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Here is the detailed report for Sunita Gupta (Patient ID: CCDA00279), a 66-year-old female, tested at Priority Hearing Care Pvt. Ltd. on 09 June 2026.
Videonystagmography (VNG) Report - Detailed Summary
Patient Information
| Field | Details |
|---|---|
| Name | Sunita Gupta |
| Patient ID | CCDA00279 |
| Age / Gender | 66 years / Female |
| Date of Test | 09 June 2026 |
| Clinic | Priority Hearing Care Pvt. Ltd. |
1. Saccades Test
Saccades assess rapid, voluntary eye movements. Normal velocity is typically >200 °/s; normal latency is ~150-200 ms; normal precision is >90%.
Horizontal Saccades
| Parameter | Frequency | Right Eye | Left Eye | Interpretation |
|---|---|---|---|---|
| Velocity | 0.3 Hz | 374.34 °/s | 450.73 °/s | Within normal range |
| Precision | 0.3 Hz | 87.78% | 67.67% | Left eye mildly reduced |
| Latency | 0.3 Hz | 300.00 ms | 272.94 ms | Both slightly prolonged |
| Velocity | 0.45 Hz | 413.59 °/s | 585.92 °/s | Within normal range |
| Precision | 0.45 Hz | 82.56% | 73.72% | Mildly reduced bilaterally |
| Latency | 0.45 Hz | 350.48 ms | 321.90 ms | Moderately prolonged |
Vertical Saccades
| Parameter | Frequency | Right Eye | Left Eye | Interpretation |
|---|---|---|---|---|
| Velocity | 0.3 Hz | 292.71 °/s | 319.64 °/s | Normal |
| Precision | 0.3 Hz | 85.18% | 81.87% | Mildly reduced |
| Latency | 0.3 Hz | 353.85 ms | 356.92 ms | Prolonged |
| Velocity | 0.45 Hz | 292.56 °/s | 301.91 °/s | Normal |
| Precision | 0.45 Hz | 81.18% | 78.32% | Mildly reduced |
| Latency | 0.45 Hz | 206.67 ms | 200.00 ms | Normal |
Summary: Saccade velocities are adequate. Precision is mildly reduced in both eyes (more so in the left), and latencies are mildly-to-moderately prolonged at lower frequencies, suggesting some degree of oculomotor slowing, possibly age-related or suggestive of mild central involvement.
2. Smooth Pursuit Test
Smooth pursuit evaluates the ability to track a moving target smoothly. Normal gain is approximately 0.8-1.0.
Horizontal Smooth Pursuit
| Parameter | Frequency | Right Eye | Left Eye |
|---|---|---|---|
| Rightward Gain | 0.2 Hz | 0.32 | 0.34 |
| Leftward Gain | 0.2 Hz | 0.35 | 0.36 |
| Rightward Gain | 0.4 Hz | 0.33 | 0.28 |
| Leftward Gain | 0.4 Hz | 0.26 | 0.25 |
Vertical Smooth Pursuit
| Parameter | Frequency | Right Eye | Left Eye |
|---|---|---|---|
| Upward Gain | 0.2 Hz | 0.30 | 0.36 |
| Downward Gain | 0.2 Hz | 0.29 | 0.38 |
| Upward Gain | 0.4 Hz | 0.18 | 0.19 |
| Downward Gain | 0.4 Hz | 0.13 | 0.18 |
Summary: Smooth pursuit gains are markedly reduced in all directions (normal ~0.8-1.0; values here are 0.13-0.36). This bilateral symmetric reduction in gain is consistent with central pathology (e.g., cerebellar dysfunction or diffuse cortical/brainstem involvement) or may reflect age-related decline. The gain deteriorates further at higher frequency (0.4 Hz), which is typical of central smooth pursuit impairment.
3. Optokinetic Test (OKN)
OKN assesses the reflex eye movements in response to moving full-field visual stimuli. Normal gain is ~0.8-1.0.
| Direction | Parameter | Right Eye | Left Eye |
|---|---|---|---|
| Left to Right (10°) | Gain | 0.93 | 0.91 |
| Right to Left (10°) | Gain | 0.98 | 0.91 |
| Top to Bottom (10°) | Gain | 0.98 | 1.11 |
| Bottom to Top (10°) | Gain | 1.03 | 1.02 |
| Fast Phase Direction (all) | - | - | - |
Summary: OKN gains are normal bilaterally in all four directions (all close to 1.0). No fast phases were noted. This contrasts with the impaired smooth pursuit and suggests that the large-field optokinetic reflex pathway is intact, whereas foveal/voluntary smooth pursuit is impaired - a pattern often seen in cerebellar or brainstem lesions.
4. Spontaneous Nystagmus
| Condition | Parameter | Right Eye | Left Eye |
|---|---|---|---|
| In Light | Slow Phase Velocity (H/V) | - | - |
| In Light | Amplitude (H/V) | - | - |
| In Dark | Slow Phase Velocity (H/V) | - | - |
| In Dark | Amplitude (H/V) | - | - |
Summary: No spontaneous nystagmus was detected in either light or dark conditions. This indicates no resting vestibular imbalance at the time of testing.
