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European Archives of Oto-Rhino-Laryngology

, Volume 272, Issue 9, pp 2143–2148 | Cite as

Horizontal VOR function shows frequency dynamics in vestibular schwannoma

  • Alexander BlödowEmail author
  • Julia Blödow
  • Marc Boris Bloching
  • Ralf Helbig
  • Leif Erik Walther
Otology

Abstract

The objective of this retrospective study was to investigate the horizontal vestibulo-ocular reflex (hVOR) pathway with caloric test (low-frequency hVOR) and video head impulse test (vHIT) (high-frequency hVOR) in patients with sporadic vestibular schwannoma (69 patients, 27–86 years, mean age 58.1 years) and to compare both test methods in terms of their sensitivity and specificity to detect a retrocochlear lesion. Test results with a unilateral weakness (UWCaloric) >25 % (caloric test) or a Mean-GainvHIT <0.79/asymmetry ratio of Gain (AR-GainvHIT) >8.5 % and accompanied refixation saccades (vHIT) were considered abnormal. The overall sensitivity of the caloric test was 72 %. The evaluation of AR-GainvHIT detected more abnormal cases than did Mean-GainvHIT (44 vs. 36 %). In up to 4 %, a normal caloric test result was related to an abnormal vHIT. There was only a moderate correlation of UWCaloric and AR-GainvHIT (r = 0.54, p < 0.05) with a linear regression line intercept/slope of 32.2/0.9 (p < 0.05). Receiver operating characteristics curve analysis exhibited at a UWCaloric of 50 % a vHIT sensitivity/specificity/positive predictive value/negative predictive value of 0.45/0.9/0.94/0.42. Vestibular testing at varying frequencies provides deeper insights into hVOR function and is helpful in detecting a cerebello-pontine lesion. Whereas caloric test yields a high sensitivity for nerve dysfunction, vHIT test reveals a remaining function of hVOR in the high-frequency range.

Keywords

Vestibular schwannoma Video head impulse test Caloric test Vertigo Dizziness 

Notes

Conflict of interest

The authors declare no financial interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Alexander Blödow
    • 1
    Email author
  • Julia Blödow
    • 1
  • Marc Boris Bloching
    • 1
  • Ralf Helbig
    • 1
  • Leif Erik Walther
    • 2
  1. 1.Department of Otorhinolaryngology, Head and Neck Surgery and Communication DisordersHELIOS-Clinic Berlin-BuchBerlinGermany
  2. 2.Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Medicine MannheimMannheimGermany

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