MCV ENT UPDATE
Update : August - October 2005
WHAT ECG IS IN CARDIO DIAGNOSIS IS THE ENG
IN VERTIGO DIAGNOSIS
Every day ENT surgeons and general physicians encounter many patients complaining of vertigo. Management of these problematic patients involves an in-depth knowledge, detailed history and proper investigations. The aim is to establish whether the patient has a peripheral vestibular problem or a central vestibular disorder ( since 40% are peripheral, 40% are central, 20% idiopathic ). Having established this criteria it is mandatory to localise the site and level of the lesion, and to determine the aetiology.

Primary tests of vestibular function are saccades, smooth pursuit, spontaneous nystagmus,calorics,positional tests and rotational tests, which are best done by ENG (Electronystagmography).

Recordings of heart muscle functions by amplification of electrical signals provides the electrocardiogram (ECG). Similarly voltages measured on the face that varied with eye movement are the basis for electronystagmography(ENG).

The electrical signal recorded from eye movement differs from most of the others in that the eye ball acts like a small battery, with the cornea having a positive charge with respect to the retina (negatively charged). This corneo retinal potential remains constant, and the voltage measured by skin electrodes near the eye varies because the "battery" is pointed in different directions as the eye moves.

ECG electrodes placed over the chest ENG electrodes placed over the forehead
ECG is an instrument, which receives electrical impulses as they vary during the heart cycle and tansforms them into a graphic record, similar to the ENG which recorde the changes in the electrical fields due to eye movements. ECG is the basic investigation in patients with heart problems. So also ENG is mandatory in patients with balance disorders. The advent of computerised ENG testing has been a major advance over conventional methods.

The ENG tet helps to identify and localise lesions in the vestibulo ocular sysytem and the central vestibular pathwy, which are the most commonly involved systems in balance disorders. ENG is useful to differentiate peripheral (labyrinthine) from central vestibular disorders (vestibular nucleus, brainstem, cerebellar etc.,)

Unlike ECG This test is performed in a sound treated and fully darkened room. Following the diagnosis treatment is directed towards the cause in the form of diuretics, steroids, peripheral vasodilators, clopidogril, particle repositioning maneuver, intra tympanic treatment (ITT) and vestibular rehabilitative therapy etc.

Surgical Tips
-Our technique

What material you will use for nasal packing? (cottonoids / gauze pack) which one is better tolerated by nasal mucosal and cilia of epithelium?

We use self designed septal clips which has won RAF Cooper Award. The advantages of septal clip are uniform distribution of force and non traumatic to columella and soft tissues. Use of septal clips avoids synechiae in mid meatus following combined procedures with maintenance of nasal airway and permits a comfortable post op period

This product is available from Nithya Medical Products, Coimbatore. Amongst all the ENT products developed at MCV Nasal Septal Clip is the most widely used by other ENT surgeons and a total of more than 15,000 clips have been sold till date.