Efficiency in Vestibular Testing
Maes et al (2011) evaluated 157 adults (77 men and 80 women) with respect to two issues in vestibular testing. The “diagnostic capacity” of different vestibular tests were examined, as was the “clinical effectiveness” of the caloric, rotatory, and vestibular-evoked myogenic potential (VEMP) test. Eighty of the subjects presented with a mean age of 48 years and had no history of vertigo, balance problems, or otologic disease. Seventy-seven patients with a mean age of 52 years presented with histories of unilateral peripheral vestibular pathology.
The authors note that although rotatory tests are extremely valuable for the detection of bilateral vestibular pathologies, there is no generally accepted rotational test protocol. The caloric tests are generally agreed to be the most important protocol for localizing unilateral peripheral vestibular dysfunction. Rotatory and caloric tests primarily evaluate the horizontal canal and the superior vestibular nerve, whereas the VEMP primarily evaluates saccular function and the inferior vestibular nerve.
They note that in their subgroup of 36 Meniere’s patients, 14 had spontaneous nystagmus (6 degrees/second criteria) half of which was directed to the healthy side, half to the diseased side.
Maes et al concluded that within the rotatory tests, the sinusoidal harmonic acceleration test (SHAT) at 0.01 Hz availed the highest diagnostic capacity, followed by 0.1 and 0.05 Hz. They authors recommend the same three frequencies be used in tandem with calorics and (the presence or absence of) VEMPs in combination with the asymmetry ratio to acquire a more complete examination of the vestibular system.
For More Information, References, and Recommendations
Barin K. (2009) Rotational Tests of Vestibular Function. Seminars in Hearing 30(4):253-266.
Janky KL, Shepard N. (2009) Vestibular-Evoked Myogenic Potential Testing: Normative Threshold Response Curves and Effects of Age. Journal of the American Academy of Audiology (20)8:514-522.
Maes L, Vinvk BM, Wuyts F, D’Haenens W, Bockstael A, Keppler H, Philips B, Swinnen F, Dhooge I. (2011) Clinical Usefulness of the Rotatory, Caloric and Vestibular-Evoked Myogenic Potential Test in Unilateral Peripheral Vestibular Pathologies. International Journal of Audiology 50:566-576.
McCaslin DL, Jacobson GP. (2009) Current Role of The Videonystagmography Examination in the Context of the Multidimensional Balance Function Test Battery. Seminars in Hearing 30(4)242-253.
Murnane OD, Akin FW, Lynn, SG, Cyr DG. (2009) Monothermal Caloric Screening Test Performance: A Relative Operating Characteristic Curve Analysis. Ear & Hearing 30(3):313-319.
Wu CC, Young YH. (2009) Ten-Year Longitudinal Study of the Effect of Impulse Noise Exposure from Gunshot on Inner Ear Function. International Journal of Audiology (48)9:655-660.