Vestibular Exam & Treatment

Table of Contents:

  1. Name that Nystagmus!
  2. BPPV: Exam & Treatment
  3. Physiology & Anatomy animations

1. Name that Nystagmus! (Hint: #3,4,6 are easy ones to start with)

A. View Clip
B. Answer Questions
C. Check Your Answers

The R EYE is all you see.
Mov213 DCPN.mp4

  1. First the therapist tells the patient to gaze to the Left. What happens?
  2. Then he tell her to gaze center. What happens?
  3. Last, he tells her to gaze Right. What happens?

Check your answer.

Human demo of Halpike Dix shows the Right EYE with a tiny video inset of full body positioning.

It is hard to see, but the L ear is positioned down.

  1. Describe the nystagmus in the supine position.
  2. Describe the nystagmus when brought to sitting
  3. What is the diagnosis?

Human demo of HPD, showing movements by therapist (R ear down position) and a R EYE video.

  1. Describe the nystagmus in the supine position.
  2. Describe the nystagmus when brought to sitting
  3. What is the diagnosis?

Check your answer.

Patient with Meniere's Disease.
Both EYES are shown.

  1. Describe the nystagmus during R and L gaze.

Check your answer.

UVL: Unilateral Vestibular Lesion: Vestibular Neuritis
Left EYE
There is an inset video, but all the patient does is sit on the plinth. There is no audio, but you can see the change of gaze direction.
  1. Describe the nystagmus during R and L gaze.

Central Lesion.
Full face view of both eyes

  1. Describe the nystagmus

Check your answer.

  1. Describe the nystagmus

Cerebellar Degeneration.
Right Eye

This clip has audio with the therapist telling the patient to follow the horizontal movements of his finger.

Name the nystagmus at each gaze position that is held by the patient:

  1. left
  2. center
  3. right
  4. center

#9: Central Lesion:
Pendular Nystagmus

This is just an example. There is no question.

Gaze moves slowly from center to left gaze.
Note the pendulum-like movements of the eye


2. BPPV: Exam & Treatment

1. Diagnostic maneuver for BPPV: Hallpike-Dix
Intervention for BPPV Canalithiasis: Canalith Repositioning Treatment (CRT), aka "Eppley"


2. Intervention for BPPV Cupololithiasis: Liberatory Maneuver, aka "Semont"

When HPD elicited nystagmus lasts longer than 30 sec., the Liberatory Maneuver will be indicated as treatment for Cupulolithiasis.

Nose points up, and then patient holds that position when flipped (nose pointed into the mat), and therapist shakes her head at the end.



3. Physiology & Anatomy animations

1. Middle-Ear-Pressure.gif
-- how the middle ear equalizes pressure via the Eustachian tube, i.e. how ears "pop"
2. Outer-middle-inner-ear.gif
-- shows anatomical zones
3. Vestibular nerve.gif
-- show the mechanism of hair cell deflection in the cupula from the endolymphatic fluid from the SCC that happens with head movement. The signal travels along the Vestib nerve to the Vestibular nuclei in the Pons and Medulla, and then on to the Parietal Cortex.
4. Vestibule and canals.gif
-- indicates the anatomic zones of the Vestibule and the SCC.

All video clips and animations, except <hpd-eppley.mp4>, are used with permission from
Created by Timothy C. Hain, M.D. Accessed 8-21-2006

"Vestibular Examination & Treatment" learning module authored by Carmen Casanova Abbott PT, PhD and
Evan Prost PT, DPT
University of Missouri Physical Therapy Department
.  Updated 7-7-2021.