Are Vestibular Exams as Effective as Electronystagmography?

Regardless of whether ENG is readily available, otolaryngologists should perform an office vestibular exam on their dizzy patients as a matter of principle, Dr. Hamid said. The general trend shows physicians spending less and less time with patients, and instead ordering many diagnostic tests before actually seeing the patient. Dr. Hamid called this trend less than optimal for quality care.

We all examine the ear and use the tuning fork test to get an idea of hearing before going on to get an audiogram, he said. Even if you have an ENG, a physician would be better off examining the patient before getting an ENG to confirm his or her own data because it makes a better physician. I’m not talking about replacing ENG with an office exam.

Another important issue is that many nonphysicians are now claiming expertise in dizziness, using vestibular test equipment with minimal training.

The vestibular industry is supporting this trend, Dr. Hamid said. It is expanding and will eventually undermine the clinical utility of vestibular testing and force third-party payers to look very hard at all users-including otolaryngologists and otologists. I am hoping that we can be proactive in slowing this trend.

Financial Considerations

It is a cold fact that hands-on examinations of patients cannot be recorded in the same quantifiable way that an ENG can, making it much harder for physicians to get paid for the work they are putting in. No two physicians will record exactly the same data from an office exam, making it hard to establish a coding system.

If you don’t have a recording of it, you’re not going to get paid, Dr. Gianoli said. So basically you’re talking more work for less money. You can also base future studies off ENG data, which is not true of the subjective data gleaned form an office examination.

Dr. Hamid agreed that the financial issues made adoption of his suggestions more difficult.

Let us be blunt-physicians are not appropriately rewarded for their cognitive abilities and we have been forced to use technology to circumvent that trend, he said. I still think it is always important to see the patient first, make a determination what is needed and then order further diagnostic tests-that is what medicine is all about.

I think we as physicians are in a dilemma here because, from a business point-of-view, it is difficult for most of us. If you need to see 20 or 30 patients a day, then you won’t have the time to do a full vestibular exam. But not everyone sees 20 to 30 a day.