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Abstract Background The caloric test is persistently altered in chronic peripheral vestibular hypofunction (PVH). So, we cannot depend on it to measure the degree of compensation in chronic vestibulopathy patients who are still complaining. So our aim was to assess the utility of vHIT to discover the unrevealed pathology in those patients. Our study included 20 subjects with unilateral chronic PVH who were still complaining (study group) and 20 healthy volunteers (control group). Videonystagmography (VNG) and video head impulse test (vHIT) were applied to all the subjects. Results VNG and caloric test results showed compensation signs in the study group. The caloric test indicated unilateral weakness in the affected side. According to vHIT results, a comparison between the affected lateral canal, contralateral healthy lateral canal among the study group, Rt. lateral canal, and Lt. lateral canal among the control group revealed no significant difference (P = 0.789), while comparing anterior and posterior canals showed significant differences (P = 0.005, 0.025) respectively. Conclusion The caloric test assesses only the horizontal semicircular canal and it is persistently altered in unilateral chronic PVH. So, we cannot depend on it to measure the degree of compensation in chronic vestibulopathy patients who are still complaining nor to detect unrevealed pathology regarding ant or post semi-circular canal. So we can use the vHIT test to discover the unrevealed pathology in those patients.

Vestibular migraine (VM) and Meniére's disease (MD) are characterized by episodes of vertigo of similar duration. It is well known that differentiation between both diseases is not always possible based only on the patient history, physical examination, and audiological testing. In addition, the quantification of the vestibular function can also be helpful since, among patients with MD, there is often a dissociation between a normal/pseudo-normal video head impulse test (vHIT) and reduced caloric testing. The goal of this confirmatory study was to determine the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of this dissociation to differentiate between MD and VM as well as between MD and other vestibular diseases. We performed a retrospective analysis of 2,101 patients. The examination group consisted of 1,100 patients; of these, 627 (57%) had MD according to the diagnostic criteria of the Bárány Society and 473 (43%) had VM. The comparison group consisted of 1,001 patients with other peripheral, central, or functional vestibular disorders. Statistical analysis revealed the following findings for the dissociation: MD vs. VM: specificity: 83.5%, sensitivity: 58.9%, PPV: 82.6%, and NPV: 60.5%, and MD vs. all other vestibular disorders (VM plus others): specificity: 83.5%, sensitivity: 58.9%, PPV: 60.3%, and NPV: 82.7%. The dissociation between a normal vHIT and a reduced caloric response is due to the high specificity and PPV suited for the differentiation between MD and VM. This part of the study confirms previous findings in a large cohort of patients. When it comes to differentiating between MD and all observed vestibular disorders, if there is no dissociation, the diagnosis of MD is unlikely. [ABSTRACT FROM AUTHOR]

Background and Aim: Several laboratory tools are used to evaluate balance disorders but, there is still no screening test to determine the site and the severity of the lesion. The aim was to investigate whether video Head Impulse Test (vHIT) can be used as a screening test in patients with chronic or recurrent vertigo and dizziness. Methods: The files of 965 patients who were followed up in our vertigo outpatient clinic were reviewed retrospectively. Vestibulo-Ocular Reflex (VOR) gains and saccadic movements of the right and left lateral canals in the vHIT test, and Canal Paresis (CP) in the Caloric Testing (CT) were noted. Results: A total of 325 patients were included in our study. In CT results, the group that CP was most frequently detected was Menière's Disease (MD) group (71 patients (74.7%). While vHIT results were found to be pathological in the vast majority of patients in the Vestibular Neuritis (VN) group (72.7%), the results were found to be normal at the highest rate in the vestibular migraine group (77.9%). Correlation analysis showed a significant but weak correlation between the degree of CP in the CT and the VOR gains of the lateral canals in vHIT in all groups. Conclusion: Although it has high sensitivity in cases with VN and vestibulopathy, we think that vHIT cannot be used as a screening tool in patients with vertigo, especially for chronic cases, since its sensitivity rate differs in the long term according to the cause of the disease. [ABSTRACT FROM AUTHOR]

Vestibular migraine (VM) and Menière’s disease (MD) are characterized by episodes of vertigo of similar duration. It is well known that differentiation between both diseases is not always possible based only on the patient history, physical examination, and audiological testing. In addition, the quantification of the vestibular function can also be helpful since, among patients with MD, there is often a dissociation between a normal/pseudo-normal video head impulse test (vHIT) and reduced caloric testing. The goal of this confirmatory study was to determine the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of this dissociation to differentiate between MD and VM as well as between MD and other vestibular diseases. We performed a retrospective analysis of 2,101 patients. The examination group consisted of 1,100 patients; of these, 627 (57%) had MD according to the diagnostic criteria of the Bárány Society and 473 (43%) had VM. The comparison group consisted of 1,001 patients with other peripheral, central, or functional vestibular disorders. Statistical analysis revealed the following findings for the dissociation: MD vs. VM: specificity: 83.5%, sensitivity: 58.9%, PPV: 82.6%, and NPV: 60.5%, and MD vs. all other vestibular disorders (VM plus others): specificity: 83.5%, sensitivity: 58.9%, PPV: 60.3%, and NPV: 82.7%. The dissociation between a normal vHIT and a reduced caloric response is due to the high specificity and PPV suited for the differentiation between MD and VM. This part of the study confirms previous findings in a large cohort of patients. When it comes to differentiating between MD and all observed vestibular disorders, if there is no dissociation, the diagnosis of MD is unlikely.

