Invasive procedures

Group 2
Electronystagmogram or ENG

• This study aids in the differential diagnosis of

lesions of the brainstem and cerebellum. It can
confirm the causes of unilateral hearing loss of
unknown origin, vertigo or ringing in the ears.
Evaluation of the vestibular system and the
muscles controlling of eye movement is based
on measurements of the nystagmus cycle.
• Reference Values:
Normal
Vestibular-ocular reflex: normal nystagmus
accompanying head turning is expected.
Procedure:
1. Be aware that the test is usually done in a
darken room with patient sitting or lying.
2. Remove any ear wax before testing.
3. Tape 5 electrodes in designated positions
around the eye.
4. During the study, ask the patient to look at
different object, to open and close his or her
eyes, to change head position.
5. Toward the end the test, gently blow air into
each external ear canal, first on the affected
side. Instill cold water, then warm water, into
the ears during the test to record eye
movement in response to various stimuli.
Clinical implications:
Prolonged nystagmus and postural instability following a
head turn is abnormal and can be caused by lesions of the
vestibular or ocular system, as in the following
conditions:
1. Cerebellum diseases
2. Brainstem lesions
3. Peripheral lesions occurring in elderly persons; head
trauma; middle ear disorders
4. Congenital disorders
5. Meniere’s disease
Interfering factors:

1. Test results are altered by inability of the

patient to cooperate, poor eye sight, blinking
of the eyes, or poorly applied electrodes.
2. The patient’s anxiety or medications such as
CNS depressants, stimulants or antivertigo
agents can cause false-positive test results
Interventions:
Pretest patient care
1. Explain the test purpose and procedure. no pain
or known risk are associated with the test. The
procedures to stimulate involuntary REM are
uncomfortable.
2. Have the patient remove makeup.
3. Have the patient abstain from all caffeinated
alcoholic beverages for at least 48 hours. Heavy
meals should be avoided before testing.
4. Be aware that most cases, medications such
as tranquilizers,stimulants or antivertigo
agents should be with held for 5 days before
the test.
Posttest patient after care:
1. Allow the patient to rest as necessary.
2. be aware that if present, nausea, vertigo and
weakness may require treatment and
medication. check with the clinician who
order the test.
3. Interpret test result and monitor appropriately
for brain diseases, which may manifest as loss
of balance, or middle ear disease, which may
cause spasmodic eye movement, vertigo, or
hearing loss.
Clinical alert!!!
1. The test is contraindicated in patients who
have pacemakers.
2. Water irrigation of the ear canal should not be
done when there is perforated ear drum.
Instead, a finger cot may be inserted in to the
ear canal to protect the middle ear.