Relative diagnostic value of ocular vestibular evoked potentials and the subjective visual vertical during tilt and eccentric rotation.

OBJECTIVE We compared vibration-induced ocular vestibular evoked myogenic potentials (OVEMPs) with the visual vertical during whole-body roll tilt and eccentric rotation in healthy subjects and patients with unilateral vestibular loss, to determine which test was most sensitive in discriminating impaired utricle function. METHODS OVEMPs and the visual vertical were measured in 11 patients and 11 healthy subjects. Visual vertical was measured during roll tilts between -9.6° and 9.6°, and during rotation at 400°/s with the head upright and the vertical rotation axis located between ±3.5 cm from the head center. RESULTS OVEMPs in patients were strikingly asymmetric, whereas they were approximately symmetric in healthy subjects. Patients showed impaired visual vertical gain during eccentric rotation and increased errors for both roll tilt and eccentric rotation tests. OVEMPs were superior at discriminating between patients and healthy subjects, although eccentric rotation performed nearly as well. CONCLUSIONS OVEMPs provide a powerful test for discriminating between healthy subjects and patients with chronic unilateral vestibular loss, and testing the visual vertical testing during eccentric rotation was superior to testing during whole-body roll tilt. SIGNIFICANCE OVEMPs are easier to administer, less demanding on patients, and in general are more effective at identifying chronic unilateral vestibular loss than visual vertical measurements.