Search

Objectives/Hypothesis Subjective visual vertical (SVV) is a vestibular test commonly used in adults that has not been well studied in children. In this test, the patient aligns a projected line with the perceived true vertical. Deviation of >2° is usually associated with utricular dysfunction and may also be seen with central vestibular lesions. The goal of this study was to determine the efficacy of SVV in children. Study Design Prospective, controlled study. Methods Thirty-three children aged 7 to 18 years with (n = 21) and without (n = 12) dizziness underwent static SVV. History, exam, rotary chair, and caloric testing were used to categorize subjects with dizziness into groups with peripheral vestibular loss (PVL), benign paroxysmal positioning vertigo (BPPV), central vertigo (CV), and nonvestibular dizziness (NVD). Results Mean SVV deviation was significantly higher in the peripheral vestibular loss group (n = 4; 2.1 ± 1.5) compared to BPPV (n = 5; 0.5 ± 0.3), CV (n = 7; 0.4 ± 0.3), NVD (n = 5; 0.6 ± 0.4), and control (n = 12; 0.7 ± 0.5) groups by one-way analysis of variance (P = .002). SVV deviation >2° demonstrated a sensitivity of 100%, specificity of 75%, positive predictive value of 100%, and negative predictive value of 97% for PVL. Conclusions SVV is a simple, noninvasive test that provides a valuable contribution to the assessment of peripheral vestibular function in children. Level of Evidence 3b Laryngoscope, 126:727–731, 2016

Objectives/Hypothesis We examined whether scores on a motion sensitivity questionnaire (MSQ) could distinguish between vestibular migraine (VM) and Meniere's disease (MD). As a secondary goal, we examined whether scores on the MSQ correlated with results from caloric testing. Study Design This study administered a telephone questionnaire to subjects who met clinical criteria for vestibular migraine, Meniere's disease, and controls. Methods A MSQ was administered to 20 subjects meeting American Academy of Otolaryngology (AAO) criteria for MD, 30 subjects meeting Neuhauser criteria for both probable vestibular migraine (pVM) and definite vestibular migraine (dVM), and 22 controls. Results The average score on the MSQ was 5.9 for VM, 4.25 for MD, and 0.4 for controls. Both the VM and MD scored significantly higher than the controls (P = 0.0001), but results were not statistically different from each other (P = 0.17). However, the average score for subjects with dVM was 7.1, which was significantly higher than subjects with pVM whose average score was 4.2 (P = 0.045) and higher than subjects with MD (P = 0.048). When each question of the MSQ was analyzed, motion sensitivity to riding in a car was found to be significantly different between VM (average score 1.1) and MD (average score 0.5), with P value of 0.048. Scores of MSQ did not correlate with the total eye speed (TES) on caloric testing. Conclusions Subjects with VM and MD had elevated levels of motion sensitivity compared to controls. Subjects with VM had more motion sensitivity to riding in a car than those with MD, but their TES was not different. Level of Evidence 3b. Laryngoscope, 124:969–973, 2014

Objectives: To assess the incremental diagnostic yield of testing vestibulo-ocular (VOR) gain with highfrequency pseudo-random rotational chair (PsRRC) over testing with bithermal electronystagmography caloric tests in the dizzy patient, particularly in detecting bilateral vestibular loss. Patients and Methods: One hundred ninety-eight patients presenting with dizziness underwent PsRRC and caloric testing. The VOR gain on PsRRC was measured at 0.32 to 5.0 Hz, with gain categorized as normal or decreased. PsRRC results were compared with caloric responses, also categorized as normal, or into graded categories of unilateral or bilateral vestibular loss. Results: Reduced PsRRC gain was found in 29 (15%) patients, and reduced caloric tests responses in 70 (35%), with 25 (13%) having bilateral loss. Of patients with reduced chair gain, 25 of 29 (86%) demonstrated bilateral caloric loss. PsRRC gain was normal in most patients with unilateral caloric weakness, but was decreased in all patients with bilateral caloric weakness. The probability of a patient with completely normal caloric responses having an abnormal rotation chair in this study group was under 1% (1 of 128). Conclusions: PsRRC testing does not offer much additional diagnostic benefit when caloric responses are normal. It is useful in specific conditions, such as unilateral caloric loss for which the patient is not compensating, borderline caloric loss when traditional water caloric tests cannot be used, or for monitoring progressive bilateral vestibular loss. Key Words: Pseudorandom rotation chair test, bilateral vestibular loss, high-frequency vestibular testing, dizziness, caloric testing, electronystagmography. Laryngoscope, 111:959‐963, 2001

