[Comments on the article by Drs. Koike and Mizukoshi, "the role of optokinetic nystagmas in statokinetic function tests"].
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Seven patients with bilateral vestibular dysfunction were investigated with a new broad frequency oscillatory test. The vestibular stimulation was of two types: a pseudo-random oscillation in the frequency range 0.5-4 Hz and a sinusoidal frequency sweep from 0.5 to 3.5 Hz. Compensatory eye movements were recorded by EOG. Gain and phase values between eye and head movements were extracted using power spectral analysis technique. Two different visual conditions were used: 1) fixating a stationary target and /) fixating a moving target (visual suppression test). At high frequencies all patients showed a reduced VOR gain compared to normal subjects. At low frequencies gain values were close to normal when using a predictable (sinusoidal) stimulation. With a non-predictable (pseudo-random) stimulation gain values were significantly reduced even at low frequencies. The patients with the most severe loss showed a phase lag at higher frequencies (condition 1). The results in the oscillatory test were compared to subjective symptoms and caloric responses. The new test appears to be better suited to assess the vestibular function in patients with suspected bilateral vestibular loss than the caloric test or other traditional procedures.
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Interpretation of vestibular test results derived from rotational and other electronystagmography studies often give confusing diagnostic and prognostic information. We have reviewed 90 consecutive patients seen in the Vestibular Clinic at the University of Texas Medical Branch comparing the accuracy of the damped torsion swing test (DTS) with a conventional vestibular test battery (VTB) to predict vestibular function abnormality (peripheral or central). These predictions were compared with vestibular diagnoses obtained by long-term follow-up (24-36 months). VTB and DTS results were evaluated in a double-blind study by two of the authors (W.C.L. and M.J.C.). Agreement of both VTB and DTS interpretation was uncommon (23/77) (30%); however, when present, it resulted in a 91% accuracy in predicting correct final diagnosis. Where VTB and DTS diagnoses differed, the DTS was more accurate in determining final vestibular system abnormality. In fact, while DTS testing correctly detected abnormality in 17 patients, the VTB was normal in 11. Rotation testing alone may provide a useful and accurate screening test prior to initiating further vestibular testing, particularly when central pathology is suspected.