HINTS Exam for Vertigo Explained - Head Impulse, Nystagmus, Test of Skew - Clinical Skills - Dr Gill

[@leovetta]

I'm terribly sorry to say that doc, but you should work with better patients, may i suggest one fine lady called Abbie Tutt, born on 7th of December 1996?

[@austenblumkaitis9024]

ahhahaha goated comment

[@supremebonkripper7460]

@@austenblumkaitis9024 explain pls

[@randomlydi3602]

@@supremebonkripper7460 Abby is a regular "patient" for the exams. For those who watch and follow the channel she is a legend 😁

[@Grubielec92]

Still remember Lucy born on 1st of January 1987 😌

[@igormac88]

Or that 10/10 guy for taking his red shirt off in 0.1 second from years ago. Never other "patient" could reproduce such hability lol

[@markmccallum475]

"Patients come to me with vertigo. But thanks to me, their vertigo vertiwent."

[@DrJamesGill]

🤣🤣 I like that one

[@jenniferallday]

😂😂

[@evanb8495]

Didn't go for the obvious "vertigo's vertigone"?

[@markmccallum475]

@@evanb8495 damn it.....

[@moniquewilson4179]

I wish mine would vertigo! I was in the Navy for years and NEVER got seasick. Loved it. Finished the Navy, and a year later had my first experience with vertigo, which was extremely confusing because I had no clue what the heck was going on.

[@beccadaviiidd]

I really have no business watching these. I’m a property insurance agent who has literally no exposure to the medical field except yearly checkups, but I LOVE watching your videos. They’re surprisingly soothing, and they help me relax and fall asleep. And on the occasion that I do stay awake throughout the whole thing, I always learn something new, which is really cool. So thank you for the content! I’m looking forward to your next video!!

[@DrJamesGill]

It’s always interesting the things that we find engaging outside of our normal fields

[@ryanschultz9413]

The little David Bowie flash when he says labyrinthitis is classic

[@DrJamesGill]

I was hoping people would get the connection 😊

[@colewilliams5304]

This man is the bob ross of the medical field, both career paths I have no business watching but I can’t turn it off!!

[@SH-sl7lc]

I had vertigo a few weeks after having COVID-19 and have spoken to several people with similar symptoms. It was terrifying at the time, and I thought I'd had a stroke :( My amazing GP did a phone consultation as it was during a lockdown. Thank you NHS ❤ And thank you Dr Gill for explaining things so well.

[@DrJamesGill]

Vertigo is truly one of the most unpleasant, often “not serious” issues I think there is. Much more so than pain - which can often not have an apparent cause I had vertigo - only briefly thankfully - it really feels like your body is betraying you

[@I_AM_HYDRAA]

@@DrJamesGillI got it after a plan ride when I was twelve and it scared me so much

[@mribassy]

The patient answered the name & DOB question incorrectly but Dr. Gill missed it. The answer he was looking for was “Abbie Tutt, 7th December 1996”

[@maximandi9014]

🤣🤣🤣

[@amane6397]

I don't get it :c

[@rociomontano2069]

@@amane6397 Abbie is the usual guest star of these videos and her name and DOB are now a classic

[@Punkskellytron]

Showing people with the symptoms is such a good addition.

[@DrJamesGill]

Difficult to get that footage though

[@genebrotherton9056]

Hey Dr Gill, I'm a Menieres patient, also living with diabetes. My first symptoms of Menieres began in a hotel room. During the day I felt mild vertigo which became more severe by late night. I was very seasick (in a 10 story building on solid ground) and experienced everything that occurs with severe seasickness 🤢 No doctor ever suspected Menieres until 4 years later. By that time the hearing loss on my right side was very noticeable, but the vertigo was gone. Two years after that, I experienced a very rapid onset of vertigo while I was driving. Luckily I managed to not crash. Two weeks after that episode, my gp did a full blood work up and discovered my glucose levels were 380 mg/dl. The next day at the follow up, a finger stick showed my glucose was 476. So likely that severe, rapid onset of vertigo was due to very high blood glucose, and not a return of the Menieres symptoms. (My hbA1c was 14%) Now I keep my glucose under control, A1c between 6.8 and 7.4 usually. The vertigo has never returned. But from the Menieres, my hearing loss is permanent on the right side and I must live with that constant ringing noise. The hearing on my left side is normal.

