head tilts to the right, the eyes roll slightly to the left. This reflex is important for maintaining balance and visual stability and helps the eyes to see the world in a stable way, depending on the position of the head. Purpose of the test The OCR test is used to assess the functionality of the otolith organs and the vestibular system. In particular, it indicates the source of otolith dysfunctions, vestibular nerve lesions, central vestibular disorders, dizziness and imbalances. The OCR test is a non-invasive test used to assess the function of the vestibular system and otolith organs. It has an important place especially in the diagnosis of balance disorders, dizziness and neurological diseases. 12. VHIT (Video Head Impulse Test) The VHIT (Video Head Impulse Test) is a test used to assess the function of the vestibular system, particularly the semicircular canals (semicircular canals). By measuring the vestibular-ocular reflex (VOR), the VHIT provides a rapid and non-invasive assessment of vestibular function in both ears.

Purpose of the VHIT Test:

• Assessment of the Vestibular-Oculomotor Reflex (VOR): This reflex allows the eyes to remain focused on a fixed point when the head is moved quickly. If the VOR is not working correctly, it may indicate a disorder in the vestibular system.
• Detection of Peripheral Vestibular Disorders: VHIT is used to evaluate peripheral vestibular disorders, especially vestibular neuritis.

The VHIT test is a modern and effective way to assess the functionality of the vestibular system and is used in the diagnosis of many vestibular disorders. Test results provide critical information to determine the cause of patients’ symptoms and develop appropriate treatment methods.

Tests Used in the Evaluation of Hearing

1. Pure Tone Audiometry It is based on the use of pure tones to evaluate the hearing of individuals. In our clinic, pure tone audiometry, speech tests, free-field tests and quiet room are used to accurately determine hearing loss and reach the correct diagnosis and treatment. Free-field audiometry, which is limited in Antalya, is also available in our clinic. With free-field audiometry, we determine the benefit that our patients with hearing aids receive from their hearing aids. 2. Speech Audiometry Although we determine hearing thresholds with pure tone thresholds, this is not completely sufficient. Speech audiometry in our clinic provides us with valuable information about pathologies in the middle ear, cochlea, auditory nerve, central auditory system and auditory pathways. One of the sub-tests in speech audiometry is the annoying sound level determination test. The annoying sound level test gives us important information about the origin of the loss. 3. Free Field Audiometry It is a test used to determine the hearing thresholds of adults, children or infants who are seated at a table in the center line in a silent booth. In addition to determining hearing thresholds in children and infants, it is also used in individuals with hearing aids or implants. 4. Behavioral Observation Audiometry It is generally used in infants (0-4 months). In the Free Field, pure sound stimuli, speech stimuli and various noises are sent to the baby and the hearing thresholds of the baby are determined by the audiologist by looking at the behavioral responses of the baby (blinking, head turning, hand and foot movements, crying and sucking reflex). 5. Visual Reinforcement Audiometry Usually applied in infants and children (5-24 months). Free Space or headphones are used. The child is seated so that he/she can see both sides. There are light boxes and moving toys on the right and left. During the test, an audiologist should play with the child and collect the child’s attention. Hearing thresholds are then determined by monitoring the child’s response to sounds sent to visual stimuli. 6. Play Audiometry It is usually used in children (24 months and older). The test is administered with Free Space or headphones. The child wears a headset and legos or toys are placed in front of him/her. The child is conditioned to listen to the lego every time a sound is heard and to throw the lego into the box after hearing the sound. In this way, the child’s hearing thresholds are determined.

Tests Used in the Evaluation of Tinnitus (Hearing)

In the assessment of tinnitus (ringing in the ears), various audiometric tests are used to determine the characteristics of hearing loss and tinnitus. These tests help to understand the type and severity of tinnitus and its impact on a person’s hearing. Here are the main audiometric tests used to assess tinnitus: 1. Pure Tone Audiometry: Objective: Used to determine the degree and type of hearing loss. Procedure: The patient indicates whether they can hear sounds at different frequencies through headphones. This test is used to determine whether tinnitus is associated with hearing loss. Evaluation: Most patients with tinnitus may have hearing loss at certain frequencies. Pure tone audiometry maps this loss. 2. Tinnitus Matching Test: Objective: Used to determine the frequency and severity of tinnitus. Procedure: The patient is presented with tones of various frequencies and loudness and asked to indicate which of these tones is closest to his/her tinnitus. Assessment: The frequency and intensity of the tinnitus is determined by the patient’s description of their own tinnitus. This can help in the objective assessment of tinnitus and treatment planning. 3. Tinnitus Masking Test: Objective: Used to determine the level of masking (covering) of tinnitus. Procedure: The patient is presented with sounds of a certain frequency and intensity and it is determined when the tinnitus is completely masked (inaudible) by these sounds. Assessment: Determining the level of masking provides information about the severity and management of tinnitus. It is also used to assess whether masking therapy will be effective. 4. Tinnitus Handicap Inventory (THI): Objective: Used to assess the impact of tinnitus on the patient’s quality of life. Procedure: The patient is asked questions about how tinnitus affects their daily life. This test is done in a questionnaire form. Evaluation: THI scores indicate the extent to which tinnitus affects the patient’s social, emotional and functional status. This can guide treatment planning. 5. Loudness Discomfort Level (LDL) Test: Objective: It is used to determine the sound levels at which the patient is uncomfortable. Sound sensitivity (hyperacusis) may be common in patients with tinnitus. Procedure: The patient is presented with sounds of different intensities and the level of discomfort is determined. Evaluation: The LDL results can help to plan voice therapy for patients with voice sensitivity. 6. Speech Audiometry: Objective: Used to assess how clearly the patient hears and understands speech. Procedure: The patient is given various words and sentences and asked to repeat these words or sentences. Assessment: Patients with tinnitus may have difficulty understanding speech as well as hearing loss. This test assesses speech understanding. These tests are used in combination to determine the causes, type and severity of tinnitus. Tinnitus assessment is vital for accurate diagnosis and effective treatment planning. 7. Tympanometry Tympanometry in our clinic is a test that detects the presence of fluid in the middle ear or movement disorders in the ossicular system by measuring middle ear pressure and also helps to detect middle ear air-pressure and Eustachian tube problems. It is frequently used in ear problems in children. 8. Acoustic Reflex Test Tympanometry in our clinic is a test that detects the presence of fluid in the middle ear or movement disorders in the ossicular system by measuring middle ear pressure and also helps to detect middle ear air-pressure and Eustachian tube problems. It is frequently used in ear problems in children.