European Archives of Oto-Rhino-Laryngology

, Volume 272, Issue 10, pp 2741–2747 | Cite as

Clinical efficacy of the Romberg test using a foam pad to identify balance problems: a comparative study with the sensory organization test

  • Sung Kwang Hong
  • Joo Hyun Park
  • Sae Young Kwon
  • Ji-Soo Kim
  • Ja-Won KooEmail author


The modified Romberg test using a foam pad (“MRuFP”) as a bedside examination has been used to assess the function of the complex sensory input needed for upright stance. The objective of this study was to assess its clinical value detecting vestibular falls in comparison with the sensory organization test (SOT), the gold standard. In total, 80 patients who had undergone the MRuFP, SOT, and bithermal caloric tests were included in this study. The MRuFPs were performed on two (height 12 cm, MRu2FP) or three (18 cm, MRu3FP) layers of foam pads. The odds ratios of falling on SOT were calculated. Iterative algorithms were used for linear curve fitting between the balance time on the MRuFP and SOT equilibrium score (ES). The diagnostic performance of MRuFP under different conditions was poor, with low sensitivity (0.07–0.63), when the results of SOT were used as the gold standard. However, the odds ratios of failing SOT condition 5 were 6.78 (95 % CI = 1.26–36.50) for patients with abnormal findings on eyes closed (EC)–MRu2FP and 10.91 (95 % CI = 2.58–46.11) for those on the EC–MRu3FP in patients without caloric weakness. In patients with caloric weakness, the odds ratio of failing SOT condition 5 for patients with abnormal findings on EC–MRu2FP was 7.0 (95 % CI = 0.69–70.74, p > 0.05), and 32.0 for those on EC-MRu3FP (95 % CI = 2.81–364.7). A linear equation was presented as the model fit (adjusted R 2 = 0.355) predicting the SOT condition 5 ES according to the balance time on EC–MRu3FP. In conclusion, the EC–MRu3FP, as a bedside examination, correlated well with SOT condition 5 as an objective measure.


Romberg test Screening Posture Vertigo 



This study was partly supported by Seoul National University Bundang Hospital Research Fund (Grant No. 03-2011-007).

Conflict of interest

We certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.