[@DrJamesGill]

This is a useful, if horrible example of why diabetes is so serious. I’m sorry you’ve been though this, although I’m glad you’ve not had further issues with the vertigo

[@foglight11]

I burst awake with vertigo in May 2020, thinking I was having a stroke. They told me I had BPPV, but it has never gone away completely and I have to use a cane most days due to spinning and pain in my head and ear. Some days are good but the pain never goes away and the dizziness is mild but not gone. I am glad there are tests like this to help people figure things out. It's so scary to live with. Almost crippling. Thank you for posting these :)

[@DrJamesGill]

That’s a little unusual. Did you get a referral to ENT?

[@foglight11]

@@DrJamesGill I did from my doc in the hospital, but 8 months later they said they were too busy and couldn't see me. My family doctor has been great and advocated for me to a new ENT and the waiting period is another 8-9 months, which is in March, so here is hoping :)

[@porgeous88]

I suffer with Vertigo so really looking forward to this! 😵‍💫

[@DrJamesGill]

Hopefully it helped you understand one of the tests you may have seen

[@DrJamesGill]

Perhaps we should do a video looking at WHAT vertigo actually is?

[@porgeous88]

@@DrJamesGill that would be really helpful for us spinners, especially to understand how the heck you wake up with it and if there are triggers I'm completely unaware of. Such random unpredictable occurrences but when it hits ... boy oh boy i feel like the titanic in a vortex.

[@tenorgurll4429]

Omg! I have Menieres! It’s cool to learn about all these tests for it. The tests they had me do were super different, and more similar to inebriation balance tests! They did take lots of videos of my eyes before and after different activities though lol

[@DrJamesGill]

Menieres is annoying as it’s so difficult to treat

[@joshualevesque7827]

Omg your the best doc ever I learned so much from you I'm going to medical school thx you doctor gill your the best

[@DrJamesGill]

Wonderful to hear!! Where are you going?

[@joshualevesque7827]

@@DrJamesGill I'm going to Warwick medical school and I want to to be just as a good doctor as you are I'm actually 16 but I'm practicing now so I can get better

[@sowhowwelike]

Amazing explanation, thank you for explaining hints exam, I am studying vertigo examination for my weekly exam in ENT and I believe it is going to be pretty helpful for not just now but for my next years in medical field.

[@DrJamesGill]

It’s a challenging one to get into your head - well at least it was for me. But it think once you understand HOW to use it, it’s much easier

[@jg8263]

Loved the Labyrinth Bowie appearance!

[@DrJamesGill]

👍

[@brett3554]

I had labyrinthitis in 2020 after I caught COVID, it went on for about a year (six month of intense motion sickness) followed by lesser bouts. I still get it two years later but very minor! to those recovering it does get better !

[@DrJamesGill]

It really astonishes me at time the breadth of problems covid has caused. Glad things have improved somewhat for you though 😊

[@dariusdorris2600]

Dr! When first out break of Covid hit i had to find something. I found you! For this i thank you. You have been and truthfully are being a saving grace.

[@DrJamesGill]

Welcome! Hope it’s useful

[@SOsuchukwu]

Hi Dr Gill, This was a very informative video and I thoroughly enjoyed watching! Just in case you hadn’t noticed, you mistakenly mentioned vestibular neuritis being irritation of CNVII at the beginning of the video (2:43) 😅 nonetheless, this video has informed my clinical practice, so thank you! Best wishes :)

[@DrJamesGill]

Drat. Good catch. Unfortunately you can’t add amendments😞

[@SOsuchukwu]

@@DrJamesGill No worries at all! It could be an idea to put the correction in the description box, perhaps?

[@ferzmat2313]

Spontaneous Nystagmus sounds like a spell xD I can totally imagine Hermione correcting my pronunciation.

[@DrJamesGill]

🤣🤣

[@kiarona.]

"It's SponTANeous NysTAGmus, not SpontaNEOUS NYStagmus!"

