How is the fistula test performed in a dizziness evaluation?

Updated: Jun 26, 2018
  • Author: Wayne T Shaia, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Fistula test

  • The fistula test is designed to elicit symptoms and signs of an abnormal connection (fistula) between the labyrinth and surrounding spaces. Fistulas may be acquired, most commonly as a result of cholesteatoma or, less commonly, as a dehiscence of bone overlying the superior semicircular canal. Iatrogenic causes include chronic ear surgery and stapes surgery.

  • The test involves the application of pressure to the patient's ear canal and observation of eye movements with Frenzel lenses in place. Occluding the ear canal with the patient's tragus or using a Bruening otoscope can provide pressure to the ear canal. The direction of nystagmus depends on the site of the fistula, a topic that is beyond the scope of this article.

  • Carefully examine the cranial nerves, especially cranial nerves V and VII.

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