Sensitivity and Specificity of Clinical and Laboratory Otolith Function Tests

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Objective:To evaluate clinic based and laboratory tests of otolith function for their sensitivity and specificity in demarcating unilateral compensated complete vestibular deficit from normal.Study Design:Prospective cross-sectional study.Setting:Tertiary care hospital vestibular physiology laboratory.Subjects:Control group—30 healthy adults, 20–45 years age; Case group-15 subjects post vestibular shwannoma excision or post-labyrinthectomy with compensated unilateral complete audio-vestibular loss.Intervention:Otolith function evaluation by precise clinical testing (head tilt test—HTT; subjective visual vertical—SVV) and laboratory testing (headroll-eye counterroll—HR-ECR; vesibular evoked myogenic potentials—cVEMP).Main Outcome Measure:Sensitivity and specificity of clinical and laboratory tests in differentiating case and control subjects.Results:Measurable test results were universally obtained with clinical otolith tests (SVV; HTT) but not with laboratory tests. The HR-ECR test did not indicate any definitive wave forms in 10% controls and 26% cases. cVEMP responses were absent in 10% controls.HTT test with normative cutoff at 2 degrees deviations from vertical noted as 93.33% sensitive and 100% specific. SVV test with normative cutoff at 1.3 degrees noted as 100% sensitive and 100% specific. Laboratory tests demonstrated poorer specificities owing primarily to significant unresponsiveness in normal controls.Conclusions:Clinical otolith function tests, if conducted with precision, demonstrate greater ability than laboratory testing in discriminating normal controls from cases with unilateral complete compensated vestibular dysfunction.

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