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Old 11-13-2005, 12:59 PM   #1
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Question Rotary Chair Test Versus ENG

Hi Everyone,

This question was kind of asked on another post but never got answered so I thought I make a separate post for it.

I had been wondering this for awhile as I had the Rotary Chair test done, but my doctor never did an ENG. He did a few other minor test too. He wants me to have another CT-Scan done, but am hesitant on doing it.

Anyway, I was reading some old posts and one of CL's caught my eye as she had both done and it showed some vestibular damage on the Rotary Chair Test.

My question is, how are the results of the two test different? Are they both providing the same information? Can the rotary chair test indeed show vestibular damage?

I know the test aren't 100% accurate, but am really confused about what I am reading about the differnce in the two types of tests. The rotary chair test did show that my eye movement was faster than my brain was compensating for movement. He didn't say I showed any vestibular damage and hasn't even brought that up as a possibility which I strongly believe is what is wrong with me. Should I push for an ENG at this point or do you think the rotary chair test was enough and at this point it really doesn't matter if I have the ENG done or not?

Any information on this would be helpful. I know there is someone else out there that was wondering about the difference between these two tests as well.

Take care everyone - Gloria

Last edited by gloria2936; 11-13-2005 at 01:02 PM.

 
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Old 11-13-2005, 03:34 PM   #2
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Cool Re: Rotary Chair Test Versus ENG

Hi Gloria

..."Anyway, I was reading some old posts and one of CL's caught my eye as she had both done and it showed some vestibular damage on the Rotary Chair Test."...

Good question...I'll give it a try...and conclude with reference to the Northwestern Univ(Dr/Prof Hain's site)..for some in depth...

..."The purpose of the ENG is to determine whether or not dizziness may be due to inner ear disease. There are four main parts to the ENG. The calibration test evaluates rapid eye movements. The tracking test evaluates movement of the eyes as they follow a visual target. The positional test measures dizziness associated with positions of the head. The caloric test measures responses to warm and cold water circulated through a small, soft tube in the ear canal."...

...." The ENG test is the gold-standard for diagnosis of ear disorders affecting one ear at a time. For example, the ENG is excellent for diagnosis of vestibular neuritis. The ENG is also useful in diagnosis of BPPV and bilateral vestibular loss, although the rotatory chair test is better at the diagnosis of bilateral vestibular disorders than is the ENG. The calibration and tracking tests are intended to diagnose central nervous system disorders, such as cerebellar degenerations. These tests are generally insensitive compared to an examination by a neurologist or an MRI scan. ENG, however, is much less expensive than an MRI in most institutions. "....

..."The purpose of rotational testing is to determine whether or not dizziness may be due to a disorder of inner ear or brain. There are three parts to the test. The chair test measures dizziness (well jumping of the eyes really -- called nystagmus) while being turned slowly in a motorized chair (see rightward illustration above). Persons with inner ear disease become less dizzy than do normal persons. The optokinetic test measures dizziness caused by viewing of moving stripes (see leftward illustration above). Optokinetic testing is sometimes useful in diagnosis of bilateral vestibular loss and central conditions. The fixation test measures nystagmus while the person is being rotated, while they are looking at a dot of light that is rotating with them. Fixation suppression is impaired by central nervous system conditions and improved by bilateral vestibular loss. "....

..."Rotatory chair tests are usually obtained in addition to ENG (caloric) testing. Why get both when both test the same part of the ear (lateral semicircular canal) ? The reason is to add accuracy. ENG tests by themselves may be falsely positive or falsely negative. They can be falsely positive when wax blocks one ear canal. Rotatory chair testing is not affected by mechanical obstructions of the ear. They can be falsely negative particularly in situations where there is damage to each ear."...

For more & there is a lot more---the Northwestern Univ Web Site: (it is the same web site--just a different page on the server--- called out in the information archive post--sticky--first post on board)

http://www.dizziness-and-balance.com/testing/engrot.html

I wish...Doc's would take the time..to make sure a patient...understood---what was going on/down....the only way I have been able to solve it---sort of---is---I always ask for a complete copy of all tests...Doc's "notes"...etc...by law..they must provide them..may cost...but not much...they will cough them up....u will be surprised what u see...at least I was....


Last edited by Subs30; 11-13-2005 at 03:38 PM.

