Rotational chair instead of ENG as the primary vestibular test

Abstract

Objectives: To present a rotational chair based testing algorithm for initial evaluation of dizzy patients. Methods: Retrospective chart review. Results: One thousand consecutive patients undergoing evaluation for dizziness and imbalance at a tertiary care, referral balance center were included. Rotatational chair testing was used as the primary vestibular study with ENG used as a confirmatory test instead of a vestibular screening test. The rotational chair protocol included an ocular screening battery, VOR (vestibulo-ocular reflex testing with sinusoidal and step velocity testing and visual-vestibular interaction testing including VVOR and visual fixation studies. Rotational chair data without ENG was adequate for confirming the vestibular pathology diagnosis in 70% of patients. Only 10% of patients with normal rotation chair results had abnormal ENG results. In nearly 40% of patients with rotational chair abnormalities, the ENG results were normal. Conclusions: Given the broader array of vestibular and visual-vestibular-interaction information available, rotational chair testing may be a better vestibular screening study than ENG in diagnosing dizzy patients. Prospective investigation of this topic is warranted.