Office vestibular tests: A battery approach to guide the diagnosis of dizzy patients

Abstract Background: Laboratory vestibular tests are relatively expensive and may be not available in every clinic. On the other hand, office vestibular tests can be easily performed and are low-cost. Objectives: To measure the sensitivity of a proposed battery approach to be conducted as an office procedure to diagnose side and site of vestibular lesions. Methods: This study was conducted on 36 patients suffering from vertigo with a confirmed diagnosis of vestibular disorder by laboratory vestibular tests. These included a standard video nystagmography (VNG) test that entails recording of eye examination including gaze testing, saccadic eye movements and smooth pursuit together with positional and positioning examinations as well as bithermal calorics and Vestibular Evoked Myogenic Potential (VEMP) tests. Patients were evaluated independently by history, examination of eye movements and a battery of office vestibular tests that included the Head Shake nystagmus Test (HST), Head Thrust Test (HTT) and Fukuda Stepping Test as well as the Dix-Hallpike test. Audiological, radiological and laboratory tests were applied to establish aetiological diagnosis whenever indicated. Results and conclusions: One patient showed abnormal eye movements that were confirmed by full diagnostic work-up for vestibular disorders in keeping with a diagnosis of multiple sclerosis, and was excluded from forthcoming analysis. Sensitivity of the HST test with respect to results of the laboratory vestibular tests (VNG and VEMP) was 51.5% while that of HTT was 43%. Moreover, the Fukuda Stepping Test showed a sensitivity of 48.5% with non-significant correlation to the side of caloric weakness and a significant correlation to the side of abnormal VEMP response. The proposed battery of office vestibular tests proved to be a quick screening approach that was successful in helping to identify site and side of peripheral vestibular lesions in 77% of patients. On the other hand, normal office vestibular tests were obtained in patients with laboratory findings showing mild caloric weakness or with only an abnormal VEMP.