[@cavcaptor]

I get vertigo and nystagmus as part of migraine prodrome and it's a very good prompt to go have a lie down... But as you've said elsewhere, one of the worst non-pain symptoms.

[@DrJamesGill]

Unpleasant. But as you say, it does work well as an alert

[@e.diokno2000]

Thank you ..watching from the Philippines

[@DrJamesGill]

Thanks for watching!

[@e.diokno2000]

@Dr. James Gill..it is very informative..i will share it here in Philippines

[@juniorrantan4559]

My favorite doctor.

[@DrJamesGill]

👍

[@kaysmith8992]

I burst out at laughing at the sudden Labyrinth reference.

[@DrJamesGill]

👍👍 SUCCESS!!!

[@0verWay]

The audio is extra crispy. I like it.

[@ezequielduarte5425]

Doc un saludo desde argentina!

[@brandonmoucatel9630]

Keep it up Gill

[@DrJamesGill]

We’re trying 😊

[@yasminvaughn2975]

I love these blogs! Dr Gill is cute also!

[@kellyk209]

Thanks for the info. I have suffered with this since a young child, I would wake up during the night/early hours where I would be so dizzy everything would spin and walking was impossible as I would stumble and fall side to side. If I opened my eyes I would projectile vomit everywhere. It would sometimes lead into a migraine. I had to be left in complete darkness for 2-3 days until it passed and prey I didn’t need to use the toilet. My mum would take me back and forth to our GP but nothing made it better. As an adult I still get this except the migraines are less common and lying flat or moving a certain way can trigger it, symptoms are less intense though I do get pins and needles down one side of my leg when it does happen. Don’t know why 🤷‍♀️

[@porgeous88]

I also get it randomly when waking up. Absolutely awful. Sometimes when I'm sat in a chair it manifests like i'm falling off the chair sideways and sometimes when i go to bed it kicks up and feels like I've been drinking heavily for days as the headspin is so intense and so painful (I don't drink). absolutely horrific and a lot of people think vertigo is all about heights. Nope! GP just gave me travel sick pills, not so great but also I don't know yet what triggers it, especially when you wake up with it! Weird huh?! I don't get migraines though thankfully.

[@thegirlwiththatface]

Hi Dr Gill, I love watching your videos even though I’m going down a different medical field branch (I’m currently in my undergrad in a Pre-occupational therapy concentration) and I noticed a lot of this exam requires looking directly into the examiner’s eyes. I was just wondering what you might do if you were working with someone on the spectrum as I’ve heard sometimes someone who is on the spectrum finds it almost physically painful to look people in the eyes. What sort of alternatives might there be?

[@DrJamesGill]

You explain the need and what you are looking for As you say, looking into someone’s eyes can be very uncomfortable. There are MANY tests - blood taking as just a simple example - that are uncomfortable, but as long as people understand the need, are happy to undertake It’s all about communication

[@thegirlwiththatface]

@@DrJamesGill fair enough thank you for the response 🙏

[@emmythebun]

Your student in the demonstration looks so sad like a kid that just got put in time out lol aw

[@coalsparks]

Bonus points for the Bowie reference.

[@DrJamesGill]

👍

[@jp10p66]

Absolutely love your content - especially this video. I think there might be one mistake though at 2m48 when you say the vestibular nerve is cranial nerve vii - it should be viii? Apologies if I'm wrong!

[@DarkFilmDirector]

I would love to attend whatever medical school Dr Gill offers instruction and education at.

[@DrJamesGill]

Warwick has application open

[@madhvichellemboyee2032]

Very interesting and explanation of utmost precision. Thank you. Do you have any video on allergies and their effects? I have a friend who keeps sneezing and she has always been given paracetamol and Piriton. It has been 3 years now since she has this symptom and took the risk of consuming allercet without prescription. Could you please help. Thank you.

[@DrJamesGill]

We might be able to deal with allergies sure 😊

[@tbip2001]

This video is nothing short of exceptional. I don’t think I’ve seen another video that detailed why the hints shouldn’t be performed in certain patient groups. Have you sorted your Audio now? I did see a video where you had a lav mic on but still seemed to have a large amount of hiss . Check out the zoom f2 recorder.

