title: The high-frequency/acceleration head heave test in detecting otolith diseases.
abstract: OBJECTIVE
  To investigate whether transient, high-acceleration interaural head heaves (translational vestibulo-ocular reflex [tVOR]) could aid in the diagnosis of otolith diseases.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Thirteen patients with symptoms suggestive of otolith diseases and 10 age-matched controls.
  
  
  METHODS
  Patients underwent a clinical otoneurologic examination and standard laboratory audiovestibular evaluation, including audiometry, electronystagmography with bithermal caloric, Halmagyi-Curthoys head thrust test with search coils, and vestibular-evoked myogenic potential. All subjects underwent subjective visual vertical (SVV) and tVOR testings.
  
  
  METHODS
  Sensitivity (ratio of peak eye to peak head velocities) and velocity gain (ratio of actual to ideal peak eye velocities).
  
  
  RESULTS
  Five of 13 patients showed no abnormality in any tests. Of the remaining 8, 3 (38%) had reduced tVOR responses, whereas 1 (13%) had abnormal SVV. Sensitivity and velocity gains were symmetrically reduced in 2 patients, who had symptoms for 8 and 24 months. A third patient, symptomatic for 7 weeks, had asymmetric reduction of tVOR responses and a deviated SVV.
  
  
  CONCLUSIONS
  Both head heave and SVV tests detect acute, asymmetric otolith diseases. Subjective visual vertical test relies on imbalance of utricular tone and may not detect bilateral symmetric diseases or partial diseases with central compensation. Our preliminary data in a small group of patients show that measuring the tVOR in a higher and more physiologic range of frequencies may serve as useful adjunct to detect acute and chronic otolith dysfunction and seems to be superior to the SVV in detecting bilateral symmetric or asymmetric otolith diseases.
authors.affiliation: Department of Otolaryngology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Kessler
authors.forename: David
authors.initials: D
authors.lastname: Tomlinson
authors.forename: Alan
authors.initials: A
authors.lastname: Blakeman
authors.forename: John
authors.initials: J
authors.lastname: Rutka
authors.forename: Paul
authors.initials: P
authors.lastname: Ranalli
authors.forename: Agnes
authors.initials: A
authors.lastname: Wong
mesh_terms: D000054:Acceleration; D000328:Adult; D000368:Aged; D001299:Audiometry; D002150:Caloric Tests; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D004584:Electronystagmography; D005133:Eye Movements / Q000502:physiology; D005260:Female; D019416:Head Movements / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009759:Nystagmus, Pathologic / Q000175:diagnosis; D010037:Otolithic Membrane; D010775:Photic Stimulation; D011446:Prospective Studies; D012027:Reflex, Vestibulo-Ocular / Q000502:physiology; D015837:Vestibular Diseases / Q000175:diagnosis*; D014724:Vestibular Function Tests