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Quix, question about the VNG test!
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Quix, question about the VNG test!

Quix,

I was reading your comment to one of the others here about the visual tracking problems. I was wondering about the VNG that you mentioned. I just looked it up to see what it involves, and was surprised to see that some parts of it looked a little familar. The part about them blowing cool and then warm air into each ear separately was something that was tested on me in a test called the three-pack. They also looked at my eye movements and watched my tracking manually, but not with me wearing goggles like the information that I looked up said that it was done. They did move my head in different positions to see if it induced dizziness and looked at my eyes during this, but still all done manually without any goggles or machines. They were looking for inner ear problems that mayt be causing the dizziness, they found no problem with my inner  ear or my hearing. The thing is I only had dizziness, vertigo for three months, and this was about three months after the onset in 2006. I am interested in the testing for eye tracking problems, as this seems to be the problem that I  have been expieriencing from the onset. All doctors say that my eye movements are normal, and this may be true, but I cannot track anything along a straigh line and at the first paragraphs and things I tried to focus on jumped all over the place. It was like the scene I was trying to see would not be still or stable. This has improved, but is still there to a certain degree. Any ideas what might be causing this or how it might be tested. And also would this type of problem have anything to do  with the visual field defect that I have?

Santana
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147426_tn?1317269232
Well, when the test is done manually and the eyes are "observed" for problems it is VERY inaccurate!  That's why the computerized VNG is so much better.  In the best form of the test, the computer actually can sense the actual and tiniest movements of the eye by focusing a sensor on the cornea.  They also video tape the covered eye so that the doctor can view the tape later enlarged and see exactly what the computer recorded.  

The test you had was "quick and dirty" and very gross (meaning they could see only the biggest of problems).  I have  never heard of using air.  The best method uses hot and cool water to exact temperatures in an extremely flexible balloon which flows into the entire ear canal and up against the eardrum.  Some places use the water directly.  That works but is a big mess.

The littlest problems with smooth pursuit, optikinetic testing, gaze and pendulum tracking, calorics will often show up.  I highly recommend seeking out a vestibular expert.  You can look on the VEDA website

****.org

and find a Dr. in your region.  

Quix
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Avatar_f_tn
I HAD A VNG,IT WAS A 3 PART TEST,I WORE GOOGLES AND HAD A FEW ELECTRODES ATTACHED TO THE HEAD.THESE ELECTRODES WERE CONECTED TO A COMPUTER.

THE FIRST PART WAS TRACKING RED LIGHTS ON A BLACK LIGHT,WITH THE ROOM DARK.THIS WAS THE OCULAR MOTOR TEST.

SENCOND PART WAS A POSITIONAL TEST,HEAD SIDE TO SIDE,SIT UP AND DOWN.THEN MOVE HEAD UP AND THEN THEY DROPPED IT BELOW THE TABLE.

THIRD PART WAS THE CALORIC PART TO WHERE THEY PUT WATER IN THE EARS.FIRST COLD THEN WARM .

THESE TEST, TEST FOR PERIPHERIAL DISORDERS AND CENTRAL(AS IN BRAIN)

WHEN I HAD THIS TEST DONE IT DETECTED INO--- A FORM OF NYSTAGMUS AND A BRAIN STEM LESION.

DID YOU EVER GET THE RESULTS? DID THEY DO THE TRACTING WITH THE EYES?

T-LYNN
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429949_tn?1224695179
This sound almost exactly like the three test they did on me, except for they had me look on a wall and try to follow the moving objects. They  were behind a booth and I did have some kind of wire glued to my head, but no goggles. They said they said my eye movements were normal. I have been told by my opthalmologist and my neuro and even by the technitians who done these test that my eye movements are normal. But I feel a restriction and some kind of paralysis when I try to attempt an upward gaze. They say this may just be a weak eye muscle. At the onset two years ago my eyes were completely numb and so was my forehead and I had terible twitching around my eyes and on my face upon attempted eye and face movement. This has since improved but is still there somewhat. The tracking and focusing problems were sevier at first. I could not focus on any one object without loosing my focus right away. I couldn' t read because I couldn't keep my place in the text. It was like the words wouldn't be still. When I did have the virtigo at its worst, about one year ago it was like everything in the invironment was moving. Nothing was being still. When I walked the floor and ground looked slanted. This has all improved, and I am now able to read a lot better, but still have this, but not as sevier, from time to time. Like when the opthalmologist tells me to look at his nose, I cannot look at his nose without loosing my focus. I have to keep moving my eyes back on the nose and still I loose control again. They did not use water, and did use cool and then warm air. They also put some kind of thing in my ear and said they were checking to see if the main nerve in my inner ear was getting the messeges to the brain. They said I had no inner ear problems and my hearing was normal. They thought that the vertigo and dizziness at first came from the  cut in my vision field. But this  still doesn't tell me why I cannot focus and hold my eyes on any one target without loosing focus immediately. It also  doesn't explain why I cannot track a moving object. I went to a low vision specialist the other day and he documented that I have diplopia on extreme right gaze. He also documented  on the cover test that I had something called exophoria. I know that I need more test to figure out all of this   dysfunction, but don't know exactly what to ask for. I have wondered about a possible lesion on my brain stem, but they did include my brainstem in one of my brain MRI's and said that they only saw some arthritis/ degenerative stuff back there. The thing is I had a sevier stiff neck for the first six months of this and sometimes have reaccuring stiffness and pain in the  back of my neck right where the neck connects to the brain. Is this MRI of my brainstem accurate enough to check my brainstem or do I need a spinal MRI?

