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Vertigo of vestibular origin is made more noticeable with eyes closure and may be felt by palpation.  Alternatively, Frenzel glasses with +20 diopter can be used to eliminate visual fixation.


Frenzel glasses in-used (Rechargeable battery-operated with head-band). 


 Frenzel glasses (hand-held battery operated).

Spontaneous nystagmus is defined as nystagmus occurring without optic fixation: eyes under Frenzel glasses, or eyes open in total darkness or eyes closed.  It indicates active vestibular-ocular imbalance. 


Reference: Gordon B. Hughes. Textbook of Clinical Otology. ISBN 0-86577-183-9.

Horizontal Nystagmus

Peripheral Nystagmus: Caloric-Induced

Peripheral Nystagmus: Acute Vestibular Neuronitis

These jerky eye movements is called nystagmus.  It is described by the direction of the fast component (towards left) and the affected side is the reverse.  This is spontaneous (not induced).  This phenomena is seen in peripheral lesion affecting the labyrinth or the vestibular system.  Patient presents with vertigo (spinning/rotating sensation) which may be associated with vomiting.  Presence of hearing loss or tinnitus indicates labyrinthine disorder in contrast to acute vestibular neuronitis (vertigo without hearing loss or tinnitus).  Parenteral labyrinthine medication is required in the early phase when the the symptoms were intense.  Symptoms will usually resolved within few days. 

Halmagyi Head Thrust Maneuver

Dix-Hallpike Test



 Rotatory nystamus in BPPV.