The Most Common Audiovestibular Laboratory Tests, and the Specific Conditions in Which They May Assist in Making or Supporting the Diagnosis

VN = vestibular neuritis; VM = vestibular migraine; VP = vestibular paroxysmia; vHIT = video head impulse test; VNG = video-nystagmography; ENG = electronystagmography; VOG = video-oculography; VEMPs = vestibular evoked myogenic potentials; SCDS = superior canal dehiscence syndrome; BPPV = benign paroxysmal positional vertigo; BVL = bilateral vestibular loss; PPPD = persistent postural perceptual dizziness (no specific test is helpful to make this diagnosis, but patients often develop PPPD as the result of another poorly treated or anxiety-provoking vestibular disorder - e.g., vestibular migraine, BPPV or vestibular neuritis) - Not usually helpful + May be helpful ++ Very helpful 1 In the acute setting when spontaneous nystagmus is present 2 During provocative maneuvers (including Valsalva, pinched-nose Valsalva, tragal compression, loud sounds, Dix-Hallpike/supine roll test, hyperventilation) 3 Rotary chair may show slightly low time constants and gains with unilateral vestibular loss, and may show prolonged time constants in migraine 4 Depending on the posterior fossa localization, there may be caloric weakness with some strokes 5 VEMPs may assist in the localization of inferior versus superior division vestibular neuritis 6 Neuroimaging is needed (MRI internal auditory canal [IAC]) protocol w/wo) in migraine and Meniere's cases where there is diagnostic uncertainty or atypical features. In SCDS, CT temporal bones is the test of choice. For vestibular paroxysmia, heavily T2-weighted CISS or FIESTA imaging. In BVL, if the cause is clearly ototoxicity from gentamicin for instance, neuroimaging will not be helpful. Otherwise, neuroimaging is essential. For additional reading on audiometry: https://collections.lib.utah.edu/details?id=1306738 For additional reading on vHIT: https://collections.lib.utah.edu/ark:/87278/s62n91vq For additional reading on VNG, ENG, and VOG: https://collections.lib.utah.edu/ark:/87278/s6fz193n For additional reading on rotary chair: https://collections.lib.utah.edu/ark:/87278/s6b60jbs For additional reading on calorics: https://collections.lib.utah.edu/ark:/87278/s6kq21sh For additional reading on VEMPs: https://collections.lib.utah.edu/ark:/87278/s66d9smh