title: Insensitivity of the "Romberg test of standing balance on firm and compliant support surfaces" to the results of caloric and VEMP tests.
abstract: OBJECTIVE
  The objective of this study was to assess the sensitivity, specificity, and positive and negative predictive value of the Romberg Test of Standing Balance on Firm and Compliant Support Surfaces (RTSBFCSS) for the identification of patients with vestibular system impairments affecting the horizontal semicircular canal, saccule, and/or inferior and superior vestibular nerves. The RTSBFCSS was developed for the National Health and Nutrition Examination Survey (NHANES) and was used recently to estimate the numbers of individuals aged 40 yr or older with vestibular system impairments among the general population of the United States.
  
  
  METHODS
  A retrospective analysis of the medical records of 103 consecutive patients aged 40 yr or older (mean age 59 ± 12 yr, 71 females) who had undergone vestibular assessment at the Balance Disorders Clinic at the Vanderbilt University School of Medicine. Patients with complete electro- or videonystagmography testing, cervical vestibular evoked myogenic potential (cVEMP) testing, and the RTSBFCSS screening test were included in the analysis. A series of 2 × 2 tables were created that represented the number of "true positives," "true negatives," "false positives," and "false negatives" of the RTSBFCSS under conditions where the caloric test was abnormal and then separately where the cVEMP test was abnormal. The data were analyzed in a manner such that sensitivity, specificity, and both positive and negative predictive value of the RTSBFCSS could be calculated.
  
  
  RESULTS
  When the caloric test was used as the criterion standard and the subject selection criteria in the NHANES study were used (i.e., subjects who were able to maintain postural stability for trials 1-3 of the RTSBFCSS; N = 45), the sensitivity and specificity of the RTSBFCSS to impairment of the horizontal semicircular canal or superior vestibular nerve were 55% and 64%, respectively, yielding positive and negative predictive values of 55% and 64%, respectively. When all patients aged 40 yr or older were evaluated (N = 103), the sensitivity and specificity were 61% and 58%, respectively, yielding positive and negative predictive values of 39% and 78%, respectively. Using the cVEMP test as the criterion standard for the detection of impairment affecting the saccule and/or inferior vestibular nerve did not improve the performance criteria of the NHANES screening measure.
  
  
  CONCLUSIONS
  The RTSBFCSS should not be used as a screening measure for vestibular impairment.
authors.affiliation: Division of Vestibular Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA. gary.jacobson@vanderbilt.edu
authors.forename: Gary P
authors.initials: GP
authors.lastname: Jacobson
authors.forename: Devin L
authors.initials: DL
authors.lastname: McCaslin
authors.forename: Erin G
authors.initials: EG
authors.lastname: Piker
authors.forename: Jill
authors.initials: J
authors.lastname: Gruenwald
authors.forename: Sarah
authors.initials: S
authors.lastname: Grantham
authors.forename: Lauren
authors.initials: L
authors.lastname: Tegel
mesh_terms: D000328:Adult; D000368:Aged; D002150:Caloric Tests; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D004856:Postural Balance / Q000502:physiology*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012444:Saccule and Utricle / Q000503:physiopathology; D012665:Semicircular Canals / Q000503:physiopathology; D012680:Sensitivity and Specificity; D015837:Vestibular Diseases / Q000175:diagnosis* / Q000503:physiopathology*; D058585:Vestibular Evoked Myogenic Potentials; D014724:Vestibular Function Tests / Q