[@cale115]

Watching from Ottawa, different Ottawa! But named after the same prairie tribe that got run up to Canada.

[@rafaelcruz9613]

They did this when I was diagnosed with vestibular migraines

[@DrJamesGill]

This is one of the points we discussed - sometimes these can present with features suggestive of stroke, and it’s hugely important to be able to quickly rule it in or out 😊

[@chuckoneill2023]

Are there circumstances in which it would be appropriate to administer stroke treatment --- due to time pressures --- before you've completed the assessment? Appreciate the willingness of your student to allow you to put him through that -- not all professors inspire that level of trust.

[@DrJamesGill]

Unfortunately not, as the treatment for a stroke (clot) would worsen the treatment for a stroke (bleed) as an example

[@ChrisStumer]

If you suspect a stroke, contact an ambulance straight away.

[@bicchu68]

Top notch video. Thanks doc.

[@DrJamesGill]

👍

[@benh9688]

I have a question concerning Boolean logic - if a patient has only prolonged vertigo but no nystagmus (as opposed to both), is the HINTS exam still indicated? Is nystagmus an essential accompaniment to the vertigo? Thanks for any clarification you can offer!

[@potencjalnypracownik2966]

His changing of cameras causes Vertigo too. Also watch music video retrovertigo.

[@TheScientist43]

I have suffered from vertigo since 2014 and have had utterly terrifying experiences with it including a vestibular migraine related one. Would have loved a video like this.

[@DrJamesGill]

Oh dear. That is horrible. Are you under the care of ENT?

[@TheScientist43]

@@DrJamesGill I had the neurology team come round and try figure me out while an inpatient. They never really figured it out, I did. It was a few things like bad eye strain, new glasses required and migraine, all combined with little sleep. I still get it if I'm not careful. I have stemetil but I developed a phobia of not getting enough sleep and getting the vertigo, which as you can imagine is not conducive to a normal life.

[@detroit7543]

I have a patients presenting to the ER with Vertigo and Stroke. He said he has prolonged vertigo and his family said he has Nystagmus. How to differentiate if it is central or peripheral? what test to use?

[@TheTruthWholeTruthNothingButTh]

I had vertigo a couple months back and a chiropractor fixed it immediately. Wondering your thoughts on chiropractors doc

[@DrJamesGill]

The commonest cause of vertigo is BPPV - so issues with the otoliths in the ear. This is treated with a series of movements called Epleys. It is likely that they had you do this

[@Mr.C0ffee]

Is this 14:13 done with glasses?

[@TheGamingTV]

James , where would you go at a point where you experience quite literally every symptom explained in this video (beside an obvious stroke) my mother , age 51 , has been experiencing everything talked about in this video virtually her entire life now. Been to so many clinics to try and identify what the problem is , but to this day there is still no answer , she experiences severe nausea, sickness , vertigo very very often , caused by looking up for more than a few seconds , moving her heard too fast , sleeping on the opposite side , hearing impediment as well , also tinnitus and some occasional nystagma

[@DrJamesGill]

First port of call would be GP with view to ENT clinic - but it is likely there would need to be a further referral to subspecialist clinic from there too

[@herrlejon4714]

16:26 me sitting and thinking about regrets in life

[@giuliabird8422]

I had oto-neurological testing done at the hospital a couple years back when my vertigo was horrid - the spinning was just awful.. although i did find out from the audiologist that i had perfect hearing.. ha ha

[@راشدالعميري-ن9ع]

Thank you doctor for the nice video, but I have a question, what kind of watch is yours?

[@DrJamesGill]

Garmin Fenix 7

[@راشدالعميري-ن9ع]

@@DrJamesGill thank you dr

[@laurieinjapan]

Audio is so tough to get right! Extra recorders and extra mics can be really helpful if you're doing something complicated and you don't want to have to do it again!

[@DrJamesGill]

Oh that’s a fact. I’ve ONE microphone that seems to work, I’ve also bought a Rode Video+ and it ALWAYS just sounds to echoey and just naff

[@gritnix]

Love the David Bowie Jareth cameo. :)

[@InfiniteClouds]

Power of the voodoo

[@DrJamesGill]

Not as powerful as antibiotics though 😜

[@InfiniteClouds]

@@DrJamesGill Unless one overuses them!

