Autorotation test of the horizontal vestibulo-ocular reflex in Menière's disease

Sixty-four patients with the diagnosis of Menière's disease were tested at the House Ear Clinic with an active head-rotation test system, the Vestibular Autorotation Test (VAT). The VAT is a portable, computerized test that measures the horizontal vestibulo-ocular reflex (VOR) with the use of high-frequency (2 to 6 Hz) active head movements to obtain gain and phase. The purpose of this study was to characterize the horizontal VOR at high frequencies in patients with Menière's disease. At frequencies from 5 to 6 Hz, all patients demonstrated horizontal phase greater than 180 degrees and 85% showed abnormal VAT results. The most common patterns were decreased gain or increased phase values, or both, relative to normative data. No significant differences in the degree of abnormality in gain and phase were noted among groups of patients when the patients were clinically staged. We conclude that, in our test population of patients with Menière's disease, the VAT shows common gain and phase patterns and abnormalities of the horizontal VOR. This may contribute to high retinal image velocities, which render the patient unable to stabilize retinal images during locomotion (visual field image slip), in as many as 85% of the patients tested, regardless of clinical stage. Such high-frequency testing can reveal abnormalities of the horizontal VOR not apparent from conventional vestibular testing. Thus VAT provides additional information about the functioning VOR when combined with the present vestibular test battery.