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What Is Useful in Vestibular Testing?

This review compares the efficiency of currently available test for diagnosing patients suffering vertigo based upon our experience since 1991 in the ORL Department of the Robert Debré Pediatric Hospital in Paris. A battery of instrument-based tests were adapted for children including testing the canal system (caloric bithermal test, earth vertical axis rotation and pendular rotation), testing the otolith system (off-vertical axis rotation, subjective vertical and horizontal measurement, vestibular myogenic potentials). This battery of tests was always preceded by a complete neurovestibular examination which included many tests that attempt to reproduce the same vestibular stimulation as the instrument-based tests. The usefulness of the respective instrument-based tests depends upon the investigative priorities determined by the characteristics of each case: beside the priority for determining the etiology of the vertigo, it can also be essential to date the onset of the inner ear disease, to evaluate the degree of fluctuation of vestibular function, to assess of completeness of a vestibular lesion, or establish a report of lesions for insurance or legal purposes. For 80–85% of cases of equilibrium problems in children, the minimum testing required for diagnosis is confined to a complete clinical vestibular and neurological examination as well as a caloric test. The more specialized tests become necessary for evaluations of variability or progressiveness of a vestibular impairment, comparisons of results between successive examinations, and assessment of the completeness of a vestibular lesion.