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Beyond the Naked Eye: The Hidden Eye Movements That Could Save Your Brain

Vestibular Testing in Sydney: Advanced Assessment for Dizziness, Vertigo and Balance Disorders

At Sydney Neuro & Integrative Health, we provide vestibular testing in Sydney using advanced infrared video goggles to accurately assess dizziness, vertigo and balance disorders.

Deep within the inner ear are three fluid-filled semicircular canals, located within the petrous portion of the temporal bone. Together, these structures form a key part of the vestibular system, which detects head movement and acceleration and helps the brain understand where the body is positioned in space.

In simple terms, human posture and balance are maintained through the integration of three main systems:

  1. Sensory feedback from the inner ear (vestibular system)

  2. Proprioceptive input from stretch receptors in the feet, joints and upper neck

  3. The visual system

When one or more of these systems is not functioning optimally, symptoms such as dizziness, vertigo, imbalance or falls may occur.

Advanced Vestibular Assessment at Sydney Neuro & Integrative Health

At Sydney Neuro & Integrative Health, we use infrared vestibular video goggles equipped with high-speed cameras to accurately record eye movements during vestibular testing. This advanced technology allows us to detect subtle abnormalities that are often missed during routine bedside examinations.

Infrared video goggles are particularly valuable in helping to assess and differentiate conditions such as:

Without infrared goggles, subtle pathological eye movements are extremely difficult to observe in normal room lighting. During vestibular testing, abnormal inner ear or brainstem function often produces a characteristic pattern of eye movement known as nystagmus, where a slow eye movement is followed by a rapid “fast-phase” correction. These movements may be too subtle to detect with the naked eye alone.

Why Infrared Video Goggles Matter

In many peripheral vestibular disorders, such as BPPV caused by head injury or inner ear infection, abnormal eye movements are naturally suppressed when a patient fixates on a visual target. Because fixation occurs in normal light, these abnormalities can go unnoticed during standard clinical examination.

Infrared video goggles remove visual fixation by placing the patient in darkness, dramatically enhancing the visibility of slow- and fast-phase eye movements. Research shows that infrared video goggles detect significantly greater slow-phase velocities than naked-eye observation and closely match the accuracy of specialised vestibular research equipment.

Studies also demonstrate that clinicians can miss up to two-thirds of abnormal eye movements when examining dizzy patients without video goggles, particularly in cases of BPPV – the most common cause of episodic vertigo. Left untreated, BPPV significantly increases the risk of falls and fractures.

Improved Detection of Central Causes of Dizziness

Certain eye movements, known as covert saccades, occur during head motion and are invisible without video technology. These are commonly seen in patients with brainstem or central nervous system pathology. While basic bedside tests may only detect obvious abnormalities, infrared video goggles significantly improve diagnostic accuracy – including for serious conditions such as stroke.

Systematic reviews show that video goggles achieve sensitivities and specificities exceeding 87–94% for diagnosing vestibular neuritis, outperforming bedside examination alone. Importantly, this technology also improves detection of central causes of vertigo, where early identification is critical.

Objective Data, Better Care

Infrared video goggles provide objective measurements such as eye-movement waveforms, slow-phase velocities, and head-eye coordination data. These recordings can be reviewed over time.

At Sydney Neuro & Integrative Health, infrared video goggles support the assessment of:

With advanced vestibular testing and specific neurological training, our clinic is equipped to identify serious conditions that may otherwise be misdiagnosed as “simple vertigo,” highlighting the importance of thorough assessment.

In Summary

Infrared vestibular video goggles are a critical tool in the accurate assessment of dizziness and balance disorders. They significantly enhance diagnostic precision for conditions affecting the inner ear, brainstem, and cerebellum, ensuring that serious causes of vertigo are not overlooked.

At Sydney Neuro & Integrative Health, this technology allows us to provide a higher standard of care for patients experiencing dizziness, imbalance or unexplained neurological symptoms.

The research is clear – it is fundamentally critical to utilise infrared video goggles when examining patients with dizziness in any setting, whether in the emergency department or outpatient settings.  Just as a cardiologist relies on a stethoscope, functional neurology clinicians depend on infrared video goggles to enhance diagnostic accuracy and provide the highest standard of vestibular care.

