Head-shaking nystagmus in patients with a vestibular schwannoma

The aim of this study was to calculate the sensitivity of the head-shake test for peripheral and central vestibular dysfunction associated with unilateral sporadic vestibular schwannoma and to discuss the feasibility of using the head-shake test as a screening test. The study group consisted of 102 patients with unilateral sporadic vestibular schwannomas, who were seen consecutively for preoperative vestibular assessment, including the head-shake test. The sensitivity of the head-shake test for vestibular schwannoma was found to be 22%, and the sensitivity and specificity of the head-shake test for canal paresis (>/=25%) were found to be 27% and 88%, respectively. Patients with abnormalities in the central vestibular system and with a greater canal paresis were more likely to have head-shake nystagmus, although, even for severe canal paresis, the sensitivity of the test remained low at 36%. The direction of nystagmus was found to be contra-lateral to the side of the tumour in 86% of patients. It was concluded that the head-shake test is of insufficient sensitivity to be used as a screening test either for vestibular schwannoma or for vestibular-system abnormalities associated with vestibular schwannoma. The deduction is made that the head-shake test is of insufficient sensitivity or specificity to be of clinical value as a screening test for vestibular dysfunction in a general population with symptoms of imbalance.