Frenzel Glasses Research Articles

Investigation of vestibular function in patients with vestibular neuritis

To optimize the diagnostic algorithm for vestibular neuritis based on an assessment of the sensitivity of clinical methods for studying vestibular function in the recovery period of the disease. A comprehensive assessment of the sensitivity of clinical methods for the study of vestibular function in the acute (up to 14 days: at the time of initial treatment, on the 7th and 14th day) and subacute (up to 3 months: on the 28th and 90th day) periods of the disease in 52 patients with upper vestibular neuritis was carried out. The timing of the processes of restoration of vestibular function after a transferred vestibular neuritis is individual: after 14 days, restoration of vestibular function was recorded in 52% (n=27) patients, after 1 month - in 62% (n=32), after 3 months - in 71% (n=37) patients with upper vestibular neuritis. Statocoordination, statokinetic, oculomotor tests under visual control have the highest sensitivity in the acute period of vestibular neuritis, within up to 7 days from the onset of symptoms. In the subacute period of vestibular neuritis, the study of spontaneous nystagmus and nystagmus in the head shaking test retains high sensitivity only when using special tools (Frenzel goggles or videonystagmography). A decrease in the sensitivity of the head rotation test and the dynamic visual acuity test in the subacute period of vestibular neuritis is associated with the processes of central compensation and the formation of a latent saccade. The sensitivity of clinical tests in patients with vestibular neuritis depends on the timing of the examination.

Prevalence of benign paroxysmal positional vertigo in a population-based setting among 75-year-olds.

Benign paroxysmal positional vertigo (BPPV) is one of the most frequently diagnosed cause of dizziness among older adults. To investigate the prevalence of BPPV and positional symptoms of dizziness and nystagmus among 75-year-olds and to identify factors associated with BPPV and positional dizziness and nystagmus. In this cross-sectional population-based study of 75-78-year-olds in Gothenburg, 887 participants were examined with questions regarding dizziness and health and social factors. A total of 681 participants underwent the Dix-Hallpike test or the side-lying test for BPPV using Video Frenzel goggles. In total 32% reported problems with dizziness (n = 887). The prevalence of BPPV was 4% in the unweighted and 4.5% in the weighted analyses, compensating for selective attrition of women and participants with previous positional dizziness. Positional dizziness without nystagmus was found in 2% and nystagmus without dizziness was found in 9%. Individuals with BPPV and positional dizziness experienced more dizziness in everyday life compared with those with normal tests, while those with positional nystagmus did not. The estimated prevalence of BPPV among 75-year-olds was 4.5%. Despite weighted analyses, the true prevalence may be higher since many participants with dizziness refused testing. Dizziness was associated with fear and discomfort so strong that around 20% of the participants declined testing.

Case series: Downbeat nystagmus in SCA27B

BackgroundSpinocerebellar ataxia (SCA) 27B, first reported in late 2022, is caused by the abnormal expansion of GAA repeats in the first intron of the FGF14 gene, which encodes the fibroblast growth factor 14. Case presentationWe present two late-onset cases, each manifesting mild cerebellar ataxia accompanied by omnidirectional downbeat nystagmus, which was enhanced in a suspended head position. None of the patients exhibited impaired head impulse or caloric tests. Repeat-primed PCR and targeted long-read nanopore sequence analysis of the FGF14 GAA repeat site identified more than 250 repeats, leading to the diagnosis of SCA27B. DiscussionDownbeat nystagmus is reported to be associated with disturbances in the suppression of the vestibulo-ocular reflex (VOR). Our patients with SCA27B demonstrated downbeat nystagmus, likely due to a disruption of the VOR at the level of the cerebellar cortex, a potentially characteristic clinical feature of SCA27B. We have included video footages of eye movements recorded using Frenzel goggles for these cases. ConclusionsOmnidirectional downbeat nystagmus may be a distinctive clinical feature of SCA27B.