Lateral semicircular canal (LSCC) malformations represent one of the most common types of inner ear malformation. As many cases of LSCC malformations are asymptomatic, detailed vestibular functions in such cases remain unclear. We present a case with bilateral LSCC malformations for whom the function of each vestibular organ was evaluated by caloric testing, video Head Impulse Test (vHIT) and vestibular evoked myogenic potentials (VEMP). Caloric testing showed canal paresis of the left side, whereas vHIT showed bilateral normal semicircular canal function. The results of VEMP indicated left saccular dysfunction. Discrepancies in caloric testing and vHIT results were observed and these discrepancies are thought to be due to endolymphatic hydrops rather than vestibular hypofunction, similar to that in Meniere disease. [ABSTRACT FROM AUTHOR]

Objectives: To perform vestibular assessment using cervical and ocular vestibular evoked myogenic potential, video head impulse test and caloric testing in patients with sudden hearing loss. Moreover, to evaluate the correlation of dizziness with vestibular tests and the correlation of vestibular tests with hearing prognosis. Methods: This is an observational, longitudinal and prospective study, including participants diagnosed with sudden hearing loss. The participants underwent cervical and ocular vestibular evoked myogenic potential, video head impulse test and caloric testing. The audiometric assessment was performed at the beginning and at the end of the follow-up. A value of p ≤ 0.05 was considered statistically significant. Results: Seventeen patients were included in the study sample, with a mean age of 45.4 ± 11.1 years. Five participants (29.41%) had dizziness and 15 (88.23%) had tinnitus. All participants underwent vestibular evaluation through cervical and ocular vestibular evoked myogenic potential and video head impulse test, and 13 of them were evaluated through caloric testing. The cervical vestibular evoked myogenic potential was considered altered in five (29.41%) participants, while 11 (64.71%) showed alterations at the ocular vestibular evoked myogenic potential. The video head impulse test and the caloric testing were considered altered in seven (41.18%) and five (38.46%) participants, respectively. There was no statistically significant correlation between the clinical data and the results of vestibular tests or hearing recovery, nor between the results of vestibular tests and hearing recovery. Conclusion: The assessment through vestibular evoked myogenic potential, video head impulse test and caloric testing showed vestibular involvement in some participants. However, it cannot be stated that the results of the vestibular tests are related to the hearing prognosis of sudden hearing loss.

Objective: Cold and warm water ear irrigation, also known as bithermal caloric testing, has been considered for over 100 years the 'Gold Standard' for the detection of peripheral vestibular hypofunction. Its discovery was awarded a Nobel Prize. We aimed to investigate the diagnostic accuracy of Caloric Testing when compared to the video head impulse test (vHIT) in differentiating between vestibular neuritis and vestibular strokes in acute dizziness. Design: Prospective cross-sectional study (convenience sample). Setting: All patients presenting with signs of an acute vestibular syndrome at the emergency department of a tertiary referral center. Participants: One thousand, six hundred seventy-seven patients were screened between February 2015 and May 2020 for Acute Vestibular Syndrome (AVS), of which 152 met the inclusion criteria and were enrolled. Inclusion criteria consisted of a state of continuous dizziness, associated with nausea or vomiting, head-motion intolerance, new gait or balance disturbance and nystagmus. Patients were excluded if they were younger than 18 years, if symptoms lasted < 24 h or if the index ED visit was > 72 h after symptom onset. Of the 152 included patients 85 completed testing. We assessed 58 vestibular neuritis and 27 stroke patients. Main outcome measures: All patients underwent calorics and vHIT followed by a delayed MRI which served as a gold standard for vestibular stroke confirmation. Results: The overall sensitivity and specificity for detecting stroke with a caloric asymmetry cut-off of 30.9% was 75% and 86.8%, respectively [negative likelihood ratio (NLR) 0.29] compared to 91.7% and 88.7% for vHIT (NLR 0.094). Best VOR gain cut-off was 0.685. Twenty-five percent of vestibular strokes were misclassified by calorics, 8% by vHIT. Conclusions: Caloric testing proved to be less accurate than vHIT in discriminating stroke from vestibular neuritis in acute dizziness. Contrary to classic teaching, asymmetric caloric responses can also occur with vestibular strokes and might put the patient at risk for misdiagnosis. We, therefore, recommend to abandon caloric testing in current practice and to replace it with vHIT in the acute setting. Caloric testing has still its place as a diagnostic tool in an outpatient setting. [ABSTRACT FROM AUTHOR]

