Vestibular function testing: An evaluation of current techniques

Abstract

Despite new technology, diagnosis of the dizzy patient remains a problem. While computer analysis permits objective, quantitative assessment of vestibular function, the large variability in normal subjects makes diagnosis difficult-particularly in minor dysfunction. This study assesses the diagnostic capabilities of the three modalities of vestibular testing: caloric irrigation, sinusoidal rotation, and posturography. METHODS AND MATERIALSSeventy consecutive patients with subjective reports of vertigo underwent extensive vestibular evaluation. The group included 23 men and 47 women, with an average age of 46.7 years. Final diagnosis was based on clinical impressions and interpretation of diagnostic tests.Bithermal caloric stimulation was performed using the Fitzgerald-Hallpike technique, with responses considered to be abnormal when asymmetry exceeded 20 percent. Rotational testing included multiple frequency sinusoidal rotations in the dark about a vertical axis. Methods of stimulation, eye movement recordings, and data analysis have been published previously. ' Posturographic testing was performed using the commercially available computerized dynamic posturography platform. A complete description of this test is available in the literature.' Results of the tests were compared to normative data collected in the laboratory or supplied by the manufacturer in the case of posturography. RESULTSIn this group of patients, diagnoses included: endolymphatic hydrops ( 12); acoustic neuroma (6); unilateral peripheral dysfunction (1 5); bilateral peripheral dysfunction (5); nonlocalizing vestibular dysfunction

Application of the Vestibular Disorders Activities of Daily Living Scale

“…The diagnosis of chronic vestibulopathy was based on two criteria: 1) a complaint of vertigo, i.e., the illusory sense of motion, for 3 months or longer, and 2) positive findings from caloric testing or decreased vestibulo‐ocular reflex gains with low‐frequency sinusoidal rotations in darkness. 9,10 Patients with chronic vestibulopathy had episodic vertigo varying in frequency from a few episodes per week to more than 10 per day, but all subjects reported having moments in the day while they were sitting still when they did not have vertigo. The diagnosis of BPPV was based on a complaint of vertigo during pitch head rotations and the clinical finding of a positive response to the Dix‐Hallpike maneuver, with nystagmus beating upward and a torsional component either counterclockwise in head hanging right or clockwise in head hanging left 11 with a latency to onset of nystagmus and vertigo of 2 to 15 seconds and a duration of no longer than 60 seconds.…”

A double-blind, randomized, placebo-controlled trial of intravenous l-ornithine-l-aspartate on postural control in patients with cirrhosis

“…To evaluate equilibrium, all patients and controls underwent the sensory organisation test, which has been described in detail elsewhere (20,21) and will be described only briefly here. Visual and kinaesthetic stimuli are manipulated in the six conditions of the test, each of which has three 20-s trials.…”

Development of the Vestibular Disorders Activities of Daily Living Scale

“…Of these subjects, 66 had chronic vertigo (mean ± SD age, 55 ± 16.6 years; range, 25-92 years), the diagnosis of which was based on clinical examination and a diagnostic battery of dynamic posturography, bithermal caloric testing, and lowfrequency sinusoidal testing in the rotatory chair. 24 All subjects in this group with chronic vertigo had vertigo for at least 3 months; this group excluded subjects with Ménière disease, 25,26 benign paroxysmal positional vertigo, residual vertigo after resection of acoustic neuroma, head trauma, and other neurologic disorders. They fit the profile for the diagnosis of chronic or recurrent vestibulopathy.…”