Subjective Visual Vertical in Various Vestibular Disorders by Using a Simple Bucket Test

  • Naik ChetanaEmail author
  • Rane Jayesh
Original Article


Subjective Visual Vertical (S.V.V.) assesses the ability to perceive verticality which depends on visual, vestibular and somatosensory inputs. The judgment of verticality is altered when there is otolith dysfunction. Objective of our study was to present a simple method to assess S.V.V. and to analyze S.V.V. changes in various vestibular disorders. 100 subjects presenting with vestibular disorders in period of 1 year 2 months were subjected to Neurotological history and examination. Patients with non-vestibular causes were excluded. S.V.V was tested with a simple innovative device—a specially designed bucket. The angle of deviation from vertical was noted in degrees. Normal deviation is 0 ± 2°. Out of 23 patients with vestibular neuritis 83 % showed abnormal S.V.V. Amongst 11 patients of Meniere’s disease, 55 % and 42 patients of BPPV, 71 % had abnormal S.V.V. Amongst 24 patients with other causes 15 % showed abnormal S.V.V. S.V.V is a reliable screening tool in assessment of vestibular dysfunction along with other clinical tests. It has a prognostic value during recovery following vestibular damage. The modified ‘Bucket’ is a simple, easy to use and cost-effective device to do the S.V.V. in daily practice.


Subjective visual vertical Bucket test Otolith dysfunction Vestibular vertigo 


  1. 1.
    Zwergal A, Rettinger N, Frenzel C, Dieterich M, Brandt T, Strupp M (2009) A bucket of static vestibular function. Neurology 72:1689–1692PubMedCrossRefGoogle Scholar
  2. 2.
    Friedmann G (1970) The judgement of the visual vertical and horizontal with peripheral and central vestibular lesions. Brain 93:313–328PubMedCrossRefGoogle Scholar
  3. 3.
    Vibert D, Hausler R, Safran AB (1999) Subjective visual vertical in peripheral unilateral vestibular diseases. J Vestib Res 9(2):145–152PubMedGoogle Scholar
  4. 4.
    Noh H, Chae S (2007) Change of Subjective Visual Vertical (SVV) in Patients of Vestibular Neuritis. J Korean Balance Soc 6(2):143–149Google Scholar
  5. 5.
    Min KK, Ha JS et al (2007) Clinical use of subjective visual horizontal and vertical in patients of unilateral vestibular neuritis. Otol Neurotol 28(4):520–525PubMedCrossRefGoogle Scholar
  6. 6.
    Gómez García A, Jáuregui-Renaud K (2003) Subjective assessment of visual verticality in follow-up of patients with acute vestibular disease. Ear Nose Throat J 82(6):442–444PubMedGoogle Scholar
  7. 7.
    Vibert D, Hausler R (2000) Long-term evolution of subjective visual vertical after vestibular neurectomy and labyrinthectomy. Acta Otolaryngol 120:620–622PubMedCrossRefGoogle Scholar
  8. 8.
    Hong SM, Park MS et al (2008) Subjective visual vertical during eccentric rotation in patients with benign paroxysmal positional vertigo. Otol Neurotol 29(8):1167–1170PubMedCrossRefGoogle Scholar
  9. 9.
    Asai M, Aoki M, Hayashi H et al (2009) Subclinical deviation of the subjective visual vertical in patients affected by a primary headache. Acta Otolaryngol 129(1):30–35PubMedCrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2014

Authors and Affiliations

  1. 1.Department of E.N.TSmt Kashibai Navale Medical CollegePuneIndia
  2. 2.Vertigo ClinicGhaisas ENT HospitalPuneIndia
  3. 3.M.I.M.S.R Medical CollegeLaturIndia

Personalised recommendations