Abstract Objectives The purpose of this study was to assess the effects of cochlear implantation on the functional integrity of the horizontal semicircular canal using multiple methodologies, and to discuss and highlight the limitations of using isolated vestibular tests to assess vestibular function in surgical ears. Methods Ten cochlear implant patients were consented to undergo a preoperative and 3‐month postoperative vestibular assessment. The horizontal semicircular canal (SCC) was assessed using three different vestibular test measures that assess function using different stimuli and at different frequencies ranges: caloric testing, sinusoidal harmonic acceleration testing in the rotary chair, and video head impulse testing in the plane of the horizontal SCC. Data was analyzed using different methods: descriptive, statistical, and by an examination of individual case studies. Results Each analysis method yielded a different interpretation. Statistical analysis showed no significant group mean differences between baseline pre‐op vestibular test results and 3‐month post‐op vestibular test results. Descriptive analysis showed 30% of individuals presented with postoperative abnormal vestibular testing findings. A case study examination showed that only one patient presented with a post‐op decrease in vestibular function in the implanted ear. Conclusions There are several limitations of conventional vestibular testing in postsurgical cochlear implant patients. A test‐battery approach, including case history, and test interpretation made on a case‐by‐case basis is needed to determine whether the patient has undergone vestibular damage, is at risk for falling, or in need of further management. Level of Evidence 2b individual cohort study.

Objective: To investigate the relative sensitivity and agreement of caloric testing and video head impulse test (vHIT) across four groups of vestibular disorders., Methods: Caloric and vHIT results of 118 patients with either Ménière's disease, vestibular neuritis/labyrinthitis, vestibular migraine, or vestibular schwannoma were retrospectively analyzed. vHIT gain, gain asymmetry, and catch-up-saccades (≥100°/sec) were compared with reference limits of 91 controls., Results: Abnormal caloric results and vHIT gain were recorded in 57.6 % and 33.1 % of patients, respectively. Consideration of all three measures increased vHIT sensitivity to 43.2 %, and concordance with caloric results improved from 66.1 % to 70.3 %. A significant interaction effect confirmed the relationship between tests depended on the diagnosis (p = 0.013). Vestibular migraine and vestibular neuritis/labyrinthitis produced similar results on both tests, usually normal and abnormal respectively. Vestibular schwannoma produced more caloric abnormalities than vHIT gain but not compared with catch-up-saccades and gain asymmetry; Ménière's disease produced more caloric abnormalities than all vHIT measures. When vHIT was normal (all measures), a 37 % canal paresis was 90 % specific for Ménière's disease., Conclusions: Rates of vHIT catch-up-saccades and gain asymmetry can improve sensitivity and concordance with caloric testing, but this is disease-dependent., Significance: vHIT outcome measures are complementary to the caloric test and each other., (© 2024 International Federation of Clinical Neurophysiology. Published by Elsevier B.V.)

Objective: To evaluate caloric response changes after endolymphatic sac decompression (ESD), together with hearing outcomes and the functional benefit of the operation., Methods: A retrospective chart review of subjects who underwent endolymphatic sac decompression at a tertiary referral centre was performed. Data on audiological results, caloric testing, and functional level scale of the patients were analysed., Results: Twenty-eight patients who met our criteria were eligible for enrolment in the study. The average follow-up after surgery was 25 months (range, 13-41). Postoperative pure-tone threshold averages and reduced vestibular response values (RVR) were not significantly altered by ESD; whereas, functional level scores improved significantly., Conclusion: Endolymphatic sac decompression is a surgical procedure that preserves hearing and vestibular function, and improves the daily functional level of patients with Ménière's disease. ESD can be preferred both in bilateral and unilateral disease because it does not alter vestibular function and preserves hearing., Competing Interests: Declaration of competing interest There is no conflict of interest among the author., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The development of less traumatic surgical techniques, such as the round window approach (RWA), as well as the use of flexible electrodes and post-operative steroid administration have enabled the preservation of residual hearing after cochlear implantation (CI) surgery. However, consideration must still be given to the complications that can accompany CI. One such potential complication is the impairment of vestibular function with resulting vertigo symptoms. The aim of our current study was to examine the changes in vestibular function after implantation in patients who received CI using less traumatic surgery, particularly the RWA technique.Methods: Sixty-six patients who received CI in our center were examined by caloric testing, cervical vestibular evoked myogenic potential (cVEMP) and ocular VEMP (oVEMP) before or after implantation, or both, to obtain data on semicircular canal, saccular and utricular function, respectively. Less traumatic CI surgery was performed by the use of the RWA and insertion of flexible electrodes such as MED-EL FLEX soft, FLEX 28, and FLEX 24 (Innsbruck, Austria).Results: Caloric response and the asymmetry ratio of cVEMP and oVEMP were examined before and after implantation using less traumatic surgical techniques. Compared with before implantation, 93.9, 82.4, and 92.5% of the patients showed preserved vestibular function after implantation based on caloric testing, cVEMP and oVEMP results, respectively. We also examined the results for vestibular function by a comparison of the 66 patients using the RWA and flexible electrodes, and 17 patients who underwent cochleostomy and insertion of conventional or hard electrodes. We measured responses using caloric testing, cVEMP and oVEMP in patients after CI. There were no differences in the frequencies of abnormal caloric and oVEMP results in the implanted ears between the RWA and cochleostomy. On the other hand, the frequency of abnormal cVEMP responses in the implanted ears in the patients who received implantation by cochleostomy was significantly higher than that in the patients undergoing surgery using the RWA.Conclusion: Patients receiving CI using less traumatic surgical techniques such as RWA and flexible electrodes have reduced risk of damage to vestibular function.