 
Old 11-13-2005, 07:10 PM   #3
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Re: Rotary Chair Test Versus ENG

Subs:

Question.. I took a slew of tests at a Balance Center in NY ..called Northern Westchester Hospital Balance Center

I took:

Posturography:
Sensory Organization tests: Which Falls where noted on conditions 5 and 6. 1-4 were normal

RVT (Rotational Vestibular Testing):
Vestibular Ocular Relflexes, Optokinetic (OPK) both were normal.


ENG:

Calibration and Oculo-motor tasks of tracking of smooth Pursuit and Gaze are within normal limits

Testing of Saccades reveals abnormal peak velocity and accuracy, bilaterally
Right beating Nystagmus is superimposed onto Saccadic Responses.

Hallpike provoked no nystagmus or dizziness

Their was right beating spontaneous and positional nystagmus recorded in all positions 2-5 degrees
Calorics:
RC 50 degrees LB
LC 41 degrees RB
RW 27 degrees RB
LW 5 degrees LB

Caloric Weakness could not be calculated.. The responses to air caloric Stimulation are judged to be influenced by central suppression effects

Ice water Calorics: Intact eardrums noted on typanograms performed on this test date. responses to ice water stimulation rise signifigantly above those obtained with standard air caloric stimulation
Right Ear 65 degrees LB
Left ear 70 degrees LB

Impressions: Basic Balance Function tests indicate normal and symetrical vestibular responses to ice water caloric stimulation. Caloric weakness was not calculated for standard air stimulation due to the effects of central suppression. Vestibular Ocular reflex responses to rotational vestibular testing are within normal limits.


Cental Nervous system involvment is supported by abnormal Saccadic Latency, Accuracy, amd Superimposed Right beating Nystagmus. Ocular Motor tasks of Calibration, gaze and tracking of smooth pursut are within normal, limits...It should be noted that there was right beating nystagmus and positional nystagmus in all positions of standard positional testing

Posturography testing indicates a vestibular dysfunction paqttern


Basically this was the testing done on me. Doctor said I had a vestibular disorder and dysfunction. He sent me for VRT which I been doing since January 05. I am anywhere from 805 to 90%....recently 80% with a few colds going on...I have had this 22 months. Wemt undiagnosed until 11 months in

You seem very bright and intelligent. What does my testing mean in English that I can understand.... Is theri anything else I can do but VRT? I also had a ton of other tests such as MRI, MRA brain, CT scan and many others.. All were normal

Thank you for your help,

Howie

 
Old 11-14-2005, 12:18 AM   #4
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Cool Re: Rotary Chair Test Versus ENG

Hi Howie

If I'm reading it right:

The Vestibular testing(i.e. everything except MRI, MRA, CT, etc..) indicated a inner ear problem on the right side...but...all those tests(vestibular) could not rule out a "Central Cause",i.e. balance problem being caused by your "brain".

Thus the MRI, MRA, CT, etc...to rule out a "Central Cause"...which u say were normal....

Leaves u with a balance problem being caused by an inner ear(vestibular)i.e. "Peripheral" vice "Central"...looks like on the right side...of unknown origin

....i.e., Lab, VN, BPPV, etc

....which can not be ruled in or out

...since the testing(vestibular)..capability that exists--to day---does not provide for that degree of fidelity/accuracy....for them to say conclusively

....i.e., they can't Dx it beyond "Peripheral" right side(I think)....

Looking at the:

..."abnormal Saccadic Latency, Accuracy, amd Superimposed Right beating Nystagmus"....

Which is same prob I had...to me...indicates...an underlying vision issue...which...will/can slow down VRT's ability to reach full compensation(my case also)...and will be the critical path to 100%...so, if:

U have had ur vision checked by a Ophthalmologist---who understood---u had the:

..."abnormal Saccadic Latency, Accuracy, amd Superimposed Right beating Nystagmus"....

And he/she found no underlying vision issue,i.e, need glasses, etc...or corrected one---found....its:

VRT's---with emphasis on visual one's---but:

Vision is a biggie...to get...back on track...takes time, time, time, time, VRT's, VRT's, etc.... most/ a lot of people just reach a point...and..say this is not working and stop....it's working....but just takes a long time, time,time...

...read/reread...my post to Firechick...it is one of the most complex of the "three" input signals/senses....requried by the brain's equilibrium center...