A new portable Fresnel magnifying loupe for nystagmus observation: a clinical education and clinical practice setting study

BackgroundDizziness is a common complaint of patients treated by primary care physicians. It is predominantly caused by peripheral vestibular disorders; however, central nervous system disorders should be excluded. Examination of the eye movements and nystagmus can help differentiate the disorders of the central nervous system from the peripheral vestibular disorders; however, it is often not performed appropriately. In medical education practice, nystagmus observation may facilitate an understanding of vestibular function and nystagmus characteristics. Thus, we proposed a medical education practice to master nystagmus observation using a recently developed portable Fresnel magnifying loupe that could be shielded by one eye.MethodsThirty-three students from the Department of Physical Therapy and the Department of Speech, Language, and Hearing Therapy of the Mejiro University participated in this study. Postrotatory nystagmus was measured and compared using the new loupe and control methods, namely the naked eye and Frenzel goggles; we rated the ease of visibility using a five-point scale.ResultsThe number of detected cases of nystagmus was significantly higher with the new loupe than with the naked eye (p = 0.001). In addition, there were no significant differences in the nystagmus counts between the observations using the new loupe and Frenzel goggles (p = 0.087). No significant difference was observed in the visibility of eye movements between the loupe and naked eye (p = 1.00). The Frenzel goggles provided better visibility compared to that by the loupe (p = 0.034); however, none of the participants reported poor visibility using any of these methods.ConclusionsOur newly developed Fresnel loupe allows for the observation of nystagmus counts a level of reduction in fixation suppression similar to that of Frenzel goggles in an educational practice setting. Furthermore, it enables the detection of significantly more nystagmus counts compared to that by the naked eye. It offers several advantages over Frenzel goggles, including its lightweight, thin, durable, and portable design. Additionally, the loupe does not rely on a power source and can be used under normal room lighting conditions.Trial registrationThis study was approved by the Medical Research Ethics Committee of Mejiro University (approval number: 21medicine-021).

Acute mixed vestibulopathy. History case from the vestibulologist practice. Case report

Patients with acute vestibulopathy are among the most uneasy (in terms of severity of symptoms) and challenging (in terms of determining the level of damage). At the same time, the methods of traditional otoneurological examination often do not allow to reveal the cause of unexpected balance disorders. In order to determine the degree of vestibular function decompensation and develop the tactic for the urgent treatment, Saint Petersburg Research Institute of Ear, Throat, Nose and Speech uses both screening methods included in the Vestibular Passport and computerized vestibulometry techniques. Methods of oculomotor and postural reactions assessment are described in details using the example of case history. The high diagnostic significance of the results of instrumental vestibulometry using the Frenzel glasses, foam pad, computer electrooculography, video oculography and computer dynamic posturography is demonstrated. The therapeutic tactics of managing a patient with acute mixed vestibulopathy is shown.

Teaching Video Neuro Images : Unilateral RIMLF lesion

A 45-year-old woman presented with acute vertigo and a vertical gaze palsy. Examination with Frenzel goggles showed that during vertical saccades the eyes were torsionally deviating to the left (counterclockwise from the patient's point of view) and slowly returned to the initial zero torsion after

Incidence of Benign Paroxysmal Positional Vertigo and Course of Treatment Following Mild Head Trauma-Is It Worth Looking For?

This study aimed to identify the incidence of benign paroxysmal positional vertigo following head trauma. This study is a prospective cross-sectional study. Initially, a targeted search for the identification of patients with the international classification of diseases (ICD-10) diagnosis of cerebral commotio at relevant emergency units in the Northern Region of Denmark was done. This was followed by a clinical examination to determine the incidence of benign paroxysmal positional vertigo (BPPV) within this population. Of the 295 patients diagnosed with commotio cerebri during a 4-and-a-half month period, 85 patients were included. All patients underwent clinical examination in a mechanical repositional chair wearing Video Frenzel Goggles. Additional examinations included a complete video head impulse test. A total of six patients were identified with benign paroxysmal positional vertigo (BPPV) following minor head trauma. Bilateral BPPV, multicanal BPPV, and BPPV of a single semicircular canal were identified. All patients experienced relief of benign paroxysmal positional vertigorelated symptoms within 3 treatment sessions. Five patients were identified with a pathological video head impulse test, 54 with an inconclusive examination, and 15 with a normal video head impulse test. The incidence of benign paroxysmal positional vertigo following minor head trauma was 7%. A relatively high number of atypical subtypes of benign paroxysmal positional vertigo was found. When applying strict criteria for the interpretation of video head impulse test examination, the number of patients with inconclusive video head impulse test examination was higher than expected and 6.7% of patients had a pathological video head impulse test examination. No relationship between benign paroxysmal positional vertigo and pathological video head impulse test was observed.

