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Electronystagmography

Definition

Electronystagmography is a test that looks at eye movements to see how well two nerves in the brain are working. These nerves are:

  • Vestibular nerve (8th cranial nerve), which runs from the brain to the ears
  • Occulomotor nerve, which runs from the brain to the eyes

Alternative Names

ENG

How the Test is Performed

Patches called electrodes, are placed above, below, and on each side of your eyes. They may be sticky patches or attached to a headband. Another patch is attached to the forehead.

The health care provider will spray cold water or air into each ear canal at separate times. The patches record eye movements that occur when the inner ear and nearby nerves are stimulated by the water or air. When cold water enters the ear, you should have rapid, side-to-side eye movements called nystagmus.

Next, warm water or air is placed into the ear. The eyes should now move rapidly toward the warm water then slowly away.

You may also be asked to use their eyes to track objects, such as flashing lights or moving lines.

The test takes about 90 minutes.

How to Prepare for the Test

Most of the time you do not need to take special steps before this test.

  • Your health care provider will tell you if you need to stop taking any medicines before you have this test.
  • Do not stop or change your medications without talking to your doctor first.

How the Test will Feel

You may find cold water in the ear slightly uncomfortable. Brief dizziness (vertigo) may occur during the test.

Why the Test is Performed

The test is used to determine whether a balance or nerve disorder is the cause of dizziness or vertigo.

Your doctor may order this test if you have:

  • Dizziness or vertigo
  • Hearing loss
  • Possible damage to the inner ear from certain medicines

Normal Results

Certain eye movements should occur after the warm or cold water or air is placed into your ears.

Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

Abnormal results may be a sign of damage to the nerve of the inner ear or other parts of the brain that control eye movements.

Any disease or injury that damages the acoustic nerve can cause vertigo. This may include:

  • Blood vessel disorders with bleeding (hemorrhage), clots, or atherosclerosis of the blood supply of the ear
  • Cholesteatoma and other ear tumors
  • Congenital disorders
  • Injury
  • Medications that are toxic to the ear nerves, including aminoglycoside antibiotics, some antimalarial drugs, loop diuretics, and salicylates
  • Multiple sclerosis
  • Movement disorders such as progressive supranuclear palsy
  • Rubella
  • Some poisons

Additional conditions under which the test may be performed:

Risks

Rarely, too much water pressure inside the ear can injure your ear drum if there has been previous damage. The water part of this test should not be done if your eardrum has been perforated recently.

Considerations

Electronystagmography is very useful because it can record movements behind closed eyelids or with the head in many positions.

References

Griggs RC, Jozefowicz RF, Aminoff MJ. Approach to the patient with neurologic disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 403.

Kerber KA, Baloh RW. Neuro-otology: l diagnosis and management of neuro-otological disorders. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Saunders Elsevier; 2012:chap 37.


Review Date: 5/28/2013
Reviewed By: Luc Jasmin, MD, PhD, FRCS (C), FACS, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles CA; Department of Surgery at Los Robles Hospital, Thousand Oaks CA; Department of Surgery at Ashland Community Hospital, Ashland OR; Department of Surgery at Cheyenne Regional Medical Center, Cheyenne WY; Department of Anatomy at UCSF, San Francisco CA. Review provided by VeriMed Healthcare Network.
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