5. Head Shake & Hyperventilation Nystagmus
| Test | Parameter | Right Eye | Left Eye |
|---|---|---|---|
| High Frequency Head Shake | Slow Phase Velocity (H/V) | - | - |
| High Frequency Head Shake | Amplitude, Frequency | - | - |
| Hyperventilation | Slow Phase Velocity (H/V) | - | - |
| Hyperventilation | Amplitude, Frequency | - | - |
Summary: No post-head-shake nystagmus and no hyperventilation-induced nystagmus. Absence of head-shake nystagmus argues against a significant unilateral peripheral vestibular deficit.
6. Gaze Test (Fixation & Without Fixation)
No pathological nystagmus (slow phase velocity, amplitude, fast phase direction, or frequency all recorded as "-") was detected in any of the following gaze positions - either with or without fixation:
- Center, Left, Right, Up, Down (with fixation)
- Center, Left, Up, Right, Down (without fixation)
Summary: No gaze-evoked nystagmus. This makes a gaze-evoked cerebellar nystagmus pattern less likely, though smooth pursuit impairment still points to possible central involvement.
7. Positional Tests - Dix-Hallpike
The Dix-Hallpike test assesses for Benign Paroxysmal Positional Vertigo (BPPV), particularly of the posterior semicircular canal.
Dix-Hallpike Right
| Position | Parameter | Right Eye | Left Eye |
|---|---|---|---|
| Sit Head Right | All parameters | - | - |
| Supine + Head Ext. Right | Vertical Slow Phase Velocity | 4.27 °/s | - |
| Supine + Head Ext. Right | Vertical Amplitude | 4.35° | - |
| Supine + Head Ext. Right | Frequency | 1.25 Hz | - |
| Sit Head Right (return) | Horizontal SPV | - | -13.78 °/s |
| Sit Head Right (return) | Horizontal Amplitude | - | -3.81° |
| Sit Head Right (return) | Frequency | - | 0.89 Hz |
Dix-Hallpike Left
| Position | Parameter | Right Eye | Left Eye |
|---|---|---|---|
| Supine + Head Ext. Left | Horizontal SPV | -2.84 °/s | - |
| Supine + Head Ext. Left | Vertical SPV | 5.32 °/s | 5.81 °/s |
| Supine + Head Ext. Left | Amplitude | 3.59° | 3.53° |
| Supine + Head Ext. Left | Fast Phase Direction | 236.38° | - |
| Supine + Head Ext. Left | Frequency | 1.59 Hz | 0.79 Hz |
| Sit Head Left (return) | Horizontal SPV | - | -15.88 °/s |
| Sit Head Left (return) | Horizontal Amplitude | - | -3.90° |
| Sit Head Left (return) | Frequency | - | 1.32 Hz |
Summary: Nystagmus was elicited on both Dix-Hallpike maneuvers (right and left). The presence of nystagmus on Dix-Hallpike Left (with both vertical and horizontal components, bilateral eye involvement, fast phase direction ~236°) is suggestive of possible BPPV of the left posterior semicircular canal, though the mixed horizontal component may indicate cupulolithiasis or canal conversion.
8. Positional Tests - Yacovino (Geotropic)
The Yacovino test is used to detect anterior canal BPPV.
| Position | Parameter | Right Eye | Left Eye |
|---|---|---|---|
| Supine Begin | Horizontal SPV | -11.76 °/s | -23.15 °/s |
| Supine Begin | Vertical SPV | -53.38 °/s | -62.10 °/s |
| Supine Begin | Amplitude (V) | -12.81° | -13.68° |
| Supine Begin | Fast Phase Direction | 102.23° | 119.05° |
| Supine Begin | Frequency | 2.67 Hz | 2.79 Hz |
| Supine Head Ext. 90° | Vertical SPV (L) | - | 14.65 °/s |
| Supine Head Ext. 90° | Vertical Amplitude (L) | - | 5.10° |
| Supine Head Flex 45° | Horizontal SPV (R) | 3.35 °/s | - |
| Supine End | All parameters | - | - |
Summary: Strong nystagmus (especially vertical, SPV up to -62 °/s bilaterally) was elicited in the Supine Begin position of the Yacovino sequence. This is a significant positive finding and may suggest anterior canal BPPV or involvement of the anterior semicircular canal system. The nystagmus was predominantly downbeat/vertical at onset, consistent with anterior canal pathology.
