Utility of quick oculomotor tests for screening the vestibular system in the subacute and chronic populations

The goal of this study was to determine the sensitivity and specificity of some widely used, easily administered clinical tests.

Simple tests of oculomotor function have become widely used for clinical screening of patients suspected of having vestibular disorders despite a paucity of evidence showing good statistical support for their use in this highly variable population.

Healthy controls with no history of otologic or neurologic disorders (n = 291) were compared to patients with known vestibular disorders (n = 62). All subjects performed passive and active head shaking, un-instrumented head impulse tests (HT), and video head impulse tests (vHIT) recorded with infrared video-oculography.

For both passive and active head shaking, using presence/absence of vertigo and of nystagmus, sensitivity was low (<0.40). Sensitivity of presence/absence of saccades on HT was even lower (<0.15). On vHIT, gains were all approximately = 1.0, so sensitivity was very low (approximately 0.15-0.35). Sensitivity and specificity for presence/absence of saccades were moderately poor (less than 0.70).

None of these tests are adequate for screening patients in the out-patient clinic for vestibular disorders or for screening people in epidemiologic studies to determine the prevalence of vestibular disorders.