The oculocephalic response (OCR) is a simple office maneuver that assesses the vestibulo-ocular reflex (VOR). An abnormal response is manifested clinically as refixation saccades following a rapid horizontal head movement. Because little attention has been given to the OCR in the literature, a prospective study was undertaken with 112 consecutive patients who presented with dizziness and underwent OCR testing followed by caloric evaluation. Agreement was good between the OCR and caloric evaluation (kappa = 0.44). Specificity was quite high (97%); sensitivity was found to be less (39%). Positive (68%) and negative (90%) predictive values of the OCR illustrate that the clinician can often anticipate the results of caloric testing based on this response. This easily performed test of the VOR is a useful tool in the evaluation of the dizzy patient.

The monothermal differential caloric test allows determination of vestibular recruitment and decruitment, variables which may help discriminate peripheral from central vestibular lesions. Previous reports indicated a strong association between vestibular recruitment and Menière's disease. This study examined patients having unilateral Menière's disease. Nystagmus beat frequency (NBF) and slow-component velocity (SCV) responses were recorded by electronystagmography (ENG). Electronystagmographic findings showing unilateral dysfunction were present in 54% of patients by slow-component velocity and in 31% by nystagmus beat frequency. Unilateral hypofunction was the most frequent lateralizing ENG finding. Absolute vestibular recruitment occurred in less than 10% of patients but relative recruitment was found in nearly 20% of patients. Slow-component velocity had higher sensitivity than nystagmus beat frequency, with excellent clinical concordance. Monothermal caloric testing as described in this study best detects peripheral vestibular disease in Meniere's patients using slow-component velocity to determine unilateral hypofunction and relative vestibular recruitment.

The usefulness of rotatory testing (impulsive and sinusoidal) as an indicator of impaired horizontal semicircular canal function was evaluated in 63 patients with unilateral and bilateral decreased caloric responses. The rotatory stimuli were precisely controlled over a large magnitude range and EOG recorded nystagmus responses were quantified using digital analysis techniques. Rotatory testing was consistently abnormal in patients with complete unilateral caloric paralyses but was normal in over one-half of the patients with significant but less than complete unilateral caloric paralyses. The difference in maximum slow component velocity (SVMX) of induced nystagmus after the largest rotatory stimuli was the best indicator of unilateral impaired function. The patients with bilateral decreased caloric responses demonstrated three categories of rotatory response: 1. normal at all magnitudes of stimulation, 2. decreased but present after large magnitude stimuli, and 3. absent responses. It is concluded that although rotatory testing cannot replace caloric testing it can provide useful clinical information particularly in patients suspected of having bilateral vestibular disease.

Forty-three patients with a surgically confirmed unilateral acoustic neuroma were studied preoperatively with both alternate and simultaneous binaural bithermal caloric tests using horizontal lead electronystagmography. Twenty-four patients had a significant reduced vestibular response on the side of the tumor utilizing the alternate binaural bithermal calorization of Fitzgerald-Hallpike. The addition of the simultaneous binaural bithermal stimulus improved the diagnostic accuracy of caloric testing from 56% to 86%. The simultaneous test was of particular accuracy in diagnosing the inferior vestibular nerve neuroma. The simultaneous stimulus, which adds only six and one-half minutes to overall testing time, is felt to be a valuable adjunct to the alternate test of Fitzgerald-Hallpike.

On certain occasions it becomes important to evaluate vestibular function in a patient with otitis media. The potential application of the air caloric test in evaluating such patients was examined. Patients with unilateral otitis media before and after surgery were studied to answer certain clinical questions. More questions were raised than answers provided. The preliminary conclusions from this study are: 1. Patients with tympanostomy tubes or small perforation of one ear may show a caloric response in the perforated ear equal to that of the intact ear. 2. Patients with a large tympanic membrane perforation on one side may show hyperactive caloric responses on the perforated side. 3. Patients with a moist ear may show inverted horizontal nystagmus to warm air caloric testing. This applies to patients with a large perforation or mastoidectomy cavity. 4. Patients with a dry open mastoid or fenestration cavity are likely to show a hyperactive caloric response on the side of previous surgery, accompanied by vegetative symptoms. This size of the cavity appears to be less important than the presence of the cavity per se. 5. Patients may be safely tested in the early postoperative period.