References

Baba, S., Fukumoto, A., Aoyagi, M., Koizumi, Y., Ikezono, T., & Yagi, T. (2004). A comparative study on the observation of spontaneous nystagmus with Frenzel glasses and an infrared CCD camera. Journal of Nippon Medical School, 71(1), 25–29. https://doi.org/10.1272/jnms.71.25

Baron, R., Steenerson, K. K., & Alyono, J. (2021). Acute vestibular syndrome and ER presentations of dizziness. Otolaryngologic Clinics of North America, 54(5), 925–938. https://doi.org/10.1016/j.otc.2021.06.007

Bery, A. K., Wang, C. F., Gold, D. R., & Chang, T. P. (2021). The fixation suppression test can uncover vertical nystagmus of central origin in some patients with dizziness. Neurological Sciences, 42(12), 5343–5352. https://doi.org/10.1007/s10072-021-05657-9

Edlow, J. A., & Newman-Toker, D. (2016). Using the physical examination to diagnose patients with acute dizziness and vertigo. Journal of Emergency Medicine, 50(4), 617–628. https://doi.org/10.1016/j.jemermed.2015.11.014

Gurley, K. L., & Edlow, J. A. (2021). Diagnosis of patients with acute dizziness. Emergency Medicine Clinics of North America, 39(1), 181–201. https://doi.org/10.1016/j.emc.2020.08.002

Halmagyi, G. M., McGarvie, L. A., & Strupp, M. (2020). Nystagmus goggles: How to use them, what you find, and what it means. Practical Neurology, 20(6), 446–450. https://doi.org/10.1136/practneurol-2020-002546

Kattah, J. C., Talkad, A. V., Wang, D. Z., Hsieh, Y.-H., & Newman-Toker, D. E. (2009). HINTS to diagnose stroke in the acute vestibular syndrome: Three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke, 40(11), 3504–3510. https://doi.org/10.1161/STROKEAHA.109.551234

Kim, H. J., Park, J., & Kim, J. S. (2020). Update on benign paroxysmal positional vertigo. Journal of Neurology, 268(5), 1995–2000. https://doi.org/10.1007/s00415-020-10314-7

Lawson, J., Bamiou, D. E., Cohen, H. S., & Newton, J. (2008). Positional vertigo in a falls service. Age and Ageing, 37(5), 585–589. https://doi.org/10.1093/ageing/afn123

Liao, W. L., Chang, T. P., Chen, H. J., & Kao, C. H. (2015). Benign paroxysmal positional vertigo is associated with an increased risk of fracture: A population-based cohort study. Journal of Orthopaedic & Sports Physical Therapy, 45(5), 406–412. https://doi.org/10.2519/jospt.2015.5676

Machner, B., Choi, J. H., Trillenberg, P., Heide, W., & Helmchen, C. (2020). Risk of acute brain lesions in dizzy patients presenting to the emergency room: Who needs imaging and who does not? Journal of Neurology, 267(Suppl 1), 126–135. https://doi.org/10.1007/s00415-020-10277-x

Newman-Toker, D. E., Kerber, K. A., Hsieh, Y.-H., Pula, J. H., Omron, R., Saber Tehrani, A. S., Mantokoudis, G., Hanley, D. F., Zee, D. S., & Kattah, J. C. (2013). HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness. Academic Emergency Medicine, 20(10), 986–996. https://doi.org/10.1111/acem.12178

Nogi, A., Ludwig, D., Millar, J., Carey, J., Gold, D., & Schubert, M. (2022, October). The influence of a multidisciplinary decision tree to optimize clinical outcomes in individuals with vestibular pathology. International Vestibular Conference, Minneapolis, MN, USA. (No DOI available)

Özel, H. E., Karakuzu, A. T., Temir, H., Alpay, M., Özdoğan, F., & Genç, S. (2022). Effect of ocular fixation on positional nystagmus in BPPV patients. International Journal of Audiology. Advance online publication. https://doi.org/10.1080/14992027.2022.2069676

Tarnutzer, A. A., Berkowitz, A. L., Robinson, K. A., Hsieh, Y.-H., & Newman-Toker, D. E. (2011). Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ, 183(9), E571–E592. https://doi.org/10.1503/cmaj.101391

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