Background: The development of less traumatic surgical techniques, such as the round window approach (RWA), as well as the use of flexible electrodes and post-operative steroid administration have enabled the preservation of residual hearing after cochlear implantation (CI) surgery. However, consideration must still be given to the complications that can accompany CI. One such potential complication is the impairment of vestibular function with resulting vertigo symptoms. The aim of our current study was to examine the changes in vestibular function after implantation in patients who received CI using less traumatic surgery, particularly the RWA technique. Methods: Sixty-six patients who received CI in our center were examined by caloric testing, cervical vestibular evoked myogenic potential (cVEMP) and ocular VEMP (oVEMP) before or after implantation, or both, to obtain data on semicircular canal, saccular and utricular function, respectively. Less traumatic CI surgery was performed by the use of the RWA and insertion of flexible electrodes such as MED-EL FLEX soft, FLEX 28, and FLEX 24 (Innsbruck, Austria). Results: Caloric response and the asymmetry ratio of cVEMP and oVEMP were examined before and after implantation using less traumatic surgical techniques. Compared with before implantation, 93.9, 82.4, and 92.5% of the patients showed preserved vestibular function after implantation based on caloric testing, cVEMP and oVEMP results, respectively. We also examined the results for vestibular function by a comparison of the 66 patients using the RWA and flexible electrodes, and 17 patients who underwent cochleostomy and insertion of conventional or hard electrodes. We measured responses using caloric testing, cVEMP and oVEMP in patients after CI. There were no differences in the frequencies of abnormal caloric and oVEMP results in the implanted ears between the RWA and cochleostomy. On the other hand, the frequency of abnormal cVEMP responses in the implanted ears in the patients who received implantation by cochleostomy was significantly higher than that in the patients undergoing surgery using the RWA. Conclusion: Patients receiving CI using less traumatic surgical techniques such as RWA and flexible electrodes have reduced risk of damage to vestibular function. [ABSTRACT FROM AUTHOR]

A retrospective analysis of the horizontal video head impulse test (vHIT) results and caloric testing results was undertaken on 644 patients who attended a neuro-otology outpatient facility. Presenting symptoms included spontaneous vertigo, positional vertigo, imbalance or chronic subjective dizziness. For 570 patients, the results of vHIT and caloric testing were concordant. Both tests were normal in 500 subjects with an average vHIT gain = 0.92 ± 0.09 (L); 0.98 ± 0.10 (R) and canal paresis (CP) = 7.88 ± 6.12; (range 0–28%). 54 had concordant asymmetries, average ipsilesional vHIT gain = 0.56 ± 0.15, average contralesional vHIT gain = 0.88 ± 0.12. CP = 68.02 ± 24.38 (range 31–100%). 16 subjects had bilateral vestibular hypofunction with average vHIT gains of 0.42 ± 0.20 (L); 0.41 ± 0.19 (R), peak slow phase velocity (SPV) on warm caloric testing = 2.68 ± 2.08, range 0–6°/s (L) and 3.75 ± 3.43 range, 0–10°/s (R). 36 patients showed a dissociation of results between the two tests. In these subjects, the vHIT gain was normal (0.93 ± 0.06 left and 0.98 ± 0.07 right) and the caloric test showed a CP > 30% (48 ± 13.8%). Their final diagnoses included clinically definite Meniere's disease (MD) (n = 27), vestibular schwannoma (VS) (n = 2) vestibular migraine (VM) (n = 1), vestibular neuritis (VN) (n = 5) and unknown (n = 1). No patient with abnormal HSCC gain on vHIT had a normal caloric result. The caloric test complements the vHIT in the assessment of vestibular disorders and is most useful in suspected endolymphatic hydrops. Asymmetric caloric function in the presence of normal horizontal head impulse tests is most commonly associated with Meniere's disease and may function as a diagnostic marker. [ABSTRACT FROM AUTHOR]

Unilateral or bilateral vestibular hypofunction presents most commonly with symptoms of dizziness or postural imbalance and affects a large population. However, it is often missed because no quantitative testing of vestibular function is performed, or misdiagnosed due to a lack of standardization of vestibular testing. Therefore, this article reviews the current status of the most frequently used vestibular tests for canal and otolith function. This information can also be used to reach a consensus about the systematic diagnosis of vestibular hypofunction. [ABSTRACT FROM AUTHOR]

