Nursing Care of Clients with Eye & Ear Disorders

Question for Group 6

Re: Question for Group 6

by Michaela Mae Rosete -
Number of replies: 0

Hello, Matthew! Here is our group's response to your queries.

 

Dix-Hallpike Maneuver

Procedure

  1. The patient shall sit straight with their legs extended in front.

  2. The patient’s head is turned at a 45-degree angle either to the right or left. 

  3. The patient must be instructed to keep  their eyes open all throughout the test.

  4. The healthcare provider will gently hold the patient’s head and assist them in leaning back to a supine position, with the head declined 30 degrees below the trunk and with one ear pointing down toward the floor.

  5. The patient must remain in this position for a minute or two.

  6. The healthcare provider must observe the patient’s eyes for any characteristic nystagmus during the maneuver.

Expected Findings

If a patient shows nystagmus movement after doing the Dix-Hallpike Maneuver, it will indicate a positive test, which means that the patient’s vertigo symptoms result from Benign Paroxysmal Positional Vertigo (BPPV). If it is a negative test, it may suggest that there is another cause of the vertigo.

Documentation

  • The documentation of the results of the Dix-Hallpike Maneuver must contain the following

    • Patient’s response

    • Presence of vertigo

    • Presence and direction of nystagmus (interpret if positive or negative)

      • The direction of nystagmus must be consistent with the canal being assessed, it also determines the affected ear.

        • Posterior canal: up-beating nystagmus

        • Superior canal: down-beating nystagmus

        • Horizontal canal: Horizontal nystagmus

            • If there is horizontal nystagmus, you can further assess using the “supine head roll test” 

              • Procedure: 

                • 1. Lying supine

                • 2. Roll head laterally to each side to move otolith along horizontal SCC axis

              • Expected Findings: The direction of the nystagmus elicited can be interpreted as 

                • Geotropic: if the direction of nystagmus beats toward the lowermost ear/ground. 

                • Apogeotropic: if fast phase of the involuntary eye movement beats away from the ground or towards the ceiling. 

              • Interpretation: 

                • Apogeotropic suggests Capulolithiasis

                • Geotropic suggests Canalithiasis

  • Example: (+) Dix-Hallpike test with R-beating nystagmus

 

HINTS Examination

Procedure (from Hohnen, 2023):

  1. To perform the head impulse test (HIT):

    1. While making sure that the neck muscles are relaxed, gently move the patient’s head side to side.

    2. Next, instruct the patient to maintain focus on your nose as you turn their head to the left and right.

    3. Rapidly turn the patient’s head to each side by 10-20 degrees and then back to the midpoint.

  2. To assess nystagmus (N):

    1. Observe the patient’s primary gaze as they look straight ahead.

    2. Subsequently, instruct the patient to gaze to the left and right without fixating on any object (which can reduce the occurrence of nystagmus).

  3. To perform the test of skew (TS):

    1. Instruct the patient to look at your nose then cover one eye.

    2. Next, quickly cover the patient’s other eye. While doing that, observe the uncovered eye for vertical and/or diagonal corrective movements.

    3. Perform the same procedure on the opposite eye.

 Expected findings in a client with vertigo/motion sickness:

  1. Head Impulse Test (HIT) - Saccade (Peripheral vertigo), No saccade (Central vertigo)

  2. Nystagmus (N) - Unidirectional (Peripheral vertigo), Bidirectional (Central vertigo)

  3. Test of Skew (TS) - No skew (Peripheral vertigo), Vertical skew (Central vertigo)

Documentation:

The documentation of the results of the HINTS exam must contain the following

  1. Head Impulse Test (indicate if positive or negative)

    1. Include if the eyes move with the head then saccade rapidly back to the point of fixation (corrective saccade)

    2. Example: (+) HIT with corrective saccades when head turned to the affected site.

  2. Evaluation of nystagmus

    1. State the direction of the saccadic eye movement

      1. Determine whether it is unidirectional (peripheral) or bidirectional (central) nystagmus

    2. Example: Horizontal nystagmus, beating away from the affected ear.

  3. Test of skew (indicate if positive or negative)

    1. Note any vertical misalignment or skew deviation observed during alternate cover testing.

    2. Example: No skew deviation during alternate cover testing.

  4. Classification of vertigo

    1. Can be peripheral or central vertigo.

 

Reference/s:

Bhattacharyya, N., Gubbels, S. P., Schwartz, S. R., Edlow, J. A., El-Kashlan, H., Fife, T., Holmberg, J. M., Mahoney, K., Hollingsworth, D. B., Roberts, R., Seidman, M. D., Steiner, R. W. P., Do, B. T., Voelker, C. C. J., Waguespack, R. W., & Corrigan, M. D. (2017). Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology–Head and Neck Surgery, 156(3S), S1–S47

Dix-Hallpike maneuver. (2023). Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/24859-dix-hallpike-maneuver

Hohnen, H. (2023, September 27). The head Impulse, nystagmus, Test of skew (HINTS) examination | Vertigo | Geeky Medics. Geeky Medics. https://geekymedics.com/the-head-impulse-nystagmus-test-of-skew-hints-examination/