Abstract
Unilateral or bilateral vestibular hypofunction presents most commonly with symptoms of dizziness or postural imbalance and affects a large population. However, it is often missed because no quantitative testing of vestibular function is performed, or misdiagnosed due to a lack of standardization of vestibular testing. Therefore, this article reviews the current status of the most frequently used vestibular tests for canal and otolith function. This information can also be used to reach a consensus about the systematic diagnosis of vestibular hypofunction.
Highlights
Vestibular hypofunction, i.e. a unilateral or a bilateral vestibulopathy, is a heterogeneous disorder of the peripheral and/or rarely central vestibular system leading typically to disabling symptoms such as dizziness, imbalance, and/or oscillopsia [1,2,3]
Using an infrared video camera, VOG detects eye movements by analyzing 2D images of the eye that is illuminated by infrared LEDs
The peripheral vestibular system strongly contributes to self-motion perceptual thresholds, as shown by significantly higher thresholds in patients with bilateral vestibulopathy compared to a control group [133,134,135]
Summary
Vestibular hypofunction ( vestibulopathy, vestibular dysfunction, -hyporeflexia, -loss, -failure, -deficiency), i.e. a unilateral or a bilateral vestibulopathy, is a heterogeneous disorder of the peripheral and/or rarely central vestibular system leading typically to disabling symptoms such as dizziness, imbalance, and/or oscillopsia [1,2,3]. The video-head impulse test (vHIT) is able to quantitatively assess the vestibulo-ocular reflex (VOR) of all six semicircular canals in the high-frequency domain and it can be used in acute, episodic and chronic vestibular syndromes [6, 18, 19]. The peripheral vestibular system strongly contributes to self-motion perceptual thresholds (especially rotations), as shown by significantly higher thresholds in patients with bilateral vestibulopathy compared to a control group [133,134,135]. In case of bilateral vestibulopathy, rotatory chair testing can be added to increase the specificity of testing (not sensitivity) [80, 144] and to help to determine residual vestibular function [82], since the responses to rotatory chair testing are often better preserved than the responses to vHIT or caloric stimulation [144]. VEMP is currently only advised for detecting superior canal dehiscence syndrome
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