Objectives This study aims to evaluate semicircular canal function using video head impulse test (vHIT) in patients with peripheral vestibular disorders without nystagmus. Methods Patients who underwent vHIT were enrolled in this study, and the proportion of abnormal findings on vHIT in patients without nystagmus was investigated. In addition, the results of vestibular testing were investigated in cases in which both vHIT and caloric testing were performed in patients without nystagmus. Results Forty-six patients (23.4%) of 197 patients who had no abnormal findings on the nystagmus tests, including the gaze nystagmus test, positional nystagmus test, and positioning nystagmus test, showed dysfunction in at least one semicircular canal on vHIT. The most frequent diagnosis was vestibular schwannoma (14/46, 30.4%), and cases with bilateral vestibular dysfunction were also included (12/46, 26.1%). A disorganized pattern of catch-up saccade was observed more frequently in patients with subjective symptoms of dizziness/vertigo compared to those without subjective symptoms. Although the sensitivity of vHIT was low compared to caloric testing, vHIT could detect isolated vertical canal dysfunction not detected by caloric testing. Conclusions vHIT is considered to be a useful test for patients without nystagmus, as vHIT could detect abnormalities in approximately one-quarter of patients without nystagmus. vHIT is considered to be one of the first tests to be performed following nystagmus testing, including the gaze nystagmus test, the positional nystagmus test, and the positioning nystagmus test. On the other hand, there are some cases in which vHIT shows no abnormality while caloric testing shows canal paresis. It is necessary to perform vHIT, bearing in mind that there are abnormalities that cannot be detected by vHIT alone., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board of Hokkaido University Hospital issued approval 023-0163. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Fujiwara et al.)

Objectives: The purpose of this study was to assess the effects of cochlear implantation on the functional integrity of the horizontal semicircular canal using multiple methodologies, and to discuss and highlight the limitations of using isolated vestibular tests to assess vestibular function in surgical ears. Methods: Ten cochlear implant patients were consented to undergo a preoperative and 3‐month postoperative vestibular assessment. The horizontal semicircular canal (SCC) was assessed using three different vestibular test measures that assess function using different stimuli and at different frequencies ranges: caloric testing, sinusoidal harmonic acceleration testing in the rotary chair, and video head impulse testing in the plane of the horizontal SCC. Data was analyzed using different methods: descriptive, statistical, and by an examination of individual case studies. Results: Each analysis method yielded a different interpretation. Statistical analysis showed no significant group mean differences between baseline pre‐op vestibular test results and 3‐month post‐op vestibular test results. Descriptive analysis showed 30% of individuals presented with postoperative abnormal vestibular testing findings. A case study examination showed that only one patient presented with a post‐op decrease in vestibular function in the implanted ear. Conclusions: There are several limitations of conventional vestibular testing in postsurgical cochlear implant patients. A test‐battery approach, including case history, and test interpretation made on a case‐by‐case basis is needed to determine whether the patient has undergone vestibular damage, is at risk for falling, or in need of further management. Level of Evidence: 2b individual cohort study. [ABSTRACT FROM AUTHOR]

Patients with inner ear damage associated with bilateral vestibular impairment often ask “how much damage do I have.” Although there are presently three clinical methods of measuring semicircular canal vestibular function; electronystagmography (ENG or VENG), rotatory chair and video head-impulse (VHIT) testing; none of these methods provides a method of measuring total vestibular output. Theory suggests that the slow cumulative eye position can be derived from the rotatory chair test by multiplying the high frequency gain by the time constant, or the “GainTc product.” In this retrospective study, we compared the GainTc in three groups, 30 normal subjects, 25 patients with surgically induced unilateral vestibular loss, and 24 patients with absent or nearly absent vestibular responses due to gentamicin exposure. We found that the GainTc product correlated better with remaining vestibular function than either the gain or the time constant alone. The fraction of remaining vestibular function was predicted by the equation R = (GainTc/11.3) – 0.6. We suggest that the GainTc product answers the question “how much damage do I have,” and is a better measure than other clinical tests of vestibular function.

BACKGROUND: The video-head impulse test employs the vestibulo-ocular reflex (VOR) to assess vestibular function. To this day, no consensus has been reached among scientists in terms of whether or not vHIT results change in MD patients as the disease progresses. OBJECTIVE: To assess whether the vHIT is more often abnormal in later stages of MD compared to earlier stages. METHODS: We retrospectively analyzed patients with 'definite' MD who had undergone a vHIT and caloric test between 2012 and 2015. Patients were evaluated based on duration of disease in years (≤1, >1≤5, >5≤10, >10) and stage of disease (stage I and II versus III and IV). For the vHIT, an abnormal vestibulo-ocular reflex was defined as a gain cut-off value of≤0.8 and presence of correction saccades including subanalyses using a cut-off value of≤0.9. RESULTS: In 89 definite MD patients (42 (47%) male, mean age 55±5 (SD)), data on both the caloric test and the vHIT were available. The risk of an abnormal vHIT was 25% in patients with a duration of disease over 10 years compared to 22% in the patients with a disease duration of 10 years or less (risk difference 3%, 95% CI:– 28% to 35%), p = 0.82). The risk for an abnormal vHIT in the Stage I and Stage II was 17% compared to 26% in Stage III and IV (risk difference 9%, 95% CI:– 30% to 11%). When using a cut-off value of 0.9 we also did not demonstrate a relationship between the duration of disease and the proportion of abnormal vHIT test results. CONCLUSIONS: There is no relationship between the proportion of abnormal vHIT test results in patients with MD in either duration or stage of disease. [ABSTRACT FROM AUTHOR]