The Efficacy of Modified Dix-Hallpike Test by Using Pillow Jacket

Background: Benign paroxysmal positional vertigo (BPPV) causes vertigo in patients. It is the most common type of peripheral vestibular disorder. The patient will have vertigo symptoms while moving the head. The symptoms are usually severe and have duration of seconds. Objective: To study the efficacy of modified Dix-Hallpike test by using pillow jacket for diagnosis of BPPV patient. Materials and Methods: The first group was evaluated by using the traditional Dix-Hallpike test and then re-evaluated using the modified Dix-Hallpike test by using pillow jacket, while the modified Dix-Hallpike test was done using pillow jacket and then the traditional Dix-Hallpike test was done in the second group. Patients were assessed for nystagmus using Frenzel glasses recording duration, latency period, and direction of nystagmus. Following completion of the test, each patient was evaluated for pain, ease of use, and level of comfort by using the VAS scale. Results: Ninety-six patients were recruited into the present study. Forty-eight participants were included in Group 1 using the traditional Dix- Hallpike and then the modified Dix-Hallpike test by using pillow jacket, while forty-five patients were in Group 2 using the modified Dix-Hallpike test by using pillow jacket and then the traditional Dix-Hallpike. There were no significant differences regards to age, gender, laterality, duration of vertiginous symptoms in each attack, or onset of symptoms. No statistical significance was noted in terms of median VAS scores for pain, comfort, or ease of use between the two groups. The sensitivity of the modified Dix-Hallpike test by using pillow jacket was 94.92%, while specificity was 91.43%. McNeMar Kappa tests were equivalent for both the modified Dix-Hallpike test by using pillow jacket and traditional Dix-Hallpike test. Conclusion: The modified Dix-Hallpike test by using pillow jacket may be reliable, with both high sensitivity and specificity in diagnosing BPPV. This method can be used to assess patients suspected of posterior canal BPPV in cases there is lack of space for head extension, or the patient is unable to change position easily as with the traditional Dix-Hallpike maneuver. Keywords: Vertigo; Benign paroxysmal positional vertigo (BPPV); Dix-Hallpike test; Modified Dix-Hallpike test

Immediate Improvement in Subjective Visual Vertical and Disequilibrium Predicts Resolution of Benign Paroxysmal Positional Vertigo Following Single Canalith Repositioning Maneuver.

To evaluate whether immediate post-canalith repositioning maneuver (CRM) vestibular changes are predictive of benign paroxysmal positional vertigo (BPPV) resolution. Retrospective cohort study. Tertiary referral center. Adults (n = 27) with posterior canal BPPV. Single CRM with Frenzel goggles. The Visual Analog Scale (VAS) for disequilibrium, the subjective visual vertical (SVV), the subjective visual horizontal (SVH), and the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB) were administered pre- and immediately following single CRM. Dix-Hallpike was performed 1-3 weeks after CRM to assess for BPPV resolution. Pre- and post-treatment vestibular assessments were compared between groups to determine if post-CRM vestibular changes could predict BPPV resolution. The change in VAS score following CRM treatment was statistically different between patients who responded to CRM treatment (n = 15) and those who did not (n = 12), (-0.07 points versus -2.40 points, respectively; P = 0.03). Likewise, a significantly greater improvement in SVV score was observed for CRM responders compared with CRM nonresponders (0.92° versus -0.06°, respectively; P = 0.02). Change in SVH and mCTSIB scores did not differ significantly between groups. Additionally, patient age was found to predict outcome of CRM treatment, with older patients more likely to experience persistent BPPV (P ≤ 0.01). Immediate improvement in VAS and SVV scores following CRM may be useful in predicting resolution of BPPV and may assist in directing the timing and need for future interventions. Younger age may have a favorable predictive value for improvement following single CRM.

