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Quix! VNG, correction to previous post!!
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Quix! VNG, correction to previous post!!

Quix,

In a previous post I had asked you about the VNG test.  I had told you that I had something called a three pack that sounded similar to your description of the VNG. Today while going through some of my medical records I found the report from that test. It says at the top that it was indeed a VNG.

I couldn't remember wearing the goggles, but with the memory slips and so many doctors and test, maybe my memory was a little foggy on this!

Summary and impression:

ABR results show no evidence of retrocochlear pathology and electrocochleography results show normal SP:AP ratios with no evidence of hydromechanical dysfunction. VNG results are normal. It is recommended that the patient consider vision therapy, to see if vision therapy  may help compensate for recent visual field changes. She may also benefit from balance therapy if problems persist after vision therapy is completed.

Quix can you help me understand these results?

Santana
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230625_tn?1216764664
Not Quix, but I believe that ABR is Audio Brainstem Response and is a brainstem evoked potential (one of the evoked potential tests).  Did they put electrodes on your head and play "clicks" in your ears?  

My neuro ordered both the BSEP (ABR) and the VNG due to my dizziness.   My BSEP and VNG were normal for CNS stuff as well, but my VNG showed a peripheral weakness.

I've had balance therapy (vestibular therapy).
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429949_tn?1224695179
They put head phones on my ears and tested my hearing with beeps. They also put some  kind of thing in my ears one at a time and said that this was to test the vestibular nerve to see if my brain was receiving information from this nerve. They said that it was normal.

I think the hearing part was one part of the test and the other test was to check for vestibular dysfunction. They said they were checking to see if the imbalance was from the inner ears, or from the brain.

At the end of all the test they told me that the hearing and vestibular testing was all normal, and they thought that the virtigo  that I had shortly after the onset was from the imbalance in my vision from the visual field cut.  They couldn't really explain the vibrating in my ears and head that I had at this same time.

All of the virtigo and vibrating is now gone. It started three months after onset and lasted about six months. I am thinking that all that this test showed was that my hearing and my vestibular functions are normal.

This is some more of the results

Saccade Test
Fixed/caligration: WNL      Random Saccades: WNL

Smooth Pursuit: Smooth, accurate horizontal pursuit movements at
0.3 Hz: WNL          0.45 Hz: WNL

OPK Test: OPK nystagmus was of normal symmetry and waveform at 20 degree/sec & 40 degree/sec

Gaze Test: gaze nystagmus at 30 degree eye deviation to the left or right or at center gaze: WNL

Positional Nystagmus:
Supine: 0                              Head Right: 0
Head Left: 0                          Head Hanging: 0
30 degree Supine: 0              Sitting: 0

Dix-Hallpike Test: for paroxysmal positional nystagmus
Head down& Right: negative          Head down and Left: negative

Bithermal Calorics
SPV[o/s]                                     Unilateral Weakness
Right Warm:12.0                           6 percent to the right
Left Warm: 18.2                            
Left Cold: 14.3                               Directional Preponderance
                                                    1 percent to the left
                                                    Failure of Fixation Suppression: Negative

SUMMARY AND IMPRESSION: ABR results show no evidence of retrocochlear pathology and electrocochleography results show normal SP:AP ratios with no evidence of hydromechanical dysfunction. VNG results are normal. Vision therapy is recommended  to help compensate for recent visual field changes. She may also benefit from balance retraining therapy if problems persist after vision therapy is completed.

This is the entire report, and I don't understand most of it!

Santana
Right Cold:16.5
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230625_tn?1216764664
The test where they stuck the probe in one ear at a time is the ABR (evoked potential).

My report just says that everything is within normal limits.  I have also had my hearing tested twice and everything was ok.

I did have a Tympanometry test and I got VERY dizzy during the testing of my right ear.  This is the ear that tested abnormal during the VNG Caloric test.  ENT and neuro were unconcerned...

My VNG results were about like yours except:

POSITIONAL NYSTAGMUS:
Head hanging:  Mild left-beating nystagmus    *** Don't know what this means ***

BITHERMAL CALORICS

UNILATERAL WEAKNESS
Right Ear (77%)            *** significant vestibular weakness in my right ear ***

DIRECTIONAL PREPONDERANCE
To the Left (35%)

LABRYINTHINE REACTIVITY
Unilateral weakness for the right ear

SUMMARY AND IMPRESSION:   Positive VNG evaluation.
Central testing was unremarkable.  Positional testing was negative for nystagmus in all head and body positions, except for head hanging.  Dix-Hallpike was negative for rotational/torsional nystagmus in both head positions.  Caloric testing did reveal a significant unilateral weakness for the right ear and a significant directional preponderance.  

IMPRESSION:  Right vestibulopathy.  1) Follow-up with neurologist   2) Follow-up with ENT.

So, both my neuro and ENT were unconcerned about the report and the vestibular weakness and didn't propose to do anything.  Neuro said let my ENT deal with it.  ENT said since I don't have vertigo, he wasn't going to treat it.  >:-|

I finally asked my ENT specifically for PT for the dizziness at a follow-up appointment for my sinus surgery.  He went ahead and ordered it.

Kind of ticked me off that I did have a test which pointed out an issue and neither of my docs would put forth the initiative to treat me for it!!!  

YOU are your best advocate and you have to keep pushing for answers!!!!

The vestibular PT did help.  I do sometimes get the lightheadedness here and there, particularly when my allergies are acting up.  Doing my exercises helps set me right.

HTH!
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429949_tn?1224695179
That is really bad that some doctors won't treat the symptoms that they dx, I haven't any treatment for any of my symptoms in two years. The nerve pain is the worst for me in my eyes, scalp, and head.

What is this test suposed to tell them anyway? If yours was positive and they still done nothing then why do the test?  Mine seemed to be pretty much normal but no one explained to me why I had the virtigo so bad at the first and also the vibrations in my ears and head!

Sometimes I wonder if any of these neuros know what is causing all of these strange symptoms that we go through!

Santana
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230625_tn?1216764664
My neuro sent me for the BSEP and VNG since he was looking for some further evidence for an MS Dx.  He didn't get it from the tests.   Since the VNG showed a problem with my inner ear, he said it was the ENT's area.  My ENTdidn't think it was significant to do anything and said that the VNG was "highly inaccurate" (I'd like to hear Quix's thoughts on that).

I'm tired of feeling like a darned ping-pong ball!!  But, we all know how it is...

I don't know what to suggest about your visual issues.  I haven't read anything in that area.  But, about the "vibrations" in your ears... is it more like a "ringing" or "pulsation" or just like a "buzzing"???
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230625_tn?1216764664
Also wanted to say that I'm sorry you're having such pain in your head and aren't getting any help for it.

Why won't your docs just treat your symptoms without having a diagnosis!!!  They are surely capable of doing that!!!  That's what makes me so mad!!  

((hugs)) Pat
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429949_tn?1224695179
The vibrating (buzziing) in my ears was three months after onset, and only lasted for about four months. It is mostly gone now, but sometimes I still feel(hear) it in the left side of my head, where most of the lesions are, when I move my eyes to the far left.

The pain in my head is more like pressure behind my eyes and it is almost gone too now. The  scalp tenderness is there tonight and it is only in one spot on the left, again where most of the lesions are.

I have been looking up scalp tenderness tonight, and have been pulling up TN.  It says that the scalp and forehead along with the eyes can be affected if the TN is in the occupital part of the nerve. I wonder if this could be what all of these symptoms are coming from?

I am going to call my neuro tomarrow and tell him about this scalp tenderness again and see if I can get him to listen this time!

Santana
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