Management of Abnormal Vestibular-Ocular Reflex (VOR) Results

Understanding the Test Results

The American Academy of Otolaryngology-Head and Neck Surgery indicates that rotatory chair test results showing abnormal VOR gain values and asymmetry percentages are indicative of bilateral vestibular dysfunction 1, 2

The American Academy of Otolaryngology-Head and Neck Surgery recommends considering additional vestibular pathology beyond BPPV, such as Ménière's disease, vestibular neuritis, or labyrinthitis, in patients with abnormal rotatory chair results 1, 3
Discordance between different vestibular test results is common in vestibular disorders, particularly Ménière's disease, where caloric testing may show abnormalities while other tests remain normal 4, 2

The American Academy of Otolaryngology-Head and Neck Surgery suggests that vestibular rehabilitation therapy should be initiated immediately to promote central compensation for the vestibular deficit, including habituation exercises, adaptation exercises for gaze stabilization, and balance training 5

If BPPV is suspected, the American Academy of Otolaryngology-Head and Neck Surgery recommends performing appropriate canalith repositioning procedures 1, 5
For patients with significant balance issues, fall prevention strategies should be implemented as vestibular dysfunction significantly increases fall risk 5

Reassessing patients within one month after initial treatment to document resolution or persistence of symptoms is recommended by the American Academy of Otolaryngology-Head and Neck Surgery 5
If symptoms persist, considering repeating vestibular function testing to assess for progression or evaluating for additional or alternative vestibular disorders is suggested 1, 3, 5

Vestibular dysfunction can significantly impact quality of life, affecting balance, mobility, and increasing fall risk, according to the American Academy of Otolaryngology-Head and Neck Surgery 6, 5

Relying solely on medication for management of chronic vestibular dysfunction is a common pitfall to avoid, as stated by the American Academy of Otolaryngology-Head and Neck Surgery 5
Failing to initiate vestibular rehabilitation, which is crucial for promoting central compensation, is another pitfall to avoid 5
Overlooking the possibility of multiple concurrent vestibular disorders is also a common mistake, according to the American Academy of Otolaryngology-Head and Neck Surgery 1, 7

The American Academy of Otolaryngology-Head and Neck Surgery recommends against the routine use of vestibular suppressant medications, such as antihistamines and benzodiazepines, as primary treatment for vestibular disorders, as they can delay central vestibular compensation and have side effects like drowsiness 8
The American Academy of Otolaryngology-Head and Neck Surgery suggests that advanced age may require more prolonged rehabilitation programs, and comorbidities like cervical stenosis, severe rheumatoid arthritis, or cervical radiculopathy may require adapted protocols 9

The American Academy of Otolaryngology-Head and Neck Surgery recommends reevaluating patients within the first month after initial treatment, and if symptoms persist, considering adjustments to the rehabilitation program, evaluation for additional or alternative vestibular disorders, or repeating vestibular function tests to assess progression 10