Horizontal VOR function shows frequency dynamics in vestibular schwannoma
- 519 Downloads
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.
KeywordsVestibular schwannoma Video head impulse test Caloric test Vertigo Dizziness
Conflict of interest
The authors declare no financial interest.
- 1.Agrawal Y, Schubert MC, Migliaccio AA, Zee DS, Schneider E, Lehnen N, Carey JP (2013) Evaluation of quantitative head impulse testing using search coils versus video-oculography in older individuals. Otol Neurotol 27Google Scholar
- 6.Zellhuber S, Mahringer A, Rambold HA (2013) Relation of video-head-impulse test and caloric irrigation: a study on the recovery in unilateral vestibular neuritis. Eur Arch Otorhinolaryngol 6Google Scholar
- 7.Mahringer A, Rambold HA (2013) Caloric test and video-head-impulse: a study of vertigo/dizziness patients in a community hospital. Eur Arch Otorhinolaryngol 15Google Scholar
- 8.Bartolomeo M, Biboulet R, Pierre G, Mondain M, Uziel A, Venail F (2013) Value of the video head impulse test in assessing vestibular deficits following vestibular neuritis. Eur Arch Otorhinolaryngol 29Google Scholar
- 9.Machner B, Gottschalk S, Sander T, Helmchen C, Rambold H (2007) Intralabyrinthine schwannoma affecting the low but not high frequency function of the vestibulo-ocular reflex: implications for the clinical diagnosis of chronic peripheral vestibular deficits. J Neurol Neurosurg Psychiatry 78:772–774PubMedCentralPubMedCrossRefGoogle Scholar
- 12.Sills AW, Baloh RW, Honrubia V (1977) Caloric testing 2: results in normal subjects. Ann Otol Rhinol Laryngol Suppl 86:7–23Google Scholar