......."anything else I can do but VRT?"........

Not that I know of...but I keep looking and listening...

Just Buckle up and go for it....with each movement u make..its a step..well..inch perhaps...closer...going to be the fight of ur life...but u'll make it---others have---and most do....but its a (fill in the blank)..

Oh...

...."You seem very bright and intelligent"....

Tks for the complement

...but all here...have been there...or are there..now...and so understand

...what ur going through

.....just ask the question...most will answer...or take a shot at it

...stay focused...on what's needed...on ur part to overcome this junk

...and when u do...and u will

....u will have an obligation...to hang around...and help the next person...trying to fight their way back...from the edge...



Last edited by Subs30; 11-14-2005 at 12:24 AM.

 
Old 11-14-2005, 06:47 AM   #5
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Re: Rotary Chair Test Versus ENG

Subs:

Thank You for the response...The only thing that showed up in the MRI's and MRA's were a possible small pituiatary cyst... I saw three Endocronolgist who said that small cysts are normal and the MRI said "possible or non specifc finding" I took all of the hormone testing several times all normal. My first MI/MRA was in March 2004 and they followed up in October 04 and the finding looked " less apparant" and did not grow.... The 3 endocronolgist stated this is normal and no follow ups unless you ever had other symptoms.... Pituatary is not near your vestibular functioning mechanism. basically they said 40% of the population have Pituitary Cysts and do not even know it. Studies done it Autopsy's

As far as the eyes I saw 2 Neuro-Opthamolgist, 2 Opthamolgist and all said everything is clear.. Nothing they can see with their testing. One said to follow up with the Neuro-Otologist as that could not be ruled out as an influence....


Neuro-Otolgist defintion: Based on the MRI/MRA nothing is wrong with my brain.... He thinks that the messages between the brain and inner ear are getting crossed up.... He said due to the capability of the inner ear testing. They can not pin point what part of the inner ear. the testing just provides them with an abnormal functioning

He said VRT , time, patience is all I can do....... Medications are more for people who can not function at all as they supress the vestibular nerve....

I am doing alot of visaual VRT 2 times a day and even trying to do this in dim light to shock the brain..... I have been doing this 11 months or so. Frist year undiagnosed so its like 22 months total. When you say long road ....Does that mean that my 11 months of VRT is still not that long.....


Thank You,

Howie

 
Old 11-14-2005, 07:19 AM   #6
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Cool Re: Rotary Chair Test Versus ENG

Hi Howie

..."its like 22 months total. When you say long road ....Does that mean that my 11 months of VRT is still not that long....."...

Doubt the first period...is a total loss...from a compensation point of view...just not targeted...at vision....but still benifcial..since more then just vision is involved...think...vision....the biggie....will slowly adapt...but it will take time...how much...no one knows...but...with few exceptions....the trajectory will be upward...but perhaps not liner...at least that was my case...but got there...u will also....u covered all the things/test/etc...and them some...that a person could/can do....so that is behind u...now u know what u need to do...and that...whatever is causing it---is benign...and ur pretty sure what the fix is...to get back...so---as ur now doing...just press forwarded...keeping an eye/ear tuned into possible...reasearch...break through....u'll get there!

Just know way of knowing how long....


 
Old 11-14-2005, 07:29 AM   #7
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Re: Rotary Chair Test Versus ENG

Thank you again subs...

I will stick around when I beat this..... I am trying other things to try and help out.... The Mav diet as it can not hurt.. started today and it can help me lose weight..... Chiropractor as it helps a little....

Most of my excercises are Visual ... Looking at differnet objects in different surroundings such as a checker board, I do them every day for an hour .....

I guess its just a matter of time and not letting anxiety or other things hurt compensation....

My VRT therapist thinks I am doing well....... I know I have made gains but just sometimes tired of the endless fight we deal with each day

Have a Great Thanksgiving next week.....

Howie

 
Old 11-14-2005, 10:46 AM   #8
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gloria2936 HB User
Re: Rotary Chair Test Versus ENG

Hi Subs,

Thanks for the information. I have actually read some of that along the way somewhere, but still am a little confused.

What I am comprehending between the two tests is that the Rotary Chair test looks at not only the vestibular system, but the central system as well versus the ENG really focusing on the vestibular system alone and what causes the dizziness.

