Relative diagnostic value of ocular vestibular evoked potentials and the subjective visual vertical during tilt and eccentric rotation

Abstract

Straumann, D; Bockisch, C J (2010with the visual vertical during whole-body roll tilt and eccentric rotation in healthy subjects and patients with unilateral vestibular loss, to determine which test was most sensitive in discriminating impaired utricle function. Methods:OVEMPs and the visual vertical were measured in 11 patients and 11 healthy subjects. Visual vertical was measured during roll tilts between -9.6 and 9.6°, and during rotation at 400°/s with the head upright and the vertical rotation axis located between ±3.5 cm from the head center.Results: OVEMPs in patients were strikingly asymmetric, whereas they were approximately symmetric in healthy subjects. Patients showed impaired visual vertical gain during eccentric rotation and increased errors for both roll tilt and eccentric rotation tests. OVEMPs were superior at discriminating between patients and healthy subjects, although eccentric rotation performed nearly as well. Conclusions:OVEMPs provide a powerful test for discriminating between healthy subjects and patients with chronic unilateral vestibular loss, and testing the visual vertical testing during eccentric rotation was superior to testing during whole-body roll tilt.Significance: OVEMPs are easier to administer, less demanding on patients, and in general are more effective at identifying chronic unilateral vestibular loss than visual vertical measurements.

Evaluation of a bedside test of utricular function – the bucket test – in older individuals

“…Age-related changes in vestibular function are a subject of increasing interest given their potential contribution to the risk of falls in older individuals. This study extends prior studies in vestibulopathic patients – patients with unilateral vestibular loss [13] and Ménière’s disease [4]–that also observed significant associations between abnormal SVV and oVEMP results. Moreover, we observed that the bucket test, previously found to be a convenient, low-cost, and accurate assessment of SVV [5], appears to be a valid bedside measure of utricular function as compared to the tap-evoked oVEMP in the elderly population.…”

“…With respect to oVEMP, although a high-frequency tap is not a selective stimulus and results in activation of both saccular and utricular afferents [3], the change in potential of the inferior oblique and inferior rectus muscles measured by oVEMP, and specifically the n1 amplitude [16], are thought to be utricle-specific [9]. With respect to SVV, in a study that used various modes of tilt and eccentric rotation to specifically vary utricular stimulation [13], patients with unilateral vestibular loss were found to have poorer SVV scores as well as greater side-to-side asymmetries in oVEMP n1 amplitude relative to controls. In the current study, SVV scores were consistent with the neurophysiological principles of utricular function [13], such that subjects experienced tilt in their SVV away from the side of greater utricular function.…”

Ocular Vestibular-Evoked Myogenic Potentials in Healthy Pilots and Student Pilots

“…More recently, the subjective visual vertical has been used during eccentric rotation, the advantage of which is that the centrifugation can selectively stimulate a unilateral utricle. The somato-sensory vertical during eccentric rotation has also been suggested as a test to identify unilateral vestibular dysfunction ( 4,12 ). However, these tests have several limitations, most notably the requirement of examinee participation and cost (in the case of eccentric rotation), but also the possibility that the other healthy sensory systems could compensate for otolith dysfunction in chronic cases ( " central compensation " ) ( 4,12 ).…”

“…Compared with visual vertical measurements, oVEMP is easier to administer, less demanding on patients, suitable for everyday testing in clinical neurotology, and in general is more effective at identifying chronic unilateral vestibular loss ( 12 ). So oVEMP is the most promising method for utricular function evaluation.…”

“…So the lower limit of nI -pI amplitude can be used to differentiate the loss of utricular function from utricular hypofunction, whereas an AR of nI -pI amplitude can be primarily used to diagnose unilateral utricular hypofunction. Since the amplitude of the oVEMP varies substantially between subjects and a gender difference exits in oVEMP amplitude, the AR, instead of absolute peak-to-peak amplitude, has been used for determining side differences in cases of Meniere's disease and vestibular neuritis ( 2,3,12 ).…”