About The Book

Electronystagmography and Videonystagmography (ENG/VNG), Second Edition remains a practical and portable resource for conducting and interpreting the electronystamography/videonystagmography examination.

In order to provide a foundation for understanding ENG/VNG test results, the early sections of the text are dedicated to a description of normal and impaired peripheral and central vestibular system function. Also addressed is the process of central nervous system compensation. These sections are followed by a description and interpretation of the ENG/VNG subtests including: an expanded ocular motor testing section, positional/ing testing, and caloric testing. The text now also includes a chapter describing the most common disorders causing dizziness and provides the diagnostic criterion for each. Finally, examples of counseling materials and illustrative case studies that serve to highlight the principles and techniques covered in the manual are provided.

Graduate students and practicing clinicians will benefit from this unitary source for protocols and procedures required for completing an ENG/VNG examination.

New to the Second Edition

  • New illustrations demonstrating key concepts within the text
  • New and updated references throughout
  • New chapters describing common disorders
  • Updated and expanded chapter on ocular motor function
  • 10 cases with 17 videos accessible on a PluralPlus companion website

From the Foreword

“Now we have before us the second edition of Dr. McCaslin’s book, and it’s even better than the first. Same firsthand clinical experience, same serious scholarship, same lucid writing, but now there’s updated and expanded information on eye movement neurophysiology and a new set of illustrations. Also new is a whole chapter listing common (and some not so common) dizziness-causing disorders. Dr. McCaslin has outdone himself here. For each disorder, he provides historical background, pathophysiology, clinical presentation, laboratory findings, and treatment. He also provides several useful appendices—a dizziness questionnaire, suggested alerting tasks to be used during caloric testing, and a table listing reliability and localizing value of various ENG/VNG findings.

Who is this book for? It should be required reading for all clinicians who perform ENG/VNG and for all students who aspire to do so. It should also be read by referring physicians. ENG/VNG test results alone rarely yield a diagnosis, but they often provide useful information to physicians who understand their implications and relate them to other medical data available for diagnosis. One need not look elsewhere to find cogent descriptions of ENG/VNG results and their implications. They’re in this book. I learned a lot. You will, too.”
Charles W. Stockwell, PhD

About The Author

Devin L. McCaslin, PhD received a Master’s degree in Audiology from Wayne State University and a PhD in Hearing Science from The Ohio State University. He currently serves as the Director of the Vestibular and Balance Laboratory at Mayo Clinic in Rochester and is an Associate Professor in the Mayo Clinic College of Medicine. He has authored and coauthored publications that cover the areas of tinnitus, dizziness, auditory function, and outcome measures development. Dr. McCaslin’s major academic, clinical and research interests relate to clinical electrophysiology, vestibular assessment, and the application of artificial intelligence to manage and treat dizzy patients. He also serves as the Deputy Editor-in-Chief of the Journal of the American Academy of Audiology and is the Past President of the American Balance Society.

Table Of Contents

Chapter 1. Neural Control of Eye Movements


Hierarchy of Oculomtor System

The Final Common Pathway of the Oculomotor System

The Functional Classes of Eye Movements

Eye Movements that Keep the Fovea Fixed on a Target

Optokinetic System


Chapter 2. Anatomy and Physiology of the Vestibular System


The Sensory Transduction of the Peripheral System

Vestibular Hair Cells

Semicircular Canal Anatomy and Physiology

Otolith Organ Anatomy and Physiology

Primary Vestibular Afferent Projections

Anatomy of the Central Vestibular System

Vestibular Nystagmus Generated by Head Movement

The VOR during Sustained Movement

Peripheral Vestibular Impairment and Central Nervous System Compensation

Impaired Central Nervous System Compensation

Laws of Compensation

Chapter 3. Pretest Procedures for VNG


Case History

The Dizziness Symptom Profile (DSP)

Assessment of Dizziness Handicap

Bedside Evaluation of the Ocular Motor System

Otoscopic Examination

The VNG Environment

Chapter 4. Eye Movement Examination



EOG/ENG: Corneoretinal Potential

Using the CRP to Record Eye Movements

Voluntary Saccade Test

Gaze Test

Smooth Pursuit Tracking Test

Optokinetic Test

Chapter 5. Positional Testing

Static Positional Testing

Positioning Testing

Treatment of Benign Paroxysmal Positioning Vertigo

Chapter 6. The Caloric Test


Caloric Stimulation of the Vestibular System

Components of the Caloric Test


Preparation for the Caloric Test

Procedure for Conducting the Alternating Binaural Bithermal Caloric Test (Water and Air)

Caloric Test Technique

Analysis of Caloric Responses

Interpretation of Caloric Responses

Summary: Significance of a Directional Preponderance

Technical Tips for Caloric Testing

Chapter 7. Common Vestibular Disorders: Clinical Presentation


 Common Disorders Causing Dizziness

Appendix A. Dizziness Questionnaire

Appendix B. Understanding Dizziness

Appendix C. Pediatric Literature for Understanding Dizziness

Appendix D. Example Alerting Tasks for Vestibular Testing

Appendix E. Reliability and Localizing Value of VNG Findings



This book comes with supplementary case videos on a PluralPlus companion website.

Case 1: Downbeat Gaze Nystagmus (1 video)
Case 2: Bidirectional Gaze-Evoked Nystagmus (2 videos)
Case 3: Hypermetric Saccades (1 video)
Case 4: Infantile Nystagmus (2 videos)
Case 5: Ocular Flutter (1 video)
Case 6: Slow Saccades (2 videos)
Case 7: Spontaneous Vestibular Nystagmus (4 videos)
Case 8: Posterior Canal Benign Paroxysmal Positional Vertigo (1 video)
Case 9: Square Wave Jerks (1 video)
Case 10: Geotropic Horizontal Canal Benign Paroxysmal Positional Vertigo (2 videos)


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