[@Frazorg]

Great video! I like this format of video a lot but I do have an unrelated question, are you planning on making more "a to z of the NHS"?

[@DrJamesGill]

Thanks, we will be, just things have been a little busy of late 😊

[@BlueSky-lb8fw]

At 4:18 how do we know that pt didn’t do that deliberately?

[@starfishgurl1984]

Great video! Couldn’t directly watch him being spun around in the chair though do to my proprioception issues making me dizzy if I did (thanks sensory processing disorder) so I only half watched from the side while mainly focusing on you, kind of ironic in my opinion though considering the video topic lol…

[@markwagner4909]

I suffer from vertigo or the dizzies as I call them I get it a couple time a month

[@DrJamesGill]

Oh dear. Your gp might be able to help with that

[@markwagner4909]

@@DrJamesGill I am given Antivert. It all started with a virus in my right ear rendering me deaf in it. Audiologists confirmed that I’m indeed deaf in the right ear but no other help with vertigo other than antivert

[@Jeremy27129]

I went to the ENT and did all these tests and they said I didn't have bppv but I still have dizziness and they said they didn't have an answer for me for why I still get dizzy, FRUSTRATING!

[@DrJamesGill]

There are many differentials for dizziness - particularly whilst dizziness Is undefined, may need further discussion with your GP

[@Rashagar]

Oh I thought this was a video giving hints for an upcoming exam

[@DrJamesGill]

Unfortunately not

[@kittybala7951]

Great information. Is this serious

[@DrJamesGill]

It certainly can be, hence the importance of knowing when do you need to do the test

[@kittybala7951]

@@DrJamesGill thank you. Will speak to my gp about this

[@elliottmellor4459]

Good video. By the way, any chance of seeing your 100k subs plaque?

[@DrJamesGill]

It hasn’t arrived yet! But don’t worry, there is a plan!

[@fawadulislam8997]

Hello Sir i am an Vestibular Rehab Specialist sir if a patient have unidirectional Nystagmus like left in the above vedio so which semi circular canal is involved and secondly same side Vestibular means left side Is Affected??

[@andrewjones1143]

I'm a nurse and sometimes I wish I had your voice. I'm unintentionally loud and I feel bad sometimes. Not always great for bedside manner 🤣

[@DrJamesGill]

To be fair, I know what you mean - I think my voices changes during the examination as my brain is doing a lot of work here. During a history, I tend to project more, and people have mentioned they can hear me outside of patients cubicles 😳

[@smeghead5021]

Jareth popping up properly made me laugh 😂👏🏻

[@DrJamesGill]

I’m really pleased that several people have got the joke 😊

[@Jiorgiapeach]

When I have vertigo flare up, if someone sat me upright and spun me in a chair, I would project vomit like poltergeist. Never had a doctor put me through this. This would be torture for someone in that condition. Not sure where you learned this doctor.

[@DrJamesGill]

Let me be very clear - as highlighted in the video - putting Atharvar in the chair is NOT part of the clinical examination, that was to spin the fluid in his middle ear, and generate the movement of his eye, as an example of what can be seen in a vestibular issue There would be no indication for this in clinic practice

[@ginakwiek722]

Hello Dr. I wanted to ask u if u can do video regarding lymph nodes. I have a lymph node in right side of my throat close to my thyroid. It started all off after I had covid last year in July 2021. Since then my lump is still there and trouble swallowing. I been for ultrasound in hospital they said is nothing to worry about and should clear off within couple weeks but it's been months now and nothing improved. What could it be? Does it need to be removed or is there anything that can be done about it?

[@shaina899]

2:50, I wasn't ready.

[@DrJamesGill]

It’s only a flash 😊

[@shaina899]

@@DrJamesGill Shoot, I thought it was only forever, which incidentally is not long at all.

[@krystalm_]

your voice is so soothing lol

[@christophermusso]

2:45 Why CN VII and not CN VIII?

