Clinical scenario Use of googles helps clinically to
Acute vertigo or dizzinessReveal nystagmus that is suppressed by fixation; discriminate an acute peripheral from an acute central vestibular syndrome (‘a nystagmus not suppressed by visual fixation is not peripheral’)
Recurrent attacks of vertigoIncrease the yield of positional testing to diagnose benign positional vertigo by removing suppression of nystagmus by visual fixation
Special situations
Head-shaking manoeuvrePrevent visual fixation of a head-shaking nystagmus, found in patients
– with a unilateral vestibular deficit
– with a central deficit leading to ‘cross-coupling’, ie, horizontal head-shaking leads to a vertical nystagmus or a change of direction of spontaneous nystagmus
HyperventilationPrevent visual fixation of a hyperventilation-induced nystagmus (rare), found in vestibular paroxysmia or vestibular schwannoma