More than a Frenzel: Do more for your patients with Video Frenzel goggles

20 January 2023

Goggles have long been a valuable tool in vestibular testing, with the newest technology taking it a step further. This article will explore the latest advancements and how you can use them to gain a more complete understanding of your patient’s condition and progress.


What are Video Frenzel goggles?

Video Frenzel goggles, also known as infrared video goggles, can record and replay eye movements, both in fixation and eyes-covered conditions. They offer a large advantage over traditional Frenzel goggles, which could only enhance and magnify the eyes for bedside observation without fixation. 

However, today’s diagnostics have moved beyond simple observation of eye movements. It is much more powerful to be able to measure and quantify the nystagmus. Quantification of a patient’s nystagmus allows not only for an accurate diagnosis but also an accurate measurement of a patient’s improvement throughout intervention and therapy.


Test screen during data collection, with a video image of the patient’s eyes and the nystagmus tracings for horizontal and vertical eye movements.
Figure 1: Spontaneous Nystagmus test data showing a left-beating nystagmus of 4 degrees per second. 


The powerful nystagmus detection algorithms in Interacoustics’ VisualEyes™ 505 can find and measure abnormal eye movements in the horizontal and vertical channels. If the software observes nystagmus in either channel, it will provide a numerical measurement to the right. A red diamond will appear if the amount of nystagmus is outside of the suggested threshold levels.


Measure more than the eyes

Bring your video goggles to a whole new level by adding a simple and small head sensor. As part of Interacoustics’ VORTEQ™ Assessment add-on bundle, the VORTEQ™ inertial measurement unit (IMU) head sensor measures head position in space and head speed.


Video Frenzel goggles seen from the front with the cover on. A green arrow is pointing toward a small head sensor, which is fixated to the top of the goggles, and would be located around the high forehead if a patient was wearing them.
Figure 2: VORTEQ™ inertial measurement unit (IMU).


Why measure head position?

Measurement of head position is especially important for accurate diagnosis in the Advanced Dix‑Hallpike and Lateral Head Roll tests. These typical tests for benign paroxysmal positional vertigo (BPPV) need accurate observation of eye movements in response to specific head positions. A 3D head model provides real-time feedback and guidance for the accurate positioning of the head during testing or treatment.


Software screen during real-time data collection. In addition to the eye tracing graphs for horizontal and vertical eye movements, there is also an eye tracing graph for torsional eye movements. The 3D head model is also displayed showing the patient in a Dix-Hallpike left position.
Figure 3: 3D head model guide.


Why measure head speed?

Measurement of head speed is useful to quantify the function of the vestibular-ocular reflex (VOR). The VOR is one of the most important reflexes for everyday movements because it allows us to maintain clear vision when the head is in motion. Following vestibular injuries or insults, the VOR is one of the most frequently affected reflexes.

Luckily, specific intervention can usually rehabilitate and improve the VOR. To define the starting point for intervention, you can perform functional VOR tests such as Dynamic Visual Acuity (DVA) or the Gaze Stabilization Test (GST). The head sensor allows for accurate measurement of head speed and provides real-time feedback so your testing can be exact.


Measure more nystagmus

The VORTEQ™ sensor allows you to measure torsional eye movements in addition to horizontal and vertical eye movements during Advanced Dix‑Hallpike testing. Previous videonystagmography (VNG) technology has not been able to be measure or quantify torsional eye movements, which are most often present in active BPPV cases.


Software screen following data collection in an Advanced Dix-Hallpike left test in a patient who has left posterior canal BPPV. The horizontal, vertical, and torsional eye movement graphs all show positive findings of BPPV.
Figure 4: Advanced Dix‑Hallpike left test that shows the data for horizontal eye movements (top graph), vertical eye movements (middle graph), and torsional eye movements (bottom graph).


Do more for your patients

Being confident in your diagnosis is so important to recommend and streamline treatment for your patients so they can improve as quickly as possible. Advanced diagnostic abilities, such as the measurements of head position and speed and the evaluation of torsional eye movements, allow for improved patient care.

Do more for your patients by improving your diagnostics and treatment. Add video goggles and a head sensor to your clinical flow.

For more information about this solution, visit Interacoustics’ VisualEyes™ 505.


About the author

Liz Fuemmeler, Au.D., is a Clinical Product Manager at Interacoustics. She graduated from Purdue University in 2019, and spent three years at Hearing and Balance Specialists of Kansas City as a Vestibular and Concussion Audiologist before joining Interacoustics in July 2022.

Dr Liz Fuemmeler
Dr. Liz Fuemmeler is a vestibular audiologist and Clinical Product Manager with Interacoustics. She graduated with her doctorate in 2019 from Purdue University and received specialty training in vestibular and balance disorders at Boys Town National Research Hospital and the Mayo Clinic. While at Mayo Clinic, she trained in a concussion evaluation and rehabilitation program, which focused on utilizing vestibular testing to identify the presence and extent of issues following a concussion. Utilizing this training, she established a concussion program at a private practice in Kansas City, MO and participated in interdisciplinary evaluations for the Concussion Management Center at the University of Kansas Medical Center. She is actively involved in vestibular and concussion research and regularly lectures for local, national, and international conferences. Outside of her role with Interacoustics, she co-hosts a monthly podcast called "A Dose of Dizzy '' that reviews current vestibular protocols and research. She also is the president of the Missouri Academy of Audiology and volunteers with the American Academy of Audiology as an advisor to the national student academy.

Published: 20 January 2023
Modified: 09 June 2023


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