Las Vegas, NV - 3120 S. Rainbow Blvd, Ste 202 -702.233.4327
Las Vegas, NV - 6475 N. Decatur Blvd, Ste 125 - 702.933.9103
Las Vegas, NV - 9430 W. Lake Mead Blvd, Ste 11 - 702.527.6066
Henderson, NV – 2642 W. Horizon Ridge, Ste A11 – 702.933.9102
Electronstagmography (ENG)/Videonystagmography (VNG)
An ENG or VNG has been ordered by your physician to help determine the cause of your dizziness or balance problem. The procedure is painless, and will last 60 to 90 minutes. During the test, eye movements will be recorded while you follow lights and lay in different positions, and while warm and cool air are introduced into each ear canal. Recordings will either be made with electrodes, which are placed on the face with tape (ENG), or by infrared goggles (VNG).
You have been scheduled for an ENG/VNG on ____________ at _________. The test requires about sixty to ninety (60-90) minutes to complete. Although some people experience some dizziness during the test, the dizziness is of short duration, and by the completion of the test, all dizziness should subside. Testing may cause a sensation of motion that may linger. If possible we encourage you to have someone accompany you to and from the appointment, however, if this is not possible try to plan your day to include an extra 15 to 30 minutes after you test before leaving the office.
Once your evaluation is completed each part is carefully evaluated and reviewed. This process is as important as your test, so please understand that your test results will not be discussed in detail at the time of your evaluation. Once the interpretation has been made a detailed report will be forwarded to you and/or your referring physician.
Patient Instructions
You will be instructed to refrain from taking certain medications for 48 hours prior to your test date. Certain medications can influence the body’s response to the test, thus giving a false or misleading result. You will find a short list below, however if you have any questions or concerns about discontinuing your medications please consult your doctor.
Antidepressants: Zoloft, Lexapro, Cymbalta, Paxil, Prozac, Elavil, Wellbutrin. Alcohol: Beer, Wine, Cough Medicine. Analgesic-Narcotics: Codeine, Demerol, Phenaphen, Tylenol with Codeine, Percocet, Darvocet. Anti-histamines: Chlor-trimeton, Dimetapp, Disophrol, Benadryl, Actifed, Teldrin, Traiminic, Hismanol, Claritin.any over the counter cold remedies. Anti-seizure Medication: Dilantin, Tegretol, Phenobarbital. Anti-vertigo Medication: Anti-vert, Ru- vert, Meclizine. Anti-nausea Medication: Atarax, Dramamine, Compazine, Antivert, Bucladin, Phenergan, Thorazine, Scopalomine, Transdermal. Sedatives: Halcion, Restoril, Nembutal, Seconal, Dalmane, or any sleeping pill. Tranquilizers: Valium, Librium, Atarax, Vistaril, Serax, Ativan, Librax, Tranzene, Xanax.
**You make take blood pressure medication, heart medication, thyroid medication, Tylenol, insulin, estrogen, etc. Always consult with your physician before discontinuing any prescribed medications.
Note: Medications can be resumed immediately following the VNG testing procedures. If there are any questions about the test or medication, please contact your doctor our offices.
Please eat lightly for the 12 hours prior to your appointment. If your appointment is in the morning you may have a light breakfast such as toast and juice. If your appointment is in the afternoon eat a light breakfast and have a light snack for lunch. Please avoid caffeine in beverages such as coffee or soft drinks. PLEASE DO NOT WEAR EYE MAKEUP (MASCARA, EYE SHADOW, ETC. Your cooperation in the following these instructions will improve the quality of your evaluation. PLEASE BRING THE COMPLETED QUESTIONAIRE TO YOUR APPOINTMENT
Las Vegas, NV – 3120 S Rainbow Blvd, Ste 202 – 702.233.4327
Las Vegas, NV – 9430 W Lake Mead Blvd, Ste 11 – 702.527.6066
Las Vegas, NV – 6475 N Decatur Blvd, Ste 125 – 702.933.9103
Henderson, NV – 2642 W. Horizon Ridge, Ste A11 – 702.933.9102
Patient Name:___________________________ DOB:____/____/____ Sex: M □ F □ Date:________ The following questions refer to your feeling of dizziness and/or imbalance. Please answer them as “yes” or “no” and fill in all blanks. Please describe in your own words, the sensation you feel without using the word “dizzy”: When did you first notice the feeling of dizziness and/or imbalance and approximately how long did it last? 1) Do you ever have any of the following sensations? (check all that apply) 2) The following refer to a typical dizzy spell (check all that apply):
□ Are you dizzy or unsteady constantly?