Santana
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230625_tn?1216764664
I had the VNG testing as well for my lightheadedness.  My neuro ordered it.  

It had 3 parts as was described as T-Lynn (with the goggles), but I had warm/cold air during the caloric portion of the test and not water.

My test came out normal for the Central Nervous System, but showed a peripheral vestibular deficiency with my right inner ear.

My neuro tries to elicit nystagmus during his office exams, but is never successful.  I agree that manual manipulation is highly inaccurate.  
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230625_tn?1216764664
It sounds like you had the same form of the test, called an ENG vs. VNG. (guessing here).

Have you ever been looked at for TMJ at all?  I have TMJ and it really affects my neck muscles.  I've read about if affecting vision, but I'm not a doc.  Maybe Quix would have some more info on that...
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429949_tn?1224695179
What is TMJ?
Santana
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147426_tn?1317269232
I need to ask that you try to break up your posts into paragraphs.  Not double spacing like your tried before, but just break it up so that there is some white space between thoughts.  It is too hard to keep my eyes tracking (great topic here, lol) in such a long, dense paragraph.  I can't read what you have written.

TMJ is TemporoMandibular Joint - the jaw joint that is right in front of the ear.

Thanks, Quix
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230625_tn?1216764664
It a temporomandibular joint disorder.  The TMJ joint is where your jaw bone joins with the temporal bone of you skull.

There's usually pain and popping in the jaw, but I don't have much pain, but have lots of popping (I can't chew on my left side without my jaw feeling like it's popping out of joint).  I was Dx'd with TMJ by both an ENT and my dentist.  

I have sinus-type headaches, ear fullness, ear pain.  My SCM, masseter muscles and the group of muscles at the back of my neck where it joins the skull is very tight and knotted.  This makes my neck very stiff and cracks like crazy when I go to turn my head.  I also have limited side-to-side motion with head turns.  I've started PT.

I'm a teeth clencher and I've chewed on my nails for almost 40 years.  Not good for the TM joint.

Symptoms:
"Pain is the most common symptom. TMJ pain is often described as a dull aching pain in the jaw joint and nearby areas, including the ear, which comes and goes. Some people, however, report no pain, but still have problems using their jaws. Other symptoms can include:
Being unable to open the mouth comfortably
Clicking, popping or grating sounds in the jaw joint
Locking of the jaw when attempting to open the mouth
Headaches
A bite that feels uncomfortable or “off”
Neck, shoulder and back pain
Swelling on the side of the face

Additional symptoms may include: ringing in the ears, ear pain, decreased hearing, dizziness and vision problems."

TMJ may be way off base for you and your symptoms, but your neck stiffness sounds similar to what I have experienced.

Just a thought...
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429949_tn?1224695179
Thanks for the information on TMJ. I don't have any pain or problems with my jaws or with chewing, but I did have vibrating in my ears and head at the same time that I had the worst of the stiff neck symptoms.

Now I only have a slight stiff neck occasionally. The stiffness is mostly on the right side of the back of my neck and right where the big joint is in the back of my neck.

If I couple my hand around the spot when it is stiff, similar to having a support collar on,  it releives the stiffness as long as I hold my hand there to support it.

My Neuro included the brainstem in one of my brain MRI's with and without contrast to see if there was something there causing this. The only thing he said he saw was some arthritic/degenerative stuff.

I have an appointment with a Rheumatologist on May 19th, and I am going to see if he can find out what is causing this stiffness. I also have problems in both knee joints and both my hip joints, so it is possible that all of these symptoms are arthritic or degenerative in nature.

