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Tests to Evaluate the Vestibular System

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Disorders of the Vestibular System

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

  1. 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.

    Article  Google Scholar 

  2. Baloh RW, Honrubia V. Clinical neurophysiology of the vestibular system. Philadelphia, PA: FA Davis; 1989.

    Google Scholar 

  3. 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.

    Article  CAS  PubMed  Google Scholar 

  4. Halmagyi GM, Curthoys IS. A clinical sign of canal paresis. Arch Neurol. 1988;45:737–9.

    Article  CAS  PubMed  Google Scholar 

  5. 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.

    Article  CAS  PubMed  Google Scholar 

  6. Hamman KF, Schuster EM. Vibration induced nystagmus: a sign of unilateral vestibular deficit. J Otorhinolaryngol Relat Spec. 1999;61:74–9.

    Article  Google Scholar 

  7. Burgio DL, Blakley BW, Myers SF. The high frequency oscillopsia test. J Vest Res. 1992;2:221–6.

    Article  CAS  Google Scholar 

  8. Walker MF, Zee DS. The effect of hyperventilation of downbeat nystagmus in cerebellar disorders. Neurology. 1999;53:1576–9.

    Article  CAS  PubMed  Google Scholar 

  9. Minor LB, Haslwanter T, Strautmann D, Zee DS. Hyperventilation-induced nystagmus in patients with vestibular schwannoma. Neurology. 1999;53:2158–68.

    Article  CAS  PubMed  Google Scholar 

  10. Vibert D, Hausler R, Safran AB. Subjective visual vertical in peripheral unilateral vestibular diseases. J Vestib Res. 1999;9:144.

    Article  Google Scholar 

  11. Tribukait A, Bergenius J, Brantberg K. Subjective visual horizontal during follow-up after unilateral vestibular deafferentation with gentamicin. Acta Otolaryngol. 1998;118:479.

    Article  CAS  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  CAS  PubMed  Google Scholar 

  14. Stewart MG. Cost effectiveness of the diagnostic evaluation of vertigo. Laryngoscope. 1999;109:600–5.

    Article  CAS  PubMed  Google Scholar 

  15. 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.

    Article  CAS  PubMed  Google Scholar 

  16. Levy RA, Arts HA. Predicting neuroradiologic outcomes in patients referred for audiovestibular dysfunction. Am J Neuroradiol. 1996;17:1717–24.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Barber HO, Stockwell CW. Electronystagmography. St Louis, MO: CV Mosby; 1980.

    Google Scholar 

  18. Eckert AM, Gizza M. Video-oculography as part of the ENG test battery. Br J Audiol. 1998;32:411.

    Article  CAS  PubMed  Google Scholar 

  19. Vitte E, Semont A. Assessment of vestibular function by videonystagmoscopy. J Vest Res. 1995;5:377–83.

    Article  CAS  Google Scholar 

  20. 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.

    CAS  PubMed  Google Scholar 

  21. 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.

    Article  Google Scholar 

  22. Bhansali SA, Honrubia V. Current status of electronystagmography testing. Otolaryngol Head Neck Surg. 1999;120:419.

    Article  CAS  PubMed  Google Scholar 

  23. Assessment: electronystagmography report of the Therapeutics and Technology Assessment Subcommittee. Neurology. 1996;46:1763–6.

    Google Scholar 

  24. Jongkees LBW, Philipszoon AJ. Electronystagmography. Acta Otolaryngol. 1964;189:1–111.

    Google Scholar 

  25. van der Stappen A, Wuyts FL, van de Heyning PH. Computerized electronystagmography: normative data reviewed. Acta Otolaryngol. 2000;120:724.

    Article  PubMed  Google Scholar 

  26. Halmagyi GM, Cremer OF, Anderson J, Murofushi T, Curthoys IS. Isolated directional preponderance of caloric nystagmus: clinical significance. Am J Otol. 2000;21:559.

    CAS  PubMed  Google Scholar 

  27. Henry DF. Test-retest reliability of open-loop bithermal caloric irrigation responses from healthy young adults. Am J Otol. 1999;20:220.

    CAS  PubMed  Google Scholar 

  28. Hess K, Baloh RW, Honrubia V, Yee RD. Rotational testing in patients with bilateral peripheral vestibular disease. Laryngoscope. 1985;95:85–8.

    Article  CAS  PubMed  Google Scholar 

  29. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 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.

    Article  PubMed  Google Scholar 

  32. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  33. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  34. 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.

    Article  PubMed  Google Scholar 

  35. 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.

    Article  CAS  PubMed  Google Scholar 

  36. 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.

    Article  CAS  PubMed  Google Scholar 

  37. 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.

    Article  PubMed  Google Scholar 

  38. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Su HC, Huang TW, Young YH, Cheng PW. Aging effect on vestibular evoked myogenic potential. Otol Neurotol. 2004;25(6):977–80.

    Article  PubMed  Google Scholar 

  40. 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.

    Article  PubMed  Google Scholar 

  41. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Waele CD. Saccular dysfunction in Meniere’s disease. Am J Otol. 1999;20:223–32.

    PubMed  Google Scholar 

  43. Rauch SD. Vestibular evoked myogenic potentials show altered tuning in patients with Meniere’s disease. Otol Neurotol. 2004;25:333–8.

    Article  PubMed  Google Scholar 

  44. Seo T. Furosemide loading vestibular evoked myogenic potentials for unilateral Meniere’s disease. Otol Neurotol. 2003;24:283–8.

    Article  PubMed  Google Scholar 

  45. 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.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Lawrence Lustig .

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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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  • DOI: https://doi.org/10.1007/978-3-031-40524-2_3

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