Interacoustics Academy Clinical Diploma

Video Nystagmography (VNG)

What is the Clinical Diploma?

The Clinical Diploma is an online course designed to deliver theoretical and practical training for the assessment of eye movement in patients with symptoms of dizziness and suspected vestibular dysfunction. Covering the anatomy and physiology of the vestibular sensory system pathways, assessment of eye movement and associated ocular motor pathways, positional and positioning testing, and the ear specific assessment of the peripheral vestibular system horizontal semicircular canal response with caloric irrigations. this course will equip delegates with the knowledge and skills to perform accurate VNG assessments in the adult population.

How does the course work?

You will follow case studies through from the point of referral, via the diagnostic process to the point of decision making regarding their management. Video presentations, demonstrations and practical sessions will be used to familiarise delegates with all aspects of VNG testing. Your Interacoustics Academy course tutors will guide you through a series of interactive tasks and knowledge checks, as well as practical components to allow you to get hands-on, to facilitate the optimum learning experience.

Who is this course for?

The course is designed for anyone who is performing or Interpreting VNG. Medical professionals such as ENT, Otoneurology, Neurology, Audiology and Physical Therapy can all benefit from the content in this course

What will this course cover?

Lesson 1 - Introduction to dizziness and VNG

Prevalence and incidence of dizziness
Symptoms: what does this mean for the patient
Causes of dizziness
The balance system and pathway assessed by VNG
The balance pathways
The different types of eye movements
Introduction to recording of eye movement
Introducing VNG as a test technique

Lesson 2 - The patient referral … how do I get started

Who requests a VNG assessment How to create the ideal testing
Why does a ENT specialist refer for VNG assessment
Why does a Neurologist refer for VNG assessment
Are Neurology and ENT looking at the dizzy patient in the same way with VNG?
The patients reported history
Medication and their effects on VNG testing
Assessment of the functional changes in the dizzy patient 
Clinical use of Dizziness Handicap Inventory
What other assessments might you want to perform prior to VNG

Lesson 3 - Preparing for the VNG assessment

How to create the ideal testing environment
Visual Stimuli presentation options
Setting up the stimulus screen
VNG goggle hardware and software introduction
Side mounted camera VNG goggle
Top mounted camera VNG goggles
Creating a VNG test protocol
How does a VNG system track eye movement
What do VNG traces look like
Calibration of the patient's eye movement for VNG
Calibration of eye movements for VNG
Calibration errors

Lesson 4 - Getting to know eye movements

Introduction to Eye Movement assessment
What is 'normal' eye movement 
Understanding Eye Movement
Torsional eye movement
Eye muscles
Eyes muscle pairings and associated eye movement
Horizontal, Vertical and Torsional recording of eye movement
Anatomy and physiology of eye movements
What measurement of eye movement do we use to evaluate the inner ear
What is nystagmus
What does nystagmus look like on in VNG recording?
Getting good quality eye movement recording

Lesson 5 – Spontaneous eye movement assessment

Static assessment of eye behaviour
Anatomy & Physiology - Spontaneous eye movement pathways 
Setting up and running a spontaneous nystagmus test
Protocol Settings
Running the Test
Abnormal results & identifying nystagmus
What other spontaneous eye movements are there
Artefacts and tester errors

Lesson 6 - Gaze Stability assessment

What is a Gaze test
Anatomy of eye movement for gaze testing
Functional pathways for gaze testing
Setting up for a gaze test measurement 
Gaze testing in action
What does a normal gaze test look like
What does an abnormal gaze test look like
Clinical significance of Gaze testing
Artefact and test errors

Lesson 7 - Saccadic eye movements

What is Saccade testing
Anatomy of saccadic eye movements
Functional pathways for saccadic eye movement
Setting up for a saccade measurement
Saccades in action (horizontal) 
Saccades in action (vertical)
Normal saccade response
Abnormalities in saccadic eye movements
Clinical significance of saccade testing
Artefacts and test errors

Lesson 8 - Smooth pursuit testing

Assessment of the pursuit systems
Anatomy of pursuit pathways
Functional pathways involved in pursuit 
Setting up for a smooth pursuit 
Smooth pursuit in action 
What does normal smooth pursuit look like
What does an abnormal pursuit test look like
Clinical significance of pursuit assessment
Artefacts and test errors

Lesson 9 – Optokinetic Test

Anatomy and functional pathways of the OKN system
Setting up for optokinetic assessment
Running an optokinetic assessment
What does a normal OKN test look like
What does an abnormal OKN test look like
Clinical significance of OKN assessment
Artefact and test errors

Lesson 10 - Positional testing 

What are we looking for in positional testing
Setting up to test positional eye movements
Performing a positional eye movements exam
Normal positional eye movements exam
Abnormal positional eye movements exam
Clinical significance of positional assessment
Artefacts and test errors

Lesson 11 - Positioning Assessment

What are we looking for in dynamic positioning testing
Performing the positionings procedure
Interpretation of abnormal findings
Clinical significance of the positioning assessment
Artefacts and test errors

