Meyer zum Gottesberge's head-shaking test for the evaluation of jumbling

Jumbling consists of loss of vestibular eye movement reflexes and resultant oscillopsia during movement of the head. This results in a failure of clear vision during head movement. The head-shaking test for evaluation of the jumbling phenomenon was initially suggested by Meyer zum Gottesberge in 1952. In this test, binocular visual acuity is measured while the patient shakes his head at a rate of 2 or 3 movements per second, 10 to 20 degrees horizontally or vertically, and compared head still position. In normal subjects, only a slight decrease in visual acuity is noted due to this head-shaking. A diagnosis of jumbling is made when the visual acuity during head-shaking is less than half the visual acuity when the head is held motionless. When the visual acuity during head movement is expressed as a percentage of the value obtained while the head is motionless, a quantitative evaluation of jumbling is possible. This test should be done at regular intervals especially on patients who receive parenteral administration of ototoxic aminoglycosides for an early detection of jumbling and an appropriate discontinuation of the drugs, along with repeated auditory testing. The test is also useful in monitoring recovery from jumbling.