  1. 1.
    Agrawal Y, Carey JP, Hoffman HJ, Sklare DA, Schubert MC (2011) The modified Romberg Balance Test: normative data in US adults. Otol Neurotol 32:1309–1311PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Nieschalk M, Delank KW, Stoll W (1995) Quantitative evaluation of the Romberg test. Laryngorhinootologie 74:489–494CrossRefPubMedGoogle Scholar
  3. 3.
    Soto A, Labella T, Santos S, Rio MD, Lirola A, Cabanas E et al (2004) The usefulness of computerized dynamic posturography for the study of equilibrium in patients with Meniere’s disease: correlation with clinical and audiologic data. Hear Res 196:26–32CrossRefPubMedGoogle Scholar
  4. 4.
    Black FO (2001) What can posturography tell us about vestibular function? Ann N Y Acad Sci 942:446–464CrossRefPubMedGoogle Scholar
  5. 5.
    Stewart MG, Chen AY, Wyatt JR, Favrot S, Beinart S, Coker NJ et al (1999) Cost-effectiveness of the diagnostic evaluation of vertigo. Laryngoscope 109:600–605CrossRefPubMedGoogle Scholar
  6. 6.
    Koo JW, Kim JS, Hong SK (2011) Vibration-induced nystagmus after acute peripheral vestibular loss: comparative study with other vestibule-ocular reflex tests in the yaw plane. Otol Neurotol 32:466–471CrossRefPubMedGoogle Scholar
  7. 7.
    Di Berardino F, Filipponi E, Barozzi S, Giordano G, Alpini D, Cesarani A (2009) The use of rubber foam pads and “sensory ratios” to reduce variability in static posturography assessment. Gait Posture 29:158–160CrossRefPubMedGoogle Scholar
  8. 8.
    Fujimoto C, Murofushi T, Chihara Y, Ushio M, Sugasawa K, Yamaguchi T et al (2009) Assessment of diagnostic accuracy of foam posturography for peripheral vestibular disorders: analysis of parameters related to visual and somatosensory dependence. Clin Neurophysiol 120:1408–1414CrossRefPubMedGoogle Scholar
  9. 9.
    Ortuno-Cortes MA, Martin-Sanz E, Barona-de Guzman R (2008) Static posturography versus clinical tests in elderly people with vestibular pathology. Acta Otorrinolaringol Esp 59:334–340CrossRefPubMedGoogle Scholar
  10. 10.
    Baloh RW, Jacobson KM, Beykirch K, Honrubia V (1998) Static and dynamic posturography in patients with vestibular and cerebellar lesions. Arch Neurol 55:649–654CrossRefPubMedGoogle Scholar
  11. 11.
    Black FO, Wall C 3rd (1981) Comparison of vestibulo-ocular and vestibulospinal screening tests. Otolaryngol Head Neck Surg 89:811–817PubMedGoogle Scholar
  12. 12.
    Evans MK, Krebs DE (1999) Posturography does not test vestibulospinal function. Otolaryngol Head Neck Surg 120:164–173CrossRefPubMedGoogle Scholar
  13. 13.
    Kong WJ, Liu B, Wu Q, Wu YY (2007) Postural characteristics of healthy subjects under different thickness of foam. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 42:721–725PubMedGoogle Scholar
  14. 14.
    Patel M, Fransson PA, Lush D, Gomez S (2008) The effect of foam surface properties on postural stability assessment while standing. Gait Posture 28:649–656CrossRefPubMedGoogle Scholar
  15. 15.
    Telian SA, Shepard NT, Smith-Wheelock M, Hoberg M (1991) Bilateral vestibular paresis: diagnosis and treatment. Otolaryngol Head Neck Surg 104:67–71PubMedGoogle Scholar
  16. 16.
    Turano K, Herdman SJ, Dagnelie G (1993) Visual stabilization of posture in retinitis pigmentosa and in artificially restricted visual fields. Invest Ophthalmol Vis Sci 34:3004–3010PubMedGoogle Scholar
  17. 17.
    Jacobson GP, McCaslin DL, Piker EG, Gruenwald J, Grantham S, Tegel L (2011) Insensitivity of the “Romberg test of standing balance on firm and compliant support surfaces” to the results of caloric and VEMP tests. Ear Hear 32:e1–e5CrossRefPubMedGoogle Scholar
  18. 18.
    Hamid MA, Hughes GB, Kinney SE (1991) Specificity and sensitivity of dynamic posturography. A retrospective analysis. Acta Otolaryngol Suppl 481:596–600CrossRefPubMedGoogle Scholar
  19. 19.
    Goto F, Kabeya M, Kushiro K, Ttsutsumi T, Hayashi K (2011) Effect of anxiety on antero-posterior postural stability in patients with dizziness. Neurosci Lett 487:204–206CrossRefPubMedGoogle Scholar
  20. 20.
    Celebisoy N, Bayam E, Gulec F, Kose T, Akyurekli O (2009) Balance in posterior and horizontal canal type benign paroxysmal positional vertigo before and after canalith repositioning maneuvers. Gait Posture 29:520–523CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Sung Kwang Hong
    • 1
  • Joo Hyun Park
    • 2
  • Sae Young Kwon
    • 1
  • Ji-Soo Kim
    • 3
  • Ja-Won Koo
    • 4
    • 5
    Email author
  1. 1.Department of Otorhinolaryngology-Head and Neck SurgeryHallym University Sacred Heart HospitalChuncheonSouth Korea
  2. 2.Department of Otorhinolaryngology-Head and Neck SurgeryDongguk University Ilsan HospitalGoyangSouth Korea
  3. 3.Department of NeurologySeoul National University Bundang HospitalSeongnamSouth Korea
  4. 4.Department of Otorhinolaryngology-Head and Neck SurgerySeoul National University Bundang HospitalSeongnamSouth Korea
  5. 5.Research Center for Sensory Organs, Medical Research CenterSeoul National UniversitySeoulSouth Korea

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