Lesson 12 – Caloric Testing

The Caloric Irrigation Test
Functional anatomy and physiology of the horizontal / lateral semi-circular canal 
Mechanisms of the Caloric Test
Setting up and Running a Caloric Test 
Patient instructions and performing the test
The normal caloric response
What does an abnormal caloric response look like 
Technical tips for caloric testing

Lesson 13 - Additional tests in VNG (VOR assessment)

Ocular Counter Roll (OCR) test

Setting up for OCR test measurement
Performing the OCR test
The normal OCR response 
The abnormal OCR response
Clinical interpretation of the OCR
Artefact and test errors

Headshake nystagmus (HSN) test

What does a normal HSN test look like
VNG recording of eye movement
What does an abnormal HSN test look like
Artefact and test errors

Lesson 14 – Additional tests in VNG (advanced oculomotor)

Saccadometry

Setting up for a saccadometry assessment
Performing a saccadometry assessment
What does a normal saccadometry assessment look like?
What does an abnormal saccadometry assessment look like?
Clinical interpretation of Saccadometry
Artefact and test errors
Clinical significance of Saccadometry

Lesson 15 - A case-based approach (peripheral vestibular conditions)

Putting the VNG assessment together
Report writing following the VNG assessment

Lesson 16 – Central conditions and their effect on VNG assessment

Review of central conditions and pathologies on VNG assessment

Lesson 17 - The diagnostic vestibular assessment toolbox

Introduction to multifrequency SCC VOR assessment (vHIT / RCT / Caloric)
Introduction to Otolith assessment (cervical VEMP and ocular VEMP)

What do I need to do?

In order to obtain the Interacoustics Academy Clinical Diploma, you will need to navigate through the course. There are a total of 17 lessons, each of which should take between 1 and 2 hours to complete. However, there is no set time limit and you can revisit each lesson as many times as you wish. You may take as long as you wish to complete the full course. Through the course you will find a series of tasks, questions and interactions to assist in your learning experience and check your knowledge. Some of these tasks are compulsory and you will need to submit evidence of completion to the Interacoustics Academy in order to obtain your Diploma. At the end of the course, the final step is completing an exam, which you must achieve a score of 80% or higher in order to pass. After you have passed the exam and submitted the compulsory tasks, we will be delighted to award you with your Clinical Diploma Certificate.

Cost: $850 USD

Presenters: Darren Whelan, Leigh Martin, Michael East and Amanda Goodhew

Darren Whelan

Darren Whelan holds an undergraduate degree in audiology and postgraduate master’s degrees in health science, neurophysiology, and clinical research. His resumé includes several clinical positions in the National Health Service (NHS). Prior to his current occupation as an International Clinical Trainer in the Interacoustics Academy, Darren held a clinical audiology and research scientist role in the UK, where he investigated patients with auditory and vestibular pathology, and managed a portfolio of NIHR adopted research studies. He has been a guest speaker at national and international conventions, enjoys teaching and providing clinical insights on the management of patients with dizziness and is a contributing author on published audiological and vestibular articles. Darren has also been an adjunct professor at Salus University in the USA, lecturing on the Doctor of Audiology degree.

Leigh Martin

Leigh Martin is a British Audiologist and adjunct lecturer at the University of Cork, Ireland. Clinically, he has worked in the National Health Service specializing in paediatric audiology as well as vestibular diagnostics and rehabilitation. Leigh has also sat on the board of directors for the British Academy of Audiology. Since 2013, Leigh has supported the growth and development of the Interacoustics Academy and holds the position of Global Manager of the Academy. Leigh has presented at numerous scientific conferences and meetings across a diverse range of audiological topics as well as having published papers in both video head impulse testing (vHIT) and wideband tympanometry.

Michael East

Michael is an Audiologist and Clinical Scientist from the UK with many years of experience working in senior clinical audiology positions within the National Health Service, specializing in both pediatric and vestibular assessment/rehabilitation. He holds undergraduate and postgraduate degrees from the University of Southampton and Aston University respectively and completed the UK’s National School of Healthcare Science “Scientist Training Program”; leading to his registration as a Clinical Scientist.

Amanda Goodhew

Amanda holds a Master's degree in Audiology from the University of Southampton. She has extensive experience holding senior audiologist positions in numerous NHS hospitals and clinics, where her primary focus has been paediatric audiology. Her specific areas of interest are electrophysiology, neonatal diagnostics and amplification, and the assessment and rehabilitation of patients with complex needs.

Payment

Direct payment is by credit card. If you are unable to pay by credit card and require a purchase order to be raised, please contact your local Interacoustics representative for assistance. If you are intending to make a bulk purchase of multiple Diplomas then please also contact your local Interacoustics representative for pricing information

Fee: 850 USD

This diploma course is intended to provide learners with an educational experience to improve their understanding and facilitate the development of clinical skills in the field of newborn hearing threshold assessment. It should be noted that this diploma course and/or the diploma certificate (as such) does not confer clinical competence or provide an assessment or qualification of the learner’s ability, skill or proficiency in the tests and fields described during the diploma course. Interacoustics assumes no liability for the materials provided – whether at the website or in the materials provided at the diploma course – and disclaims all liability for damages of any kind arising out of use.