Nystagmus in adult patients with acute otitis media or otitis media with effusion without dizziness.

The present study aimed to investigate the incidence and patterns of nystagmus in adult patients with acute otitis media (AOM) or otitis media with effusion (OME) without dizziness or vertigo, and discuss possible mechanisms. From February 2018 to November 2018, 34 consecutive patients with AOM or OME without dizziness were included. Nystagmus was examined with video Frenzel glasses. Of 34 adult AOM or OME patients without dizziness, nystagmus was observed in 28 patients (82%). In unilateral AOM or OME (n = 30), the most commonly observed nystagmus pattern was irritative-type direction-fixed nystagmus (n = 13), followed by paretic-type direction-fixed nystagmus (n = 8), and direction-changing positional nystagmus (n = 4). In bilateral AOM or OME (n = 4), direction-fixed nystagmus and direction-changing positional nystagmus were observed in two and one patients, respectively. Nystagmus was observed in as many as 82% of adult AOM or OME patients even though they did not complain of dizziness, and the pattern of nystagmus was either direction-fixed or direction-changing. Direct effect of inflammatory mediators penetrated from the middle ear and biochemical alteration in the inner ear fluids due to blood-perilymph barrier dysfunction may result in the presence of nystagmus in AOM or OME patients without dizziness.

Routine Vestibular Function Assessment in Children With Congenital CMV: Are We Ready?

Routine Vestibular Function Assessment in Children With Congenital CMV: Are We Ready?

The Feasibility and Utility of a Mobile-Based Eye Movement Recording Application: A Randomized Trial

Objectives This study was performed to assess the efficacy and feasibility of mobile application-based Frenzel tests in dizziness clinics. Methods We performed an investigator-initiated, blinded-outcome assessor, parallel, randomized controlled crossover trial at Chungnam National University Hospital between August 2019 and October 2019. Certified medical staffs were randomly assigned to the intervention group (i.e., a mobile application-based Frenzel glass system, n=15) or the observation group (i.e., a conventional desktop-based Frenzel glass system, n=15); the groups applied the respective systems for the preparation of eye movement recording and switched systems. The primary outcome was the elapsed time in seconds it took the participants to prepare the system for eye recording simulation. The secondary outcomes were perceived stress and satisfaction scores after completion of the operation, as measured by a questionnaire using 10-point Likert scales. Results The mean time of machine preparation for eye recording simulation was reduced by 50% in the mobile application group compared to the desktop group in both study periods (38.0±7.1 sec vs. 76.0±8.7 sec). We detected no carryover effect. Participants also reported lower stress while using application than while using the desktop system (2.3±1.3 vs. 4.6±2.4; p＜0.001). The application obtained a mean overall satisfaction score of 9.2 out of 10. Conclusions The implementation of an eye movement recording application in a dizziness examination was well adopted by users and decreased the time and stress related to machine operation. Keywords: Dizziness; Vertigo; Frenzel goggles; Eye movement measurement; Mobile application 중심 단어: 어지럼, 현훈, Frenzel 안경, 안구운동 기록, 모바일 ì–´í”Œë¦¬ì¼€ì´ì ˜

