Utility of Stepping, Walking, and Head Impulses for Screening Patients for Vestibular Impairments

Objective To determine if some common screening tests predict scores on detailed, objective diagnostic tests of the vestibular system. Study Design Sixty patients with vestibular disorders were compared with 60 asymptomatic controls. Setting Vestibular diagnostic laboratory, tertiary care center. Su...

Full description

Saved in:

Bibliographic Details
Published in:	Otolaryngology-head and neck surgery 2014-07, Vol.151 (1), p.131-136
Main Authors:	Cohen, Helen S., Sangi-Haghpeykar, Haleh, Ricci, Natalia A., Kampangkaew, June, Williamson, Robert A.
Format:	Article
Language:	eng
Subjects:	Adult Aged Aged, 80 and over Caloric Tests Case-Control Studies diagnosis Female Fukuda stepping test head impulse test Head Impulse Test - methods Hospitals, University Humans Male Mass Screening Middle Aged Physical Examination Postural Balance Predictive Value of Tests Sensitivity and Specificity tandem walking Vestibular Diseases - diagnosis Vestibular Diseases - physiopathology Vestibular Function Tests vestibular system Walking
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Objective To determine if some common screening tests predict scores on detailed, objective diagnostic tests of the vestibular system. Study Design Sixty patients with vestibular disorders were compared with 60 asymptomatic controls. Setting Vestibular diagnostic laboratory, tertiary care center. Subjects and Methods Subjects were screened with head impulse tests, Fukuda stepping tests while walking and marching in place, and tandem walking tests with eyes open and closed. All subjects underwent bithermal caloric tests and Dix-Hallpike maneuvers; patients underwent low-frequency sinusoidal tests of the vestibulo-ocular reflex in darkness and cervical vestibular evoked myogenic potentials. Results On tandem walking tests, patients differed significantly from controls, but receiver operating characteristic scores were < 0.80. On Fukuda tests, patients turned significantly more than controls for walking but not marching, but receiver operating characteristic values were considerably less than 0.80. On head impulse tests, patients with bithermal caloric weakness (≥20% and 0.80 only for subjects with severe bithermal caloric weakness and were highest, at 0.88, for subjects with severe weakness and age ≥ 60 years. Conclusions The Fukuda test is a poor screening test because it does not correlate well with objective test findings. Tandem walking is best used for screening older patients for vestibular disorders. Positive findings on a head impulse test are probably consistent with severe peripheral vestibular impairment and may be most useful in older patients. In younger patients with vertigo, negative results on head impulse tests may not be informative.
ISSN:	0194-5998 1097-6817