Vestibular Disorders

Indications for Vestibular Testing

Vestibular testing, including VEMP, is indicated in patients with atypical presentations, such as unusual or equivocal nystagmus findings, suspected additional vestibular pathology, failed response to treatment, or frequent recurrences of vestibular disorders, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1, 2
VEMP testing is specifically recommended prior to ablative procedures to assess vestibular function, according to the American Academy of Otolaryngology-Head and Neck Surgery 3
The American Academy of Otolaryngology-Head and Neck Surgery suggests vestibular testing for patients with failed response to treatment, particularly after multiple canalith repositioning procedures for BPPV 1

The American Academy of Otolaryngology-Head and Neck Surgery recommends Canalith Repositioning Procedures (CRP), such as the Epley maneuver, as first-line treatment for BPPV, with success rates of 80-90% for uncomplicated BPPV 1
Patient education about natural history and symptom control is essential, as emphasized by the American Academy of Otolaryngology-Head and Neck Surgery 3
Treatment for bilateral vestibular hypofunction should focus on preventing falls and improving quality of life, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 3

Abnormal VEMPs in recurrent BPPV suggest underlying otolith dysfunction, according to the American Academy of Otolaryngology-Head and Neck Surgery 1
Caloric testing results, including unilateral weakness >25% and directional preponderance >30%, can indicate peripheral vestibular hypofunction or incomplete compensation 3, 4
vHIT results, including catch-up saccades, can indicate canal dysfunction, and discordance with caloric testing is common in Menière's disease 3
VEMP results, including absent or reduced amplitude and elevated thresholds, can suggest otolith dysfunction or evolving bilateral Menière's disease 1, 3
Rotational chair testing results, including low gain and phase abnormalities, can indicate vestibular hypofunction or central disorders 1
Normal vestibular test results do not rule out BPPV, and fluctuating results are common throughout the disease course 1, 3
Absent VEMPs after treatment correlate with symptom improvement, according to the American Academy of Otolaryngology-Head and Neck Surgery 3

Overreliance on testing can lead to neglect of clinical diagnosis, which remains paramount for common disorders like BPPV, as cautioned by the American Academy of Otolaryngology-Head and Neck Surgery 1, 2
Ignoring discordant results can lead to misdiagnosis, as different tests assess different frequencies and parts of the vestibular system 3
Failing to consider medication effects, such as vestibular suppressants, can affect test results
Missing central causes, such as abnormal smooth pursuit or saccades, can lead to incomplete diagnosis, as noted by the American Academy of Otolaryngology-Head and Neck Surgery 1
Overlooking comorbidities, such as multiple vestibular disorders, can lead to inadequate treatment, as emphasized by the American Academy of Otolaryngology-Head and Neck Surgery 1