Abstract
Maintaining balance involves a complex interplay of the vestibular system, visual system (eyes and related anatomy), and proprioceptive system. Indeed, the etiology of “dizziness” can often be multifactorial and a challenging diagnosis. The thorough evaluation of a dizzy patient should always begin with a thorough history and physical exam, which are often sufficient to obtain a reasonable diagnosis explaining the patient’s symptoms [1]. However, although the majority of vestibular disorders may be elucidated from a thorough history and physical exam, appropriate vestibular tests can help refine the diagnosis and inform management decisions in specific situations. This chapter will focus on clinical and vestibular laboratory tests for the evaluation of the dizzy patient.
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References
Hajioff D, Barr-Hamilton RM, Collegde NR, Lewis SJ, Wilson JA. Is electronystagmography of diagnostic value in the elderly? Clin Otolarygol Allied Sci. 2002;27(1):27–31.
Baloh RW, Honrubia V. Clinical neurophysiology of the vestibular system. Philadelphia, PA: FA Davis; 1989.
Fife TD, Tusa RJ, Furman JM, Zee DS, Frohman E, Baloh RW, Hain T, Goebel J, Demer J, Eviatar L. Assessment: vestibular testing techniques in adults and children: report of the therapeutic and technology subcommittee of the American Academy of Neurology. Neurology. 2000;55(10):1431–41.
Halmagyi GM, Curthoys IS. A clinical sign of canal paresis. Arch Neurol. 1988;45:737–9.
Halmagyi GM, Yavor RA, Colebatch JG. Tapping the head activates the vestibular system: a new use for the clinical reflex hammer. Neurology. 1995;45:1927–9.
Hamman KF, Schuster EM. Vibration induced nystagmus: a sign of unilateral vestibular deficit. J Otorhinolaryngol Relat Spec. 1999;61:74–9.
Burgio DL, Blakley BW, Myers SF. The high frequency oscillopsia test. J Vest Res. 1992;2:221–6.
Walker MF, Zee DS. The effect of hyperventilation of downbeat nystagmus in cerebellar disorders. Neurology. 1999;53:1576–9.
Minor LB, Haslwanter T, Strautmann D, Zee DS. Hyperventilation-induced nystagmus in patients with vestibular schwannoma. Neurology. 1999;53:2158–68.
Vibert D, Hausler R, Safran AB. Subjective visual vertical in peripheral unilateral vestibular diseases. J Vestib Res. 1999;9:144.
Tribukait A, Bergenius J, Brantberg K. Subjective visual horizontal during follow-up after unilateral vestibular deafferentation with gentamicin. Acta Otolaryngol. 1998;118:479.
Vital D, Hegemann SC, Straumann D, Bergamin O, Bockisch CJ, Angehrn D, Schmitt KU, Probst R. A new dynamic visual acuity test to assess peripheral vestibular function. Arch Otolaryngol Head Neck Surg. 2010;136(7):686–91.
Gordon CR, Shupak A, Spitzer O, Melamed Y. Nonspecific vertigo with normal otoneurological examination. The role of vestibular laboratory tests. J Laryngol Otol. 1996;110(2):1133–7.
Stewart MG. Cost effectiveness of the diagnostic evaluation of vertigo. Laryngoscope. 1999;109:600–5.
Frohman TC, Em F, O’Suilleabhain P, Salter A, Dewey RB, Hogan N, Galetta S, Lee AG, Straumann D, Noseworthy J, Zee D, Corbett J, Corboy J, Rivera VM, Kramer PD. Accuracy of clinical detection of INO in MS: corroboration with quantitative infrared oculography. Neurology. 2003;61(6):848–50.
Levy RA, Arts HA. Predicting neuroradiologic outcomes in patients referred for audiovestibular dysfunction. Am J Neuroradiol. 1996;17:1717–24.
Barber HO, Stockwell CW. Electronystagmography. St Louis, MO: CV Mosby; 1980.
Eckert AM, Gizza M. Video-oculography as part of the ENG test battery. Br J Audiol. 1998;32:411.
Vitte E, Semont A. Assessment of vestibular function by videonystagmoscopy. J Vest Res. 1995;5:377–83.
Kinney WC, Wallace RC, Ross JS, Hamid MA. Retrospective blinded review of magnetic resonance imaging in patients with central electronystagmography findings. Am J Otol. 1998;19:341.
Stoddard RL, Baguley DM, Beynon GJ, Chang P, Moffat DA. Magnetic resonance imaging results in patients with central electronystagmography findings. Clin Otolaryngol. 2000;25:293.
Bhansali SA, Honrubia V. Current status of electronystagmography testing. Otolaryngol Head Neck Surg. 1999;120:419.