[@DrJamesGill]

Rats - you have caught a error there. It should be CNVIII - vestibulocochlear nerve - to ensure there is no doubt

[@syedmckenna7475]

Sir I suffered vertigo last one month ago. some days is normal but someday suddenly dizziness spinning and vomiting.pls guide

[@DrJamesGill]

You’ll need to speak to your GP

[@Anekiii]

Jimbo, I want you to be my GP ♥️

[@amberheyhi3153]

I have vertigo and it's sucks so bad. Some days it's takes forever to stop others I have to sleep or I'll get sick all day

[@DrJamesGill]

I’m sorry to hear this. Has it been investigated?

[@amberheyhi3153]

@@DrJamesGill yes my doctor gave me medicine for it to see if it helps.. so far only a little

[@MinnieHughes8]

I've had vertigo since 2015

[@DrJamesGill]

Oh dear, what treatment have you had?

[@MinnieHughes8]

@@DrJamesGill I'm currently on Serc(betahistine) tablet. It's has helped a lot still dizzy a little but mostly better except some flare ups Have tried Stematil and head exercises but no help. I also have small hearing loss and tinnitus

[@codycaraballo9421]

I miss the days when these videos were more examination and less discussion

[@I_love_BTS_2025]

Hello Dr.Gills, I get motion sickness like symptoms sometimes even when I am not travelling, at first there was ringing in my right ear too and then dizziness and pain in back of head with nausea. What could be the cause and is there any solution to my condition?

[@DrJamesGill]

Ideally you’d be best placed to talk with your Gp and get examined

[@supermewkitty7025]

I like your plant

[@seyara1]

You're poor student/patient looks like he's afraid he is about to receive some bad news

[@DrJamesGill]

I think he was just bored 🤣

[@dirklbj]

Dr sorry for that bur your glasses are crooked, left side higher than right side. Greetings from an optician and optometrist ☻

[@DrJamesGill]

Thank you for that, I’m due to see the optician, and get a check up & new glasses this week 😊

[@Sonderax]

unintentional ASMR

[@Rehlingen007]

Hahah the labyrinth reference 😂

[@DrJamesGill]

I managed to get monty python into lectures this week!

[@scottstalcup6980]

I suffered from Vertigo. Then I changed the radio station. (Flicks Vs) Take that, Bono!

[@DrJamesGill]

🤣

[@norbertmoonfluff1433]

Vertigo and panic attacks.

[@Buddha23Fett]

I’m blind and get extreme vertigo.

[@DrJamesGill]

Oh dear. I’m so sorry to hear that. When you do get an attach, how to you terminate it?

[@AlejandroDorels]

I thought it was Han Solo 😅😅

[@Thebustermann]

You remind me of the babe, what babe, babe with the power, what power, power of voodoo, who do, you do, remind me of the babe ...

[@DrJamesGill]

👍

[@ryanlongmire4899]

Why do I wish I was this young man!?! lol l

[@ethanglenn7299]

2:50 what in the-

[@JodieX-k6t]

Vestibular neuritis is not inflammation of cranial nerve 7! It is cranial nerve 8! Get your facts right!

[@colingarner6175]

Lost patience , just wanted the facts with no drivelling.

[@DrJamesGill]

Which particular bits do you mean. If you need a jump to HOW to do the exam, that is at 11mins

[@tpl2401]

Then I would suggest Google.

[@liomaru]

American doctors do none of the myriad of tests you have shown us on your channel. They look at you, as a few questions, tell you you're lying and then charge you 500 bucks.

[@DrJamesGill]

I’d hope that there is more going on, it may just be that they are using additional information sources From my point of view, I take a lot of pride with our students, knowing they are able to work clinically without having to rely on imaging etc - it’s vitally important yes, but good clinical skills will always improve patient care

[@BeeABaw]

Missing Abby already. ☹️

[@toiletsinjapan9933]

Nystagmus predicted this, you know

[@DrJamesGill]

Har har

[@robeach11]

Pretty sure the patient is freshly shaven John Oates.

[@BarraHeist]

You remind me of the babe..

[@DrJamesGill]

👍

[@michaelshanley9341]

Sounds like ttpical alcoholism.

[@michaelfisher1537]

Why are you whispering?