Unilateral examination of utricle and saccule function

Attention is directed towards the recently developed unilateral tests of saccular and utricular function. Together with the now widely used head-thrust test and the standard caloric test for semicircular canal function, these provide for a more comprehensive unilateral examination of labyrinth function. The efficacy of vestibular evoked myogenic potentials (VEMP) as a direct unilateral test of saccular function is currently being demonstrated in an increasing number of reports. Furthermore, the relevant neuronal pathways have been delineated in animal studies, so that all evidence points to the validity of the VEMP as a saccule-mediated response. Concerning utricular function, considerable headway has been made using the unilateral centrifugation paradigm. Testing is performed with a variable radius rotary chair with constant velocity rotation about the earth-vertical axis. Displacing the head by 3.5-4 cm from the rotation axis, the eccentrically positioned utricle is stimulated unilaterally by the resultant centrifugal force. This paradigm can be employed to elicit a utriculo-ocular response (UOR) or to permit measurement of the subjective visual vertical (SVV). More recently, it has also been demonstrated that testing during normal, on-centre yaw axis rotation is often sufficient to localise peripheral otolith dysfunction by means of SVV estimation. This test mode can be easily integrated into routine clinical testing. To illustrate the efficacy of such differential testing, the findings from two patients are presented that demonstrate for the first time an isolated unilateral utricular dysfunction.