□ Do the dizzy spells come in attacks?
How often? ___________________________________________
How long? ___________________________________________
Date of first spell? _____________________________________
□ Are you free from dizziness between attacks?
□ Does your hearing change with an attack?
□ Are you dizzy mainly when you sit or stand up quickly?
□ Are you more dizzy in certain positions?
Which positions? _______________________________________
□ Have you had a recent cold or flu preceding recent dizzy spells?
□ Have you had trouble walking in the dark?
□ Are you better if you sit or lie perfectly still?
□ Is there anything that you have found that makes your dizziness worse?
If yes, explain: _________________________________________
□ Is there anything that you have found that helps your dizziness?
If yes, explain: _________________________________________
□ Do you black out or faint when dizzy?
□ Do you feel lightheaded or have a swimming sensation when you are dizzy?
□ Do you find yourself breathing faster or deeper when excited or dizzy?
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Las Vegas, NV – 3120 S Rainbow Blvd, Ste 202 – 702.233.4327
Las Vegas, NV – 9430 W Lake Mead Blvd, Ste 11 – 702.527.6066
Las Vegas, NV – 6475 N Decatur Blvd, Ste 125 – 702.933.9103
Henderson, NV – 2642 W. Horizon Ridge, Ste A11 – 702.933.9102
3) Is your dizziness or imbalance brought on by (check all that apply):
□ Movement of objects □ Menstrual periods
4) The following refer to other sensations you may have (check all that apply): Have you had:
□ Weakness or clumsiness in arms or legs
□ Recent head trauma (if yes, explain)
5) The following refer to your hearing. Indicate which side has been affected:
Fullness in one ear? ……………………………………………………. Left
Change in hearing when dizzy? ………………………………………. Yes
If yes, how? _______________________________________________
Better? ……………………………………………………………. Left
Exposure to loud noises? ………………………………………………. Yes
Previous ear infections? ………………………………………………. Yes
Previous ear surgery? …………………………………………………. Yes
What? ___________________________________________________
Family history of hearing loss? ………………………………………… Yes
6) The following refer to habits and lifestyle (circle yes or no):
Did you recently change eyeglasses?. Yes
Have you ever had weakness or faintness a few hours after eating? Yes
How much? ____________________________________________
How much? ____________________________________________
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Las Vegas, NV – 3120 S Rainbow Blvd, Ste 202 – 702.233.4327
Las Vegas, NV – 9430 W Lake Mead Blvd, Ste 11 – 702.527.6066
Las Vegas, NV – 6475 N Decatur Blvd, Ste 125 – 702.933.9103
Henderson, NV – 2642 W. Horizon Ridge, Ste A11 – 702.933.9102
Past Medical History: Please list your current medical problems and length of illness: Please list all surgery performed and approximate dates: Please list all medicines you currently take (including pain medicine, nonprescription medicine, nerve pills, sleeping pills, or birth control pills): Family History: Any family history of (circle yes or no):
Please list any other diseases that run in your immediate family: Do you have anything else to tell us about your particular problem which we have not asked you on this questionnaire?
CARLTON MEDICAL PRACTICE The ‘phone number goes into your records, which are completely confidential, and won’t be given out to anyone without your consent. On average, we have about 400 AUTUMN NEWSLETTER 2013 GP appointments per week which are bookable appointments on the day of request. CANCELLING APPOINTMENTS Please ring us and let us know if you no longer need the app
Buena Fe y Lógicas Multi-agente en Derecho Internacional Público Instituto Internacional de Estudio y Formación en Gobierno y SociedadUniversidad del Salvador, Argentina; y Universidad de Pisa, ItaliaFacultad de Informática e Instituto de Relaciones InternacionalesUniversidad Nacional de La Plata, ArgentinaUniversidad Nacional de La Plata, Argentinamúltiples modos de argumentar con el