Assessment: electronystagmography report of the Therapeutics and Technology Assessment Subcommittee. Neurology. 1996;46:1763–6.
Jongkees LBW, Philipszoon AJ. Electronystagmography. Acta Otolaryngol. 1964;189:1–111.
van der Stappen A, Wuyts FL, van de Heyning PH. Computerized electronystagmography: normative data reviewed. Acta Otolaryngol. 2000;120:724.
Halmagyi GM, Cremer OF, Anderson J, Murofushi T, Curthoys IS. Isolated directional preponderance of caloric nystagmus: clinical significance. Am J Otol. 2000;21:559.
Henry DF. Test-retest reliability of open-loop bithermal caloric irrigation responses from healthy young adults. Am J Otol. 1999;20:220.
Hess K, Baloh RW, Honrubia V, Yee RD. Rotational testing in patients with bilateral peripheral vestibular disease. Laryngoscope. 1985;95:85–8.
MacDougall HG, Weber KP, McGarvie LA, Halmagyi GM, Curthoys IS. The video head impulse test: diagnostic accuracy in peripheral vestibulopathy. Neurology. 2009;73(14):1134–41.
Stevens MN, Garrison DB, Kaylie DM. What is the potential clinical utility of vHIT when assessing adult patients with dizziness? Laryngoscope. 2017;127(12):2689–90. https://doi.org/10.1002/lary.26774. Epub 2017 Jul 12.
Alhabib SF, Saliba I. Video head impulse test: a review of the literature. Eur Arch Otorhinolaryngol. 2017;274(3):1215–22. https://doi.org/10.1007/s00405-016-4157-4. Epub 2016 Jun 21.
Janky KL, Patterson J, Shepard N, Thomas M, Barin K, Creutz T, Schmid K, Honaker JA. Video head impulse test (vHIT): the role of corrective saccades in identifying patients with vestibular loss. Otol Neurotol. 2018;39(4):467–73.
Anson ER, Bigelow RT, Carey JP, Xue QL, Studenski S, Schubert MC, Agrawal Y. VOR gain is related to compensatory saccades in healthy older adults. Front Aging Neurosci. 2016;8:150.
Hullar TE, Della Santina CC. Responses of irregularly discharging chinchilla semicircular canal vestibular nerve afferents during high-frequency head rotations. J Neurophysiol. 2005;93(5):2777–86.
Weber KP, Aw ST, Todd MJ, McGarvie LA, Curthoys IS, Halmagyi GM. Horizontal head impulse test detects gentamicin vestibulotoxicity. Neurology. 2009;72(16):1417–24.
Allum JH, Shepard NT. An overview of the clinical use of dynamic posturography in the differential diagnosis of balance disorders. J Vestib Res. 1999;9(4):223–52.
Curthoys IS. A critical review of the neurophysiological evidence underlying clinical vestibular testing using sound, vibration and galvanic stimuli. Clin Neurophysiol. 2010;121(2):132–44.
Curthoys IS, Grant JW, Burgess AM, Pastras CJ, Brown DJ, Manzari L. Otolithic receptor mechanisms for vestibular-evoked myogenic potentials: a review. Front Neurol. 2018;9:366.
Su HC, Huang TW, Young YH, Cheng PW. Aging effect on vestibular evoked myogenic potential. Otol Neurotol. 2004;25(6):977–80.
Piker EG, Jacobson GP, McCaslin DL, Hood LJ. Normal characteristics of the ocular vestibular evoked myogenic potential. J Am Acad Audiol. 2011;22(4):222–30.
Zuniga MG, Janky KL, Nguyen KD, Welgampola MS, Carey JP. Ocular versus cervical VEMPs in the diagnosis of superior semicircular canal dehiscence syndrome. Otol Neurotol. 2013;34(1):121–6.
Waele CD. Saccular dysfunction in Meniere’s disease. Am J Otol. 1999;20:223–32.
Rauch SD. Vestibular evoked myogenic potentials show altered tuning in patients with Meniere’s disease. Otol Neurotol. 2004;25:333–8.
Seo T. Furosemide loading vestibular evoked myogenic potentials for unilateral Meniere’s disease. Otol Neurotol. 2003;24:283–8.
Murofushi T, Shimizu K, Takegoshi H, Cheng PW. Diagnostic value of prolonged latencies in the vestibular evoked myogenic potential. Arch Otolaryngol Head Neck Surg. 2001;127:1069–72.
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Chern, A., Lustig, L. (2023). Tests to Evaluate the Vestibular System. In: Crane, B.T., Lustig, L., de Souza, C. (eds) Disorders of the Vestibular System. Springer, Cham. https://doi.org/10.1007/978-3-031-40524-2_3
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