Reader Response: Opinion and Special Articles: Remote Evaluation of Acute Vertigo: Strategies and Technological Considerations

I fully agree with the paper by Green et al.1 However, these strategies are not always easy for a young colleague in a busy emergency department. I have many years of positive experiences using the model presented in this short paper,2 which describes an algorithm with 3 components: the Romberg test, the horizontal smooth pursuit eye movement test, and tragal pressure. This algorithm can be used at bedside without any equipment or previous training diagnosing nystagmus. I would propose for the head impulse test, nystagmus evaluation, and test of skew (HINTS) and my proposed algorithm to be used together. The tragal pressure is only relevant in the peripheral cases; I include it because of my clinical experience of overlooked cholesteatomas, presenting as a small amount of cerumen at the top of the tympanic membrane.

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