Electronystagmography (ENG) is a diagnostic test to record involuntary movements of the eye caused by a condition known as

nystagmus Nystagmus is a condition of involuntary (or voluntary, in some cases) eye movement. Infants can be born with it but more commonly acquire it in infancy or later in life. In many cases it may result in reduced or limited vision. Due to the invol ...

. It can also be used to diagnose the cause of

vertigo Vertigo is a condition where a person has the sensation of movement or of surrounding objects moving when they are not. Often it feels like a spinning or swaying movement. This may be associated with nausea, vomiting, sweating, or difficulties w ...

dizziness Dizziness is an imprecise term that can refer to a sense of disorientation in space, vertigo, or lightheadedness. It can also refer to disequilibrium or a non-specific feeling, such as giddiness or foolishness. Dizziness is a common medical c ...

balance Balance or balancing may refer to: Common meanings * Balance (ability) in biomechanics * Balance (accounting) * Balance or weighing scale * Balance as in equality or equilibrium Arts and entertainment Film * ''Balance'' (1983 film), a Bulgaria ...

dysfunction by testing the vestibular system. Electronystagmography is used to assess voluntary and involuntary

eye movement Eye movement includes the voluntary or involuntary movement of the eyes. Eye movements are used by a number of organisms (e.g. primates, rodents, flies, birds, fish, cats, crabs, octopus) to fixate, inspect and track visual objects of interest ...

s. It evaluates the

cochlear nerve The cochlear nerve (also auditory nerve or acoustic nerve) is one of two parts of the vestibulocochlear nerve, a cranial nerve present in amniotes, the other part being the vestibular nerve. The cochlear nerve carries auditory sensory informatio ...

and the oculomotor nerve (CN III). The ENG can be used to determine the origin of various eye and ear disorders.

Technique and results

Electrodes An electrode is an electrical conductor used to make contact with a nonmetallic part of a circuit (e.g. a semiconductor, an electrolyte, a vacuum or air). Electrodes are essential parts of batteries that can consist of a variety of materials dep ...

applied around the eyes record eye movements using the corneo-retinal potential. Some portions of the ENG measure a patient's ability to track a moving stimuli while others observe the presence of nystagmus. The vestibular system monitors the position and movements of the head to stabilize retinal images. This information is integrated with the visual system and spinal afferents in the brain stem to produce the vestibulo-ocular reflex (VOR). ENG provides an objective assessment of the oculomotor and vestibular systems. A newer standard for the recording is the use of infrared video systems which allow for a more detailed observation and analysis of these eye movements, called video nystagmography (VNG). A similar test is performed for testing vertigo by using the

caloric reflex test In medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of ...

, which can be induced by air or water of specific temperatures, typically ± 7 degrees Celsius from body temperature. The standard ENG test battery consists of three parts: * oculomotor evaluation * positioning and positional testing * caloric stimulation of the vestibular system The comparison of results obtained from various subtests of ENG assists in determining whether a disorder is central or peripheral. In peripheral vestibular disorders, the side of lesion can be inferred from the results of caloric stimulation and, to some degree, from positional findings. ENG or VNG can be used to record

during oculomotor tests such as

saccade A saccade ( , French for ''jerk'') is a quick, simultaneous movement of both eyes between two or more phases of fixation in the same direction.Cassin, B. and Solomon, S. ''Dictionary of Eye Terminology''. Gainesville, Florida: Triad Publishi ...

s, pursuit and gaze testing, optokinetics and also calorics (dithermal or monothermal). Abnormal oculomotor test results may indicate either systemic or

central Central is an adjective usually referring to being in the center of some place or (mathematical) object. Central may also refer to: Directions and generalised locations * Central Africa, a region in the centre of Africa continent, also known as ...

pathology as opposed to peripheral (vestibular) pathology. Optokinetics generally are used as a cross-check on abnormal responses to oculomotor tests. Both of these tests use a "light bar" involving a moving light (usually red) which the patient will track with the eyes. The caloric irrigation is the only vestibular test which allows the clinician to test the vestibular organs individually; however, it only tests one of the three semicircular canals: the horizontal canal. While ENG is the most widely used clinical laboratory test to assess vestibular function, normal ENG test results do not necessarily mean that a patient has typical vestibular function. ENG abnormalities can be useful in the diagnosis and localization of the site of lesion; however, many abnormalities are nonlocalizing; therefore, the clinical history and otologic examination of the patient are vital in formulating a diagnosis and treatment plan for a patient presenting with dizziness or vertigo.

References

External links

Vestibular Testing - Timothy C. Hain, MD

{{Operations and other procedures on the ear Electrodiagnosis Ear procedures