Role of subjective visual vertical test during eccentric rotation in the recovery phase of vestibular neuritis

Ocular vestibular evoked myogenic potentials (oVEMPs), subjective visual vertical (SVV), and fundus photographically measured binocular cyclorotation (BCR) are diagnostic tests to assess utricular function in patients with vertigo or dizziness. In 138 patients with chronic vertigo or dizziness, we asked whether the asymmetry ratio of oVEMP (normal, right side pathological, left side pathological) could predict the SVV deviation (normal, rightward deviation, leftward deviation) or BCR (normal, cyclorotation to the right, cyclorotation to the left). There was no correlation between oVEMP and SVV and between oVEMP and BCR, while SVV and BCR correlated highly. Although both oVEMP and SVV measure aspects of utricular function, our findings demonstrate that oVEMP and SVV are not redundant and may reflect different utricular pathologies. The role of fundus photographic BCR may be relegated to only confirm unclear SVV results in vestibular diagnostic workup.

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Subjective visual vertical in peripheral unilateral vestibular diseases*

Journal of Vestibular Research ◽

10.3233/ves-1999-9209 ◽

1999 ◽

Vol 9 (2) ◽

pp. 145-152 ◽

Cited By ~ 7

Author(s):

D. Vibert ◽

R. Häusler ◽

A.B. Safran

Keyword(s):

Eye Movements ◽

Prospective Study ◽

Vestibular Neuritis ◽

Subjective Visual Vertical ◽

Vestibular Loss ◽

Vestibular Neurectomy ◽

Vestibular Diseases ◽

Vestibular Cues ◽

Visual Vertical ◽

Maddox Rod

In humans, the perception of vertical is provided by input from various sensorineural organs and pathways: vision, eye-movements, and proprioceptive and vestibular cues, particularly from the otolithic organs and graviceptive pathways. Well known in several types of brainstem lesions, subjective visual vertical (SVV) abnormalities may also be observed after peripheral vestibular lesions, such as surgical deafferentation, with a deviation directed toward the operated ear. Subjective visual vertical abnormalities are presumably related to a lesion of the otolithic organs and/or to changes in the afferent graviceptive pathways. The goal of this prospective study was to measure the SVV and to define the influence of the otolithic organs in patients suffering from various types of peripheral vestibular diseases: unilateral sudden cochleo-vestibular loss, so-called “viral labyrinthitis” (VL), sudden idiopathic unilateral peripheral vestibular loss, so-called “vestibular neuritis” (Ne). Data were compared with findings after unilateral surgical deafferentations such as vestibular neurectomy (VN) and labyrinthectomy (Lab). Subjective visual vertical was measured with a binocular test (vertical frame) and a monocular test (Maddox rod). In all patients, after VN and Lab, the SVV showed a 10 – 30 ∘ tilt with the vertical frame (N: 0 ± 2 ∘ ), 5 – 15 ∘ with the Maddox rod (N: 0 ± 4 ∘ ). With the vertical frame, SVV was tilted > 2 ∘ in VL (47%) VL (41%) Our results demonstrate that SVV is frequently tilted in acute peripheral vestibulopathies such as VL and Ne. These findings suggest that otolithic function is implicated in the deficit depending on the extent and/or the localisation of the peripheral vestibular lesion.

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Re: “High variability of the subjective visual vertical test of vertical perception, in some people with neck pain – Should this be a standard measure of cervical proprioception?”

Manual Therapy ◽

10.1016/j.math.2015.09.011 ◽

2015 ◽

Vol 20 (6) ◽

pp. e18

Author(s):

Jeff Bagust ◽

Sharon Docherty ◽

Rima Abdul Razzak

Keyword(s):

Neck Pain ◽

High Variability ◽

Standard Measure ◽

Subjective Visual Vertical ◽

Visual Vertical ◽

Vertical Test

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Subjective Visual Vertical Testing in Patients With Chronic Suppurative Otitis Media

Otolaryngology ◽

10.1177/0194599820931491 ◽

2020 ◽

Vol 163 (5) ◽

pp. 1018-1024

Author(s):

Rafael da Costa Monsanto ◽

Ana Luiza Papi Kasemodel ◽

Andreza Tomaz ◽

Norma de Oliveira Penido

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Vestibular Function ◽

Chronic Suppurative Otitis Media ◽

Controlled Study ◽

Subjective Visual Vertical ◽

Suppurative Otitis Media ◽

Visual Vertical ◽

Vestibular Symptoms ◽

Vertical Test

Objective To analyze the results of the subjective visual vertical test using the “bucket method” in patients with chronic suppurative otitis media (CSOM). Study Design Cross-sectional, controlled study. Setting Outpatient otology clinic in a tertiary care hospital. Subjects and Methods Patients had CSOM, defined as the presence of chronic infection or inflammation of the middle ear cleft, associated with a perforation of the tympanic membrane, frequent or intractable middle ear suppuration, with or without cholesteatoma. Controls were selected using a nonprobability, purposive sampling method. We excluded patients with neurologic or metabolic diseases, cognitive deficits, otosclerosis, vestibular migraine, Ménière’s disease, past use of ototoxic medication, or head and neck cancer. The volunteers were subjected to the subjective visual vertical test using the “bucket method.” The results obtained in our study and control groups were analyzed using nonparametric tests. Results Our study comprised 51 patients with CSOM and 50 controls. In the CSOM group, we observed that 72.5% of the patients had vestibular symptoms in the past year, and 70.5% had abnormalities identified in at least 1 vestibular function test. The subjective visual vertical test revealed that patients with CSOM (with and without cholesteatoma) had significantly higher deviations of the true vertical as compared with controls (CSOM, 3.66°; controls, 0.76°; P < .001). Conclusion Our results revealed that CSOM was associated with high rates of vestibular symptoms, abnormal vestibular function tests, and abnormal subjective vertical visual results.

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