- Original Article
- Open Access
Rotational chair testing in patients with unilateral peripheral vestibular disorders
The Egyptian Journal of Otolaryngology volume 31, pages115–121(2015)
The aim of the study was to evaluate the rotational chair (RC) sinusoidal harmonic acceleration (SHA) test and the rotational velocity step (RVS) test in patients with unilateral peripheral vestibular disorders.
This study was retrospective in nature.
It was conducted in a clinical tertiary care vestibular function test center.
A total of 119 patients (63 men and 56 women) with documented unilateral peripheral vestibular lesions were evaluated with bithermal binaural caloric and sinusoidal and step velocity RC tests.
Clinical, caloric, and RC tests were carried out.
Patients and methods
The study group was selected by including patients with a clinical diagnosis suggestive of peripheral vestibular lesions and with documented unilateral caloric weakness matching the clinical diagnosis, and by excluding patients with a clinical diagnosis suggestive of a peripheral vestibular lesion but not documented by unilateral caloric weakness, as well as patients with incomplete tests or uninterpretable data (due to poor recordings or eye movement artifacts). Caloric testing was performed using an infrared video-oculographic system and a Brookler-Grams closed-loop irrigation unit with standard bithermal irrigations of 30 and 44°C for 45 s each in the following order: L30°C, R30°C, R44°C, and L44°C. The RC testing paradigms used in this study were the rotational SHA test and the RVS test.
When patients were classified on the basis of etiology, the most common cause of dizziness in the study group was found to be Mιniθre’s disease (34.9%), followed by vestibular neuritis (31.1%). Seventy-two patients in the study group demonstrated right caloric weakness and 47 patients demonstrated left caloric weakness, whereas only 18 of 119 patients demonstrated directional preponderance. When the RC SHA test parameters (gain, phase, and symmetry) in the study group were compared with the manufacturer’s normal values, statistically significant difference was seen in vestibulo-ocular reflex (VOR) gain at low frequencies (0.01-0.08 Hz), in VOR phase at all frequencies, and in VOR symmetry at low frequencies (0.01-0.04 Hz).
In summary, despite the encouraging results of the discriminating power of caloric testing, it should be emphasized that RC testing has its own unique capabilities, such as the following: (i) it is a physiologic stimulus whose frequency and amplitude can be varied precisely; (ii) the stimulus is unrelated to physical features of the external ear or temporal bone; (iii) it is useful in children who may not tolerate caloric testing; and (iv) it is very useful in assessing patients receiving vestibulotoxic drugs. Multiple stimuli of varying intensities can be applied to the vestibular system within a relatively short period of time.
Gianoli GJ. Fluctuating vestibular disease. In: Goebel JA, editor. Practical management of the dizzy patient. Philadelphia: Lippincott Williams & Wilkins; 2001. 211–224.
Black O. Equilibrium [Editorial]. Otolaryngol Head Neck Surg 1986; 106: 16–18.
Furman J, Cass S. Laboratory evaluation: electronystagmography and rotational testing [Chapter 17]. In: Baloh RW, Halmagyi GM, editors. Disorders of the vestibular system. New York: Oxford University Press; 1996. 11–19.
Shepard NT. Rotational chair testing. In: Goebel JA, editor. Practical management of the dizzy patient. Philadelphia: Lippincott Williams & Wilkins; 2001. 129–142.
Hamid MA, Samy HM (eds). Vestibular and Balance Rehabilitation. In: Hamid M, Sismanis A, Eds. Medical Otology & Neurotology. New York, NY: Thieme; 2006; Ch. 3:75–91.
Zee DS. Evaluation of the patient with dizziness. In: Cummings CW, editor. Otolaryngology — head and neck surgery. 3rd ed. St. Louis: Mosby Year Book 1998; 4:2623–2667.
Cass SP. Testing the vestibule-ocular reflex. In: Goebel JA, editor. Practical management of the dizzy patient. Philadelphia: Lippincott Williams & Wilkins; 2001. 77–81.
Amin M. Rotational chair testing. eMed J 2001; 2: 9.
Kamal N, Tawfik S, Ishak Abumosa H. Electrocochleography in patients with Meniere’s disease. Egypt Soc Otolaryngol 1995; 1: 2.
Kamal N, Hazzah N, El Danasory I. Otoacoustic emissions measurement in Meniere’s disease. Ain Shams Med J 1996; 16–21.
Stahle J, Arenberg K. Incidence of Ménière’s disease. Arch Otolaryngol 1978; 104: 99–102.
Tokumaso K, Fujino A, Naganuma H, Hoshino I. Initial symptoms and retrospective valuation of prognosis in Ménière’s disease. Acta Otolaryngol Suppl 1995; 524: 43–49.
El-Gohary M, Kamal N, Abdel-Maksoud A, El Kabrity R. Vestibular testing at high frequency range (MSc thesis); 2000. Ain Shams University, Egypt.
Haid C, Watermier D, Wolf S. Clinical survey of Ménière’s disease: 574 cases. Acta Otolaryngol Suppl 1995; 520: 251–255.
Stahle J. Long-term progression of Ménière’s disease. Acta Otolaryngol Suppl 1991; 485: 78–83.
Takahashi S, Fetter M, Koenig E, Dichgans J The clinical significance of head-shaking nystagmus in the dizzy patient. Acta Otolaryngol 1990; 109: 8–14.
Shepard NT, Telian SA. Practical management of the balance disorder patient. San Diego: Singular Publishing Group; 1996.
Jacobson GP, Newman CW, Hunter L, Balzer GK. Balance function test correlates of the Dizziness Handicap Inventory. J Am Acad Audiol 1991; 2: 253–260.
Shepard NT, Telian SA. Evaluation of balance system function. In: Katz J, Ruth RA, editors. Handbook of clinical audiology. 4th ed. Baltimore: Lippincott Williams & Wilkins; 1994. 424–427.
Baloh RW, Honrubia V. Clinical neurophysiology of the vestibular system. 2nd ed. Philadelphia: F.A. Davis; 1990.
Koizuka I, Yamakawa J, Naramura H, Kubo T. Time course of vestibular function in patients with Menière’s disease following vestibular nerve section. Acta Otolaryngol Suppl 1995; 519: 234–237.
Baloh RW, Sills AW, Honrubia V. Impulsive and sinusoidal rotatory testing: a comparison with results of caloric testing. Laryngoscope 1979; 89: 646–654.
Palomar-Asenjo V, Boleas-Aguirre MS, Sánchez-Ferrándiz N, Perez Fernandez N Caloric and rotatory chair test results in patients with Ménière’s disease. Otol Neurotol 2006; 27: 945–950.
Conflicts of interest
About this article
Cite this article
Ahmed, M.F.M. Rotational chair testing in patients with unilateral peripheral vestibular disorders. Egypt J Otolaryngol 31, 115–121 (2015). https://doi.org/10.4103/1012-5574.156095
- caloric test
- rotational chair test
- time constant