Can a video oculography–based ocular counter-roll measurement be used as a clinical test of otolith function?
In this case-control study of 56 individuals, video ocular counter-roll measurement with a simple bedside head tilt maneuver could detect patients with loss of vestibular function and healthy controls. The technique had a diagnostic accuracy of 83%.
The video ocular counter-roll (vOCR) test can be performed with a simple bedside maneuver to detect or track loss of otolith function.
Video-oculography (VOG) goggles have been integrated into the assessment of semicircular canal function in patients with vestibular disorders. However, a similar bedside VOG method for testing otolith function is lacking.
To evaluate the use of VOG-based measurement of ocular counter-roll (vOCR) as a clinical test of otolith function.
Design, Setting, and Participants
A case-control study was conducted to compare vOCR measurement among patients at various stages of unilateral loss of vestibular function with healthy controls. The receiver operating characteristic curve method was used to determine the diagnostic accuracy of the vOCR test in detecting loss of otolith function. Participants were recruited at a tertiary center including the Johns Hopkins outpatient clinic and Johns Hopkins Hospital, Baltimore, Maryland. Participants included 56 individuals with acute (≤4 weeks after surgery), subacute (4 weeks-6 months after surgery), and chronic (>6 months after surgery) unilateral vestibular loss as well as healthy controls. A simple bedside maneuver with en bloc, 30° lateral tilt of the head and trunk was used for vOCR measurement. The study was conducted from February 2, 2017, to March 10, 2019.
In each participant vOCR was measured during static tilts of the head and trunk en bloc.
Main Outcomes and Measures
The vOCR measurements and diagnostic accuracy of vOCR in detecting patients with loss of vestibular function from healthy controls.
Of the 56 participants, 28 (50.0%) were men; mean (SD) age was 53.5 (11.4) years. The mean (SD) time of acute unilateral vestibular loss was 9 (7) days (range, 2-17 days) in the acute group, 61 (39) days (range, 28-172 days) in the subacute group, and 985 (1066) days (range 185-4200 days) in the chronic group. The vOCR test showed reduction on the side of vestibular loss, and the deficit was greater in patients with acute and subacute vestibular loss than in patients with chronic loss and healthy controls (acute vs chronic: −1.81°; 95% CI, −3.45° to −0.17°; acute vs control: −3.18°; 95% CI, −4.83° to −1.54°; subacute vs chronic: −0.63°; 95% CI, −2.28° to 1.01°; subacute vs control: −2.01°; 95% CI, −3.65° to −0.36°; acute vs subacute: −1.17°; 95% CI, −2.88° to 0.52°; and chronic vs control: −1.37°; 95% CI, −2.96° to 0.21°). The asymmetry in vOCR between the side of vestibular loss and healthy side was significantly higher in patients with acute vs chronic loss (0.28; 95% CI, 0.06-0.51). Overall, the performance of the vOCR test in discriminating between patients with vestibular loss and healthy controls was 0.83 (area under the receiver operating characteristic curve). The best vOCR threshold to detect vestibular loss at the 30° tilt was 4.5°, with a sensitivity of 80% (95% CI, 0.62%-0.88%) and specificity of 82% (95% CI, 0.57%-1.00%).
Conclusions and Relevance
The findings of this case-control study suggest that the vOCR test can be performed with a simple bedside maneuver and may be used to detect or track loss of otolith function.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Sadeghpour S, Fornasari F, Otero-Millan J, Carey JP, Zee DS, Kheradmand A. Evaluation of the Video Ocular Counter-Roll (vOCR) as a New Clinical Test of Otolith Function in Peripheral Vestibulopathy. JAMA Otolaryngol Head Neck Surg. Published online March 25, 2021. doi:10.1001/jamaoto.2021.0176
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: