GC returned 7 months after her initial appointment, reporting spinning sensation and emisis for the past few days. The sensation lasts for hours, is provoked by head movement right.  She reports migraine headache, with visual aura and sensitivity to smell, and dizziness accompanies the headache.

Left tinnitus and bilateral aural fullness are still reported.

She is seen to repeat portions of the VNG, but not audiological evaluation.  Saccadic testing, OPK and smooth pursuit were not tested. Gaze/vision denied testing is also included now.  Caloric testing was not conducted.

The results are shown below.  (Click on image, click again to enlarge.) In the positionals (second file) the ones with an asterisk are post BPPV treatment.

• Interpret the results, and indicate what if anything has changed.
• The team seeing her a month ago was suspicious of horizontal canal BPPV causing ageotrophic nystagmus. Can this be confirmed or ruled out in this testing?
• What additional testing might you do to further investigate?