The vibrations in both my ears has gone away at the same time that the vertigo went away . The vertigo and vibrating in my ears was the reason that I ended up at a hearing specialist to start with.

The hearing doctor was the one who had this inner ear testing done, to rule out an inner ear problem. All test came back normal, and the technitian told me that she believed that all of the vertigo and vibrating in my ears earlier in this attack was caused by the visual field cut and the imbalance that it caused in my vision.

All of these symptoms, the stiff neck, vibrating in my ears, pressure in my eyes and head, pain in my eyes, transient tingling in the back part of my calves and the sides of my forearms, was part of the origional attack two years ago.

The vibrating in ears and pressure in eyes and head are completely gone. But the transient tingling in calves and forearms and stiff neck still show up occasionally, though they don't last as long. Usually only 30 minuets.

The visual field defect has improved over these two years and this shows on the repeat visual field test and also I can tell. But I still have the focusing problems and tracking problems, but not as sevier as it was at first.

I asked my neuro about all of these symptoms and he says that these are probally residual damage from the damage that the brain lesions caused.

Santana
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333021_tn?1207763233
Santana  6-paq

I had the VNG ? two wks. ago . No wires attached to head but did have goggles. It sounds like the same test you had.

When you had the caloric part of the test ( air in ear ), I had the air also, did you have any strange sensations ? I got strong clod chills on entire right side og my body and then a heavy vertigo right after.

Last wk. I was sent for pt. for it . The therapist did some neuro and eye testing and said my tracking was of a jerking motion, vestibular ... as the vng had suggested.  ( No one has given me the test result).  And no one has ever mentioned this jerking movement before , even though I have had problems for a year.

My issues sound a lot like yours .  Last June I got a permanent cramp like thingy in my r. eyebrow that slowly became a tightness and  involved both eyebrows and r. cheek, first buzzing then tingling .  All the while accompanied with uncomfortable tracking , especially looking up left, which would make me queasy. I had difficulties reading.  Lots of dizziness and some vertigo while sleeping.???

I also have had a stiff neck for months and a pain at the base of my skull..  ??  Whats up with us ??  :)    I was checked for tmj last yr. , that not it.  Someone in the last two wks did mention possible lesion. My mri does not indicate one in the brain stem.

  The therapist said I would need vestibular balance therapy ?? I'll let you know what tha tis when I go




Right now I'm getting ready for my parathyroid surgery tomorrow .  When it rains it pours.
I should feel pretty good after all this .  :)

Take care of yourself

Jo
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230625_tn?1216764664
First of all, I wish you the best during your surgery ((hugs)).  I hope that helps with some of your symptoms!

I know what you mean about having a bunch of stuff going on at the same time.  I'm right there with you!

I got dizzy during the caloric portion of the VNG.  My reactions were not nearly as strong as what you experienced.  The person that gave me the VNG testing told me the results right away.  He said that at that point, I am not showing any evidence of CNS causes, but do have a significant vestibular weakness with my right ear.

My neuro also ordered a (BSEP) Brainstem EVP to investigate my dizziness.  This was to see if there is a brainstem lesion causing it.  My testing was normal.  So, so far, I do not have any clinical evidence of a brain lesion in the brainstem (no lesion with the MRI).

I don't have buzzing or tingling in my face or neck, just a headache, ear pain, ear ringing. lightheadedness and major neck stiffness.  My lightheadedness occurs when I move my head either up/down/left/right.  It's brief and I don't have vertigo.

I did go through Vestibular Physical Therapy during December - February.  My therapist also did not find anything indicating CNS causes, but vestibular.   I'm labeled as "high functioning", whatever that means.  I guess I'm able to compensate adequately enough for the vestibular problems.

Vestibular PT was kind of fun.  Lots of balancing on foam with your eyes closed and walking while throwing a ball back-and-forth, up-and-down.   She worked on my tracking.  I have to keep my eyes focused on a letter on the wall while I move my head side-to-side and up-and-down.  

I do have alot of issues maintaining focus while doing that.  I can only move my head at half the speed of normal (I believe she said that a normal person can move their head side-to-side 2 times per second and still maintain focus.  I cannot.).  Driving is a bit difficult as I cannot focus clearly when I check left or right quickly.  I can see an object and identify it, but it's not sharp.

My home exercises are a bit uncomfortable, and I'm not that good about doing them.  When I start to feel the lightheadedness, I'll do the exercises a few times per day and it helps.  