Acute peripheral vestibular dysfunction: diagnostics and treatment

The aim of this article is to demonstrate ENT specialists, neurologists and general practitioners how to examine and treat patients with acute vertiginous complaints. Traditional otoneurologic testing that carried out for accurate topic diagnostics of acute vestibular dysfunction is described as available «Vestibular passport». Clinical diagnosis can be achieved after thorough assessment of patient’s complaints as well as history of the present illness. Gaze tests and posture control trials are demonstrated in details. Diagnostic value of each probe is shown from the viewpoint of differential diagnostics of peripheral and central vestibular dysfunction. High diagnostic value of registration and analysis of oculogyric reactions is presented by history cases of acute labyrinthopathy and acute vestibular neuronitis. In these cases absence of saccadic and pursuit gaze disturbances rule out central vestibular system dysfunction. The salient feature of these two variants of peripheral vestibular dysfunction is spontaneous nystagmus that revealed by Frenzel glasses. This significant oculomotor symptom as well as disturbances of static and dynamic postural control confirm patient’s vestibular complaints in objective way. Revelation of decompensation signs of vestibular dysfunction needs urgent medicine vertigo therapy and spare vestibular rehabilitation. Actually, medications of choice are sedative drugs with antiemetic effect, non-loop diuretics and glucocorticoids.

Практические аспекты диагностики и лечения доброкачественного пароксизмального позиционного головокружения при каналолитиазе заднего полукружного канала

Objective: The aim of the study is to assess the effectiveness of diagnosis of benign paroxysmal positional vertigo (BPPV) of the posterior semicircular canal (PSC) when using different types of Frenzel glasses compared to visual observation of nystagmus, as well as the features of diagnostic tests and therapeutic maneuvers during the initial treatment of patients with DPPV of PPC and their subsequent treatment, if necessary, multiple repetition of therapeutic maneuvers. Materials and methods: The study included 240 patients with newly diagnosed idiopathic BPPG canalolithiasis of PSC, which were divided into groups to determine 1) the appropriateness of using different types of Fresnel goggles in the diagnosis of BPPPV, 2) to determine the optimal sequence of testing of the supposed affected and unaffected parties in the test Dix-Hallpike, 3) to determine the optimal number of Epley healing maneuvers during one consultation. Results: Diagnosis of BPPPV of PPC during initial patient treatment significantly increases when using modified Fresnel goggles or video Frenzel in the Dix-Hallpike test. At the initial consultation, when conducting diagnostic tests and medical maneuvers to detect BPPV of PSC in a patient with positional vertigo, it is advisable to begin their execution from the supposed affected side according to the anamnesis in order to optimize the doctor’s time expenditures. In the absence of resolution of otolithiasis in case of BPPV of PSC after a single maneuver, multiple therapeutic maneuvers significantly prolong the visit approximately until 28 minutes. The treatment of patients with resistant persistent BPPV should be organized during the special prolonged otoneurologist consultation in order repeating maneuvers could be carried out. During one consultation not more than three repositioning maneuvers should be done, as the increase of number of maneuvers does not affect the effectiveness of BPPV treatment.

Prototipo de video frenzel-video head impulse test de bajo coste

Antecedentes: desde la introducción de las gafas de Frenzel se han desarrollados múltiples sistemas que permiten no permiten no solo observar el nistagmo, sino documentarlo y valorar su evolución y respuesta al tratamiento; pero el costo pero el costo de dichos equipos limita su uso en los países en vías de desarrollo.
 Objetivo: desarrollar un prototipo de Video Frenzel / Video Head impulse test de bajo coste.
 Materiales: utilizamos una cámara de video USB con visión nocturna, un acelerómetro/giroscopio USB, una impresora 3Dstandard, unas gafas de realidad virtual para móviles y el software MATLAB® para desarrollar el programa que registra los movimientos oculares y cefálicos. Comparamos el prototipo frente a las gafas de Frenzel mediante la valora-ción de una serie de pacientes.
 Resultados: en total incluimos 10 pacientes en nuestro estudio, con una media de edad de 62 años, el prototipo nos permitió registrar las maniobras vestibulares y valorar su eficacia.

