Objective
To determine if some common screening tests predict scores on detailed, objective diagnostic tests of the vestibular system.
Study design
Sixty patients with vestibular disorders were compared to 60 asymptomatic controls.
Setting
Vestibular diagnostic laboratory, tertiary care center.
Subjects and Methods
Subjects were screened with head impulse tests (HT), Fukuda Stepping Tests while walking and marching in place, and tandem walking tests (TW) with eyes open and closed. All subjects had bi-thermal caloric tests and Dix-Hallpike maneuvers; patients had low frequency sinusoidal tests of the vestibulo-ocular reflex in darkness, and cervical vestibular evoked myogenic potentials.
Results
On TW patients differed significantly from controls but Receiver Operating Characteristic (ROC) scores were < 0.8. On Fukuda tests patients turned significantly more than controls for walking but not marching, but ROC values were considerably < 0.80. For HT patients with bi-thermal caloric weakness ≥ 20% and < 60% did not differ from controls but patients with severe bi-thermal caloric weakness, ≥ 60%, differed significantly from controls. ROC values were > 0.80 only for subjects with severe bi-thermal caloric weakness and were highest, 0.88, for subjects with severe weakness and age ≥ 60.
Conclusion
The Fukuda is a poor screening test because it does not correlate well with objective test findings. TW is best used for screening older patients for vestibular disorders. A positive HT is probably consistent with severe peripheral vestibular impairment and may be most useful in older patients. In younger patients with vertigo a negative HT may not be informative.