Patients with inner ear damage associated with bilateral vestibular impairment often ask "how much damage do I have." Although there are presently three clinical methods of measuring semicircular canal vestibular function; electronystagmography (ENG or VENG), rotatory chair and video head-impulse (VHIT) testing; none of these methods provides a method of measuring total vestibular output. Theory suggests that the slow cumulative eye position can be derived from the rotatory chair test by multiplying the high frequency gain by the time constant, or the "GainTc product." In this retrospective study, we compared the GainTc in three groups, 30 normal subjects, 25 patients with surgically induced unilateral vestibular loss, and 24 patients with absent or nearly absent vestibular responses due to gentamicin exposure. We found that the GainTc product correlated better with remaining vestibular function than either the gain or the time constant alone. The fraction of remaining vestibular function was predicted by the equation R = (GainTc/11.3) - 0.6. We suggest that the GainTc product answers the question "how much damage do I have," and is a better measure than other clinical tests of vestibular function. [ABSTRACT FROM AUTHOR]

The Dizziness Handicap Inventory (DHI) is believed to quantitate the handicap related to the presence or severity of underlying vestibular dysfunction. However, patients with chronic vestibular diseases may manifest various degrees of behavioural and physiological adaptation resulting in variances of the DHI. Our primary study objective is to evaluate the correlation between the DHI and measurable vestibular parameters. Secondarily, we compared DHI among different vestibular disorders (central, peripheral and functional), and different types of anatomic deficits (semicircular canal vs otolithic). We also correlated the DHI and posturography. We prospectively evaluated 799 patients with precise vestibular diagnoses using video head impulse testing (vHIT), caloric irrigation, and cervical/ocular vestibular-evoked myogenic potentials (c/oVEMP). Posturography was done for 84 patients. All participants completed the DHI. No significant correlation was found between DHI and (1) vestibulo-ocular reflex parameters: unilateral weakness r = − 0.018, total calorics r = 0.055, vHIT right r = 0.007, vHIT left r = − 0.091, vHIT asymmetry r = 0.013; (2) otolith parameters: cVEMP amplitude right r = − 0.034, amplitude left r = − 0.004, asymmetry r = 0.016; oVEMP amplitude right r = 0.044, amplitude left r = − 0.007, asymmetry r = − 0.008. Patients with central vestibular disorders had higher DHI than those with peripheral (z = − 4.743, p = 0.001) or functional disorders (z = − 2.902, p = 0.004). DHI of patients with deficits of canal or otolith function did not differ significantly from those with no deficits (z = 2.153, p = 0.541). There was no significant correlation between DHI and postural sway on posturography. Therefore, the DHI does not correlate with vestibular tests, and neither reflects the presence nor severity of peripheral vestibular deficits. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study is to compare nystagmus characteristics after caloric irrigation in patients with lateral canal (LC) and posterior canal (PC) benign paroxysmal positional vertigo (BPPV) and to analyze the role of symptom duration. MATERIALS and METHODS: A prospective study was conducted in 65 patients with BPPV (20 LC and 45 PC) who were subjected to caloric testing. Average slow-phase velocity and nystagmus duration were analyzed. RESULTS: Caloric hypo-excitability was 20.4%. It was more evident in patients with apogeotropic-type LC-BPPV. The comparison of average slowphase velocity of the nystagmus and nystagmus duration between selected types of BPPV for pathologic, non-pathologic, and the control ears after warm and cold stimulation was not statistically significant (p>0.05). No correlation was found between caloric results and symptom duration (p>0.05). CONCLUSION: Some patients presented caloric hypo-excitability. Reliability of caloric testing to differentiate the ear with normal and abnormal vestibular function in different types of BPPV was low. No difference was found in the analysis of the impact of symptom duration. Caloric testing is not an ideal tool to study BPPV [ABSTRACT FROM AUTHOR]

Objective Ménière's disease affects the vestibular and audiologic systems; however, little is known about the relationship between audiometric and caloric function with increasing duration of disease. We employed a novel methodology to understand the longitudinal correlation between audiometric and caloric function in Ménière's patients. Study Design Case series with chart review. Setting Neuro-otologic tertiary care practice. Subjects and Methods Charts of 19 patients with unilateral Ménière's disease, as classified by the 1995 American Academy of Otolaryngology-Head and Neck Foundation criteria, were examined. We included patients with ≥2 videonystagmograms and audiograms. We excluded those with bilateral Ménière's, prior audiovestibular destruction, or symptoms suggesting concomitant vestibular pathology. Spearman's rank correlation of audiometric status (pure tone average [PTA], low PTA, and word recognition score [WRS]) and vestibular function (bithermal calorics) was performed. The study was Institutional Review Board approved (protocol 2015H0266). Results A total of 112 audiograms and 42 videonystagmographies were performed. There was a decline in affected ear hearing PTA and WRS with duration of disease ( r = 0.602, P < .001, and r = -0.573, P < .001, respectively). Similarly, there was a decline in vestibular function with increasing duration of disease ( r = 0.709, P < .001). There were moderate correlations between vestibular weakness and PTA, low PTA, and WRS ( r = 0.464, P = .002; r = 0.498, P = .001; and r = -0.518, P = .001, respectively). Conclusions There is a correlation between decline in objective hearing and horizontal semicircular canal function with time. As expected, this correlation is not 1:1, indicating differential involvement of both systems. Understanding this relationship may assist in counseling patients with regard to prognosis, natural history, and therapeutic interventions. [ABSTRACT FROM AUTHOR]