It sounds as if the two tests really give the same information. Having an ENG done too would really just confirm my first tests results (rotary chair results); kind of like a double check. Am I correct in my thinking?

Also, is it saying that if my condition was bilateral then the rotary chair could give a false negative result? Also if my damage is slight, could it just not have showed up on this test?

I'm also confused by the statement that a normal person without a vestibular problem would be dizzy with the rotary chair test and that a person with a vestibular problem would not be affected by the test. I did not feel any different after this test as I felt the same when it was all done.

If you can shed any clearity on the above I'd appreciate it. I'm also going to try and call my doctor to get a little more clearity on the tests results.

Take care - Gloria

Last edited by gloria2936; 11-14-2005 at 10:46 AM.

 
Old 11-14-2005, 02:11 PM   #9
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Cool Re: Rotary Chair Test Versus ENG

Hi Gloria

..."What I am comprehending between the two tests"....

To some degree..but...think it is more that one confirms the other..they both can indicate/show that an MRI should be done...since...both(if given) can raise the question of "central".....and both test vestibular

---in my case never had the Rotatory..just eng...which raised "central"...and required MRI...to include or exclude that posiblity...for me it "excluded" it....they could have gone from eng to Rotatory...but...since the only way to exclude "central" once raised by a "ENG" or "Rotatory" is an MRI....I suspect that they would only do both...the "first" (ENG or Rotatory) did not show a possible "central"...only to confirm that test...so that if the second(ENG or Rotatory)...did not show possible "Central"...they would not have to do/take MRI.....which can be very expensive.....which is why they make the statement:

...." These tests (ENG & Rotatory) are generally insensitive compared to an examination by a neurologist an MRI scan. ENG/Rotory, however, is much less expensive than an MRI in most institutions. "....

---they would just:

..."confirm my first tests results (rotary chair results); kind of like a double check. "...

...." Am I correct in my thinking?"...

Yes

..."condition was bilateral then the rotary chair could give a false negative result?"...

No---don't think so....it said:

..." The ENG is also useful in diagnosis of BPPV and bilateral vestibular loss, although the rotatory chair test is better at the diagnosis of bilateral vestibular disorders than is the ENG."....

So it is saying the rotatory chair test is "better" Dx'g "bilateral"...

...Also if my damage is slight, could it just not have showed up on this test?"...

Yes or the ENG....happens all the time...


..."I'm also confused by the statement that a normal person without a vestibular problem would be dizzy with the rotary chair test..."...

What I think their saying is a person...when spun like that---who's vestibular system is not injured

---would be have the inner ear on one side giving a signal different from the other side......which is what happens when u spin around on ice skates...one side says one thing...other side says another...brain says---dizzy(or vertigo)

..."and that a person with a vestibular problem would not be affected by the test."....

If the inner ear is damaged on one side...there is no "other" signal of any magnitude(depending on the extent of the damage)..to cause the brain to say--(sense a signal imblance)---dizzy....of course...the degree of the vestibular injury---would determine...how that would actually play out---in terms of---the magnutude...of what u felt dizzy--vertigo--nothing---whatever...

..."I did not feel any different after this test as I felt the same when it was all done"...

Indication of a Vestibular Injury......of course if you where a figure skater..for ur entire life...spinning and spining and spining...as part of your repertoire...the above...would not necessarily hold true...since your brain would have compensated...through...the VRT's(spining)...so your brain would just ignore the bum/imbalance signals....this would also...hold true for a "trapeze artist"...etc....its all relative to what u done in the past...and have stored away in "long term memory"

..."going to try and call my doctor to get a little more clarity on the tests results"...

Suggest you get your medical records, all test results and all notes made by the Doc/tester...etc...then call...


Last edited by Subs30; 11-14-2005 at 02:21 PM.

 
Old 11-14-2005, 07:09 PM   #10
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Re: Rotary Chair Test Versus ENG

Thanks so much for putting that all into perspective. All makes more sense to me. They did do an MRI and a CT Scan and everything was normal. I actually had that done way before the Rotary Chair test or any of the other test.

I'm going to take your advice and get a copy of my records and then prepare some questions for the doctor.

Thanks again for helping me to understand this testing stuff.

Hope you have a good evening. We've had beautiful weather in Pittsburgh today so hopefully you'll get it tomorrow.

Gloria

 
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