I am currently in PT for the TMJ.  My therapist applies pressure on those muscles at the base of my skull until she can feel them start to relax.  It is very uncomfortable and is very tender when she does that.  Those muscles don't aren't painful, but sore when she works on them.  She also massage the SCM muscles on the side of the neck, my forehead, temple and top of my head.  Also the masseter muscle (it's the muscle you feel tighten when you clench your jaws).

Well, I've probably told you more than you want to know, but your symptoms sound somewhat similar.

Let us know how your Vestibular PT goes!   If I can answer any more questions about it, let me know!

Take care and I wish you well tomorrow!
Pat
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429949_tn?1224695179
Yes, I did get very light headed when the air was blown in each ear, but it wore off fast. The lady said that this was a normal response. Infact she said that my entire exam was totally normal, indicating that a vestibular cause was unlikely. I don't know what is up with the stiff neck though! Mine started about three months after the onset of symptoms in April 2006.

It stayed stiff continuous for three months and has improved since then. I go long periods now without it being stiff. But sometimes I will have bouts with it that last about 30 min. I already take a low dose of Xanax for the panic disorder that I have, and taking this when it is stiff seems to relieve the stiffness, though I am not sure why this is! I am not taking the Xanax for the stiff neck, but I have noticed that it does relieve this symptom when I do take it at my normal time. This makes me wonder if this has some kind of  muscular cause behind it!

I read in one of Quix post that to get a clearer picture of the brainstem that a cervical spine scan should be done( I hope I got the name of that right). When I go to the Rheumatologist on May 19th I am going to ask him to find out what is going on in my neck and shoulders.

Good luck on your surgery, I will keep you in my prayers for this! I will update you if I find out anything about the neck stiffness!

Hugs
Santana
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Sorry, I meant to address that response to you too, and just noticed that I forgot to add your name to the title. Thanks for your information and input, it means a lot!

Santana
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230625_tn?1216764664
Ooops, sorry I misled you about the caloric test, I was wrong.  If you get dizzy, then THATS normal.  If you do not get dizzy, that means that there is a peripheral weakness.  

Now that I can remember right, I got dizzy with one ear with the warm air.  My responses were not that great though.

Sorry about that.  I've had so many tests, that I'm getting the results mixed up!  Gosh, I'm embarrassed...

Santana ~ did you have a cervical spine MRI?  

I think the Xanax relaxes the muscles, which could be why your neck feels better when you take your dosage.   I'm on lexapro for my anxiety (but will be tapering off very soon).  I do have a Xanax Rx, but I haven't taken it in quite a while.  My bilateral hand tremors go away when I'm on Xanax, but the Lexapro doesn't affect them.

When I first went to a neuro, I went for constant sinus-type headaces (I had been told at the time that my sinuses were clear, but found out later they weren't and had surgery) and for a very stiff neck.  My neuro suspected that my problems were with my neck, but a cervical spine MRI only showed some mild arthritis.  He then immediately ordered a brain MRI and the rest is history...    My very stiff neck subsided after a few weeks, but I still have isses ~ just not to the extent that I did in Jan 2007

Good luck with your rheumy appt.

Take care, Pat :)
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429949_tn?1224695179
I know what you mean about getting the test results all mixed up! Too many doctors, too many test, it starts to remind me of the movie Groundhog Day!  lol!!!

I will let you know what the Rheumatologist says!

Talk Soon,

Santana
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Avatar_m_tn
I recently had a VNG test at the Neurology Center in Rockville MD.  It was so painful that I could not make it through it, I had to beg them to stop.

The first two parts of the test were awkward and uncomfortable, but not painful.  But the last part involved inserting something into my ear and blasting me with hot air.  The pain was excruciating -- like a needle being plunged deep into the ear, and then unleashing air with the concentrated fury of a fire hose.  I knew I was in trouble about fifteen seconds into it, by thirty seconds I was emitting loud expletives and by forty I had screamed for them to stop.  The technicians inquired as to whether I was experiencing nausea, which I definitely was, but that was nothing in comparison with the intense pain of being stabbed deeply in the ear and blasted with incredibly forceful air.

I could not proceed with the rest of the test, and informed my doctor never again would I submit to a VNG.  A day later, my ear is still killing me, I'm stil queasy, and I'm not hearing all that well.

I've been reading online about VNGs and incredibly, there are no warning about the intense pain involved -- only about dizziness and nausea.  I can't figure out whether the horrible intensity of the experience is being glossed over or whether they just botched my case something awful.  In any case, I want people considering a VNG to be informed of how horrendously painful it can be.  It is not fun to have your ear stabbed and blasted with an intense air stream.  And I cannot fathom how it can possibly be safe.  In my opinion this is a procedure that the medical community needs to find a safe alternative to, and fast.
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