9. Positional Tests - McClure-Pagnini (Supine Roll Test)
This test assesses the horizontal semicircular canals (HC-BPPV).
| Position | Parameter | Right Eye | Left Eye |
|---|---|---|---|
| Sit to Supine | All parameters | - | - |
| Right Lateral | Horizontal SPV | 6.10 °/s | - |
| Right Lateral | Vertical SPV | -5.77 °/s | - |
| Right Lateral | Fast Phase Direction | 30.84° | - |
| Right Lateral | Frequency | 1.88 Hz | - |
| Supine Head Neutral (1st) | All parameters | - | - |
| Left Lateral | Horizontal SPV | -7.06 °/s | -6.73 °/s |
| Left Lateral | Vertical SPV | - | - |
| Left Lateral | Frequency | 1.19 Hz | 1.27 Hz |
| Supine Head Neutral (2nd) | All parameters | - | - |
Summary: Nystagmus was elicited in both Right Lateral and Left Lateral positions. The direction-changing horizontal nystagmus (geotropic) seen in both lateral positions is characteristic of horizontal canal BPPV (canalithiasis type), with nystagmus beating toward the ground in each position. The comparable intensities in both positions make it difficult to lateralize confidently from numerical data alone, but the slightly higher SPV on the left roll may suggest the right horizontal canal is affected (nystagmus is stronger when the affected ear is down).
10. Head Position Tests
| Position | Parameter | Right Eye | Left Eye |
|---|---|---|---|
| Yaw Right | Horizontal SPV | -6.93 °/s | - |
| Yaw Right | Amplitude | -3.32° | - |
| Yaw Right | Frequency | 1.23 Hz | - |
| Yaw Left | All parameters | - | - |
| Pitch Forward | All parameters | - | - |
| Pitch Backward | Horizontal SPV | 1.60 °/s | -1.15 °/s |
| Pitch Backward | Vertical SPV | 1.98 °/s | -17.45 °/s |
| Pitch Backward | Fast Phase Direction | 349.49° | 104.73° |
| Pitch Backward | Frequency | 2.42 Hz | 2.43 Hz |
| Roll Right | Vertical SPV | -3.96 °/s | - |
| Roll Right | Amplitude | -1.90° | - |
| Roll Right | Frequency | 0.92 Hz | - |
| Roll Left | Horizontal SPV | -8.42 °/s | -8.32 °/s |
| Roll Left | Vertical SPV | 4.83 °/s | 5.24 °/s |
| Roll Left | Fast Phase Direction | 217.69° | 217.98° |
| Roll Left | Frequency | 1.95 Hz | 2.21 Hz |
Summary: Position-dependent nystagmus in Pitch Backward and Roll Left (with bilateral conjugate fast-phase directions) continues to support a positional vestibular disturbance pattern. The symmetric fast-phase directions in Roll Left (both eyes 217-218°) indicate a consistent, conjugate nystagmus response.
11. Subjective Visual Vertical (SVV)
SVV measures otolith (utricle) function and static tilt perception. Normal deviation is ±2°.
| Condition | Trial | Deviation | Time |
|---|---|---|---|
| Clockwise | Trial 1 | 0° | 33s |
| Clockwise | Trial 2 | -1° (Left) | 33s |
| Anticlockwise | Trial 1 | -1° (Left) | 31s |
| Anticlockwise | Trial 2 | -1° (Left) | 31s |
| Blank Background | Trial 1 | 0° | 110s |
| Blank Background | Trial 2 | 0° | 110s |
Summary: SVV deviations are all within the normal range (±2°). No significant otolithic asymmetry is detected. Utricular function appears intact.
Overall Clinical Interpretation
| Domain | Finding | Significance |
|---|---|---|
| Saccades | Mildly reduced precision, prolonged latency | Possible mild central or age-related oculomotor change |
| Smooth Pursuit | Markedly reduced gain bilaterally (0.13-0.36) | Suggests central smooth pursuit impairment |
| OKN | Normal (0.91-1.11) | Large-field reflex pathway intact |
| Spontaneous Nystagmus | Absent | No resting vestibular imbalance |
| Head Shake Nystagmus | Absent | No strong unilateral peripheral deficit |
| Gaze Tests | Normal, no nystagmus | No gaze-evoked nystagmus |
| Dix-Hallpike | Positive bilaterally | Suggestive of posterior canal BPPV (L > R) |
| Yacovino | Strongly positive (Supine Begin) | Suggestive of anterior canal BPPV |
| McClure-Pagnini | Positive bilaterally | Suggestive of horizontal canal BPPV |
| SVV | Normal (0° to -1°) | Utricular function intact |
Key Clinical Impressions:
- Multiple canal BPPV is strongly suggested - positional tests are positive across posterior, anterior, and horizontal canal maneuvers. This is an unusual pattern and may reflect multi-canal involvement or cupulolithiasis variants.
- Central oculomotor impairment is indicated by the markedly depressed smooth pursuit gains (all <0.4) despite normal OKN and absent spontaneous nystagmus. This dissociation warrants further neurological evaluation.
- SVV is normal, indicating intact otolith/utricular function.
- The treating clinician's formal impressions and signature sections were left blank in this report and should be completed with clinical correlation.
Note: This is a data extraction and structured summary of the VNG report. Final diagnosis and management must be determined by the treating audiologist/neurologist with full clinical correlation.
Generate a visual comparison poster: BPPV patterns and final diagnosis ?
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