Skip to 0 minutes and 8 seconds In the clinic, if we think somebody has problems with dizziness and might have crystals in their inner ear– a condition we call benign paroxysmal positional vertigo– then we perform an assessment called a Hallpikes test. Turn your head towards me. This can be quite a physically challenging test, where we move somebody’s head around a range of different positions, in order to see whether they have any symptoms. Just rest back for me. When we perform a Hallpikes test, we look at the patient’s eyes to see whether there’s any flickering, or whether they have any symptoms. If these are present, the test is positive, and we would go on to perform a treatment known as Epley manoeuvre. Looking this way, any dizziness there?
Skip to 0 minutes and 57 seconds No. No? No. OK. So what we’re going to do now is we’re going to get you to roll onto your side. And as you roll onto your side, I’m going to keep your head turned, so you’re looking down towards the bed. During this we are encouraging the crystals to move around in the inner ear and hopefully drop out of the little canals in your ears and prevent further problems. The Epley manoeuvre is shown here, and it will give you an idea of what is involved in this treatment. And now the next thing we’re going to do is get you to drop your legs over the side of the bed and to come into sitting.
Skip to 1 minute and 31 seconds And as you sit up, I’m just going to keep your head nodded forward, so you’re looking down towards the floor. Yes. OK? Heather originally presented with symptoms suggestive of BPPV, which were completely cured when she underwent this manoeuvre. OK? Yes. Good. In the clinic, we sometimes perform complicated assessments that involve monitoring of heart rate and blood pressure in response to various challenges. One test that we perform in people who describe lightheadedness, dizziness, or blackouts after they’ve been stood for a period of time is called a head-up tilt test. During this test, we’re asking Heather to stand for up to 35 minutes, supported by a mechanical table. This table brings her from lying to standing up at 70 degrees.
Skip to 2 minutes and 25 seconds We use this angle because we know it encourages the most blood to pool in her legs. The idea of this test is to encourage this blood to pool in her legs, and over time the blood pressure will drop. And we’re watching to see if Heather has symptoms in association with a drop in blood pressure. Are you feeling OK there? I am, thank you. If she does have symptoms, this will be suggestive that her symptoms are related to changes in her heart rate or blood pressure when she stands up. This is important, because if we see this, it gives us a target that we might be able to treat to reduce her risk of falls.
Skip to 3 minutes and 10 seconds The next more complex assessment that we perform in people who present to the Falls and Syncope Service in Newcastle is a procedure called carotid sinus massage.
Skip to 3 minutes and 23 seconds There is evidence that carotid sinus hypersensitivity is a problem in people who present with falls and blackouts. Your carotid sinus is present in your neck where your carotid artery splits into two. It supplies blood to your head and can sometimes be oversensitive. And as a result, it can lead to a slowing of your heart rate or a dropping of your blood pressure. If this happens, it can limit the amount of blood going to your brain and cause you to fall or blackout. First we’ll do it lying down. If that’s all negative, we’ll do it again upright, exactly the same. Are you ready? Yes. Please let us know if you feel unwell in any ways.
Skip to 4 minutes and 7 seconds In the clinic we can test to see whether you have an overactive carotid sinus by rubbing for 10 seconds on the right and the left of your neck. When we do this we monitor your heart rate and blood pressure, and see if there’s any slowing of your heart or dropping of your blood pressure, which would suggest that there is a problem. We perform this test, first with you lying down and then standing up, to increase the likelihood of getting a positive result. We’re going to rub on your neck again to see if it affects your heart rate or your blood pressure. We’ll do it again for 10 seconds. Please let us know if you feel unwell in any way.
Skip to 4 minutes and 43 seconds I will, yes. So 10 seconds, let’s start.
Skip to 4 minutes and 55 seconds We hope that these films have helped you understand a bit more about what might be involved if you present to a Falls clinic having had a fall, or because you are at risk of falls.
Specialist falls testing
In a falls clinic an underlying medical explanation for the falls may be suspected. In this case, we may be referred for more specialised tests to help make a diagnosis.
In this video we will see some specialist tests for identifying problems with blood pressure regulation. We will see the tilt-table test which will see whether our body is prone to sudden drops in blood pressure while standing. This will help identify whether fainting (known medically as Vasovagal Syncope) may be causing falls.
We will also see a test for a condition called Carotid Sinus Syndrome which causes unexplained falls. This is looking to see whether a sensor in our carotid artery has become overly sensitive which can result in sudden drops in blood pressure or slow the heart down.
Having seen how the inner ear affects balance in steps 1.13 and 2.12, we will see how one test is performed to diagnose problems with crystals in the inner ear, known as Benign Paroxysmal Positional Vertigo (BPPV). We will see Lisa, our physiotherapist perform the test, known as the Dix-Hallpike manoeuvre. We will also learn what is involved in the treatment, known as an Epley manoeuvre, as Lisa demonstrates.
We will learn a little more about treating these problems in Week 4 of the course.
© Newcastle University