Perioperative vestibular assessment and testing

Vestibular disorders can be difficult to accurately diagnose and manage. A careful history and focused physical examination are typically adequate to establish a diagnosis and initiate medical treatment. Vestibular testing is an important component of the work-up, but it is particularly essential for patients being considered for surgical intervention for a vestibular disorder, where the testing can be used to more definitively confirm a suspected diagnosis and to determine baseline vestibular organ function. In this article, we will first briefly review key components of the history and physical examination of patients with vestibular complaints. We will then discuss the most commonly used vestibular tests and their role in the preoperative assessment of patients undergoing vestibular surgery, including nystagmography, caloric testing, rotary chair testing, video head impulse testing, and vestibular evoked myogenic potential testing.

Innovative Use of Google Cardboard in Clinical Examination of Patients of Vertigo.

Background:Vertigo is 1 of the most prominent and frequent neurological symptom. It is estimated that about 30% of all people need medical care once in their life due to this index symptom. The neurological expertise required is usually scarce in underprivileged areas. One has to look for spontaneous nystagmus, and perform Dix–Hallpike maneuver and Head Impulse test specifically to differentiate central from peripheral vertigo. The nystagmus, that is spontaneous, involuntary to-and-fro movement of the eyeball which aids in the diagnosis, can be better elicited by Frenzel glasses, Munich glasses. These devices consist of the combination of magnifying glasses and a lighting system to detect eye movements better than routine examination.Objective:To test usefulness of modified Google cardboard as Frenzel glasses in poor resource setting.Study design:A modified Google cardboard was used in 52 consecutive cases of vertigo and compared with examination with naked eye. The device consists of 2 magnifying lenses, 1 for each eye with power of +24 dioptres.Observation:The tool was found to be better for identifying spontaneous nystagmus, in Dix–Hallpike maneuver and during head impulse test as compared with the naked eye owing to the property of magnification and inhibition of fixation. Being a cheaper alternative and handy, it could be carried by every doctor in any setting.

Ocular Tilt Reaction in Compensated Vestibular Schwannoma

Ocular Tilt Reaction in Compensated Vestibular Schwannoma

Acute vestibular syndrome : Clinical examination outperforms MRI in the detection of central lesions

Asignificant number of patients who seek medical treatment in an emergency department because of vertigo or dizziness, suffer from acute vestibular syndrome. This is characterized by sustained vertigo, horizontal or horizontal rotatory jerk nystagmus, and unsteady stance and gait. In the acute situation it is crucial to differentiate patients with aperipheral vestibular disorder from those with acentral disease. Anumber of recent studies have shown that astructured clinical examination enables areliable differential diagnosis of central or peripheral disorders. Such an examination includes the head impulse test, an alternating cover test to detect askew deviation of the eyes, and observation of nystagmus in different positions of gaze and using Frenzel goggles. This examination is more sensitive for the detection of brainstem stroke than magnetic resonance imaging (MRI), at least within 48 h after symptom onset. As these facts are still little known, in practice there is an overuse of cost-intensive imaging with computed tomography and MRI, and anumber of patient brainstem strokes in the vertebrobasilar circulation may be missed. This paper describes the relevant studies on this topic.

Acute evaluation of the acute vestibular syndrome: differentiating posterior circulation stroke from acute peripheral vestibulopathies.

This review article aims to provide an evidence-based approach to evaluating the patient who presents with acute prolonged, spontaneous vertigo in the context of the acute vestibular syndrome (AVS). Differentiation of posterior circulation stroke (PCS) presenting as an AVS has been regarded as an important diagnostic challenge for physicians involved in acute care. Current evidence suggests that a targeted approach to history taking and physical examination with emphasis on the oculomotor examination, more specifically the HINTS (Head Impulse/Nystagmus/Test-of-skew) examination battery, yields a higher sensitivity for the diagnosis of PCS than even standard magnetic resonance imaging with diffusion-weighted imaging. However, most studies have only validated the utility of the HINTS examination when performed by experts, who interpret the most powerful component of HINTS, namely the head impulse test (HIT), considerably different to the novice. Several investigations useful in the differentiation of the AVS are becoming more accessible and portable, such as videooculography with Frenzel goggles and video head impulse testing (vHIT), which allows for the quantitative assessment of the HIT. In clinical practice, vHIT has already become accepted as standard of care in the evaluation of AVS.