Conclusions:Although there was a statistically significant relationship between the results of the vHIT and the caloric test, the limited strength of this relationship suggests that, for unilateral vestibular schwannoma (UVS), caloric testing and vHIT may provide complementary information on vestibular function. Objective:There is limited information that can be used to determine which of the video head impulse test (vHIT) and caloric test might be better used in the diagnosis and management of UVS. In this study, a group of participants with un-operated UVS was studied using both methods. Methods:The subjects’ vestibular function was assessed using the vHIT and caloric testing. Tumour size was quantified using MRI and their balance disturbance assessed using the Jacobsen Dizziness Handicap Inventory (DHI). Results:Twenty of 30 subjects had an abnormal canal paresis according to the Jongkees’ criterion (> 0.25); however, only 10/30 had an ipsilesional vHIT gain of <0.79. Canal paresis could be predicted from the ipsilesional and contralesional vHIT gains. Tumour size could also be predicted from the ipsilesional vHIT gain and canal paresis. However, DHI scores could not be predicted from the degree of canal paresis, vHIT gain, or the MRI measures. [ABSTRACT FROM PUBLISHER]

Caloric testing is considered the 'reference standard' in determining vestibular hypofunction. Recently, the video-head impulse test (vHIT) was introduced. In the current study we aimed to assess the diagnostic value of the vHIT as compared to caloric testing in determining vestibular function. In a cross-sectional study between May 2012 and May 2013, we prospectively analysed patients with dizziness who had completed caloric testing and the vHIT. For the left and right vestibular system we calculated the mean vHIT gain. We used a gain cut-off value of 0.8 for the vHIT and presence of correction saccades to define an abnormal vestibular-ocular reflex. An asymmetrical ocular response of 22 % or more (Jongkees formula) or an irrigation response with a velocity below 15°/s was considered abnormal. We calculated sensitivity, specificity, positive and negative predictive values with 95 % confidence intervals for the dichotomous vHIT. Among 324 patients [195 females (60 %), aged 53 ± 17 years], 39 (12 %) had an abnormal vHIT gain and 113 (35 %) had an abnormal caloric test. Sensitivity was 31 % (23-40 %), specificity 98 % (95-99 %), positive predictive value was 88 % (74-95 %), and negative predictive value 73 % (67-77 %). In case of vHIT normality, additional caloric testing remains indicated and the vHIT does not replace the caloric test. However, the high positive predictive value of the vHIT indicates that an abnormal vHIT is strongly related to an abnormal caloric test result; therefore, additional caloric testing is not necessary. We conclude that the vHIT is clinically useful as the first test in determining vestibular hypofunction in dizzy patients. [ABSTRACT FROM AUTHOR]

The video head impulse test (vHIT) has been proposed as an objective approach to detect peripheral vestibular disorder in a clinical setting. Data from several studies indicate that the vHIT is a useful addition to the vestibular test battery and can give complementary information to caloric testing. This study explores the relationship between lateral canal vestibular occular reflex gain measured using the vHIT system and canal paresis indicated using air calorics in a sample of patients attending a clinic for balance disorder. Sensitivity and specificity of the vHIT test relative to calorics was studied for a clinical sample of 51 patients (20 male, 31 female) who attended a private clinic for balance disorders. vHIT gains were compared to the manufacturer's normative range and to data from a normative study using 30 young volunteers. Of 14 patients in the clinical sample that had significant canal paresis indicated by air calorics, only 4 showed a significant abnormality in either canal using a measurement of vHIT gain. vHIT gain does not correlate with canal paresis as indicated by air caloric testing. vHIT gain appears relatively insensitive to peripheral vestibular disorder as indicated by air caloric testing, although patients that had no caloric response on one side showed abnormal vHIT gain. vHIT testing may be a useful addition to the existing vestibular test battery, but it does not appear to be an alternative to it. [ABSTRACT FROM AUTHOR]

Conclusions: Although combined utricular and canal paresis has been described previously, this is the first report of canal hyperactivity associated with utricular hypofunction. Unsteadiness and swaying were the most common symptoms, and patients with shorter duration of symptoms also had positional vertigo. We propose that this syndrome is a variant of utricular dysfunction and should be considered in the differential diagnosis of peripheral vestibular disorders. Objective: To describe a syndrome of instability associated with utricular dysfunction and hyperactive caloric responses. Methods: The study comprised 11 consecutive patients exhibiting abnormalities of the eccentric subjective visual vertical test (e-SVV) and high responses during the caloric test of the videonystagmography (VNG). We carried out a review of symptoms, physical examination, and vestibular tests. Results: There was no gender predilection or obvious etiology. The patients' main complaint included instability with linear symptoms (i.e., tilting, rocking, and swaying), with positional vertigo as a secondary symptom. Oculomotor testing, visual fixation index, and brain MRI were normal, excluding a central nervous system disorder. VNG was essentially normal except for hyperactive responses during the caloric testing in all patients. Abnormal e-SVV was found in 10 patients unilaterally and bilaterally in 1 patient. Abnormal oVEMP was found in seven of seven patients, further supporting a utricular site of lesion. [ABSTRACT FROM AUTHOR]

Background:This study compared vestibulocollic reflex and vestibulo-ocular reflex functioning in subjects with and without human immunodeficiency virus. It also described test results throughout progression of the disease and compared the results of human immunodeficiency virus positive subjects who were receiving antiretroviral therapies with those not receiving this treatment.Methods:Subjects comprised 53 adults with human immunodeficiency virus (mean age 38.5 ± 4.4 years) and 38 without human immunodeficiency virus (mean age 36.9 ± 8.2 years). Clinical examinations included cervical vestibular-evoked myogenic potential and bithermal caloric testing.Results:Abnormal cervical vestibular-evoked myogenic potential and caloric results were significantly higher in the human immunodeficiency virus positive group (p = 0.001), with an odds ratio of 10.2. Vestibulocollic reflex and vestibulo-ocular reflex involvement increased with progression of the disease. There were more abnormal test results in subjects receiving antiretroviral therapies (66.7 per cent) than in those not receiving antiretroviral therapies (63.6 per cent), but this difference was insignificant.Conclusion:Human immunodeficiency virus seems to influence vestibulocollic reflex pathways. Combining cervical vestibular-evoked myogenic potential and caloric testing may be useful to detect early neurological involvement in human immunodeficiency virus positive subjects. [ABSTRACT FROM PUBLISHER]

To evaluate the performance of the video head impulse test (VHIT) in assessing vestibular deficit in vestibular neuritis. Test validation study was conducted in Tertiary referral center. Twenty-nine patients, referred for vestibular neuritis between October 2009 and March 2012, were included. We recorded age, gender, values of caloric deficit (caloric testing), and deficits in semicircular function (VHIT) at initial presentation and at the follow-up visit (1-3 months). Multivariate linear regression analysis was performed to determine variables associated with values of caloric testing at the follow-up visit. Diagnostic values of VHIT were compared with caloric testing data using the receiver-operating characteristic (ROC) curve and subsequent statistical analysis. At the follow-up visit, complete recovery occurred in 31 % of cases according to caloric evaluation, and VHIT normalized in 51.8 %. Multivariate regression showed that a higher caloric deficit at the follow-up visit was associated with elevated age ( p = 0.012) and high caloric deficit at initial presentation ( p = 0.042). A lower caloric deficit was associated with normal VHIT results at the follow-up visit ( p < 0.001). The ROC curve showed that specificity and sensitivity of VHIT were 100 % when the caloric deficit was respectively lower than 40 % or higher than 62.5 %. At the caloric testing value of 30 %, specificity was 100 %, sensitivity 68.84 %, positive predictive value 100 % and negative predictive value 62.5 %. VHIT is a fast, convenient and specific test to detect vestibular deficits in vestibular neuritis. However, VHIT lacks sensitivity by comparison with caloric testing, especially for moderate vestibular lesions. [ABSTRACT FROM AUTHOR]

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 [ABSTRACT FROM AUTHOR]

Objectives: To perform vestibular assessment using cervical and ocular vestibular evoked myogenic potential, video head impulse test and caloric testing in patients with sudden hearing loss. Moreover, to evaluate the correlation of dizziness with vestibular tests and the correlation of vestibular tests with hearing prognosis., Methods: This is an observational, longitudinal and prospective study, including participants diagnosed with sudden hearing loss. The participants underwent cervical and ocular vestibular evoked myogenic potential, video head impulse test and caloric testing. The audiometric assessment was performed at the beginning and at the end of the follow-up. A value of p≤0.05 was considered statistically significant., Results: Seventeen patients were included in the study sample, with a mean age of 45.4±11.1 years. Five participants (29.41%) had dizziness and 15 (88.23%) had tinnitus. All participants underwent vestibular evaluation through cervical and ocular vestibular evoked myogenic potential and video head impulse test, and 13 of them were evaluated through caloric testing. The cervical vestibular evoked myogenic potential was considered altered in five (29.41%) participants, while 11 (64.71%) showed alterations at the ocular vestibular evoked myogenic potential. The video head impulse test and the caloric testing were considered altered in seven (41.18%) and five (38.46%) participants, respectively. There was no statistically significant correlation between the clinical data and the results of vestibular tests or hearing recovery, nor between the results of vestibular tests and hearing recovery., Conclusion: The assessment through vestibular evoked myogenic potential, video head impulse test and caloric testing showed vestibular involvement in some participants. However, it cannot be stated that the results of the vestibular tests are related to the hearing prognosis of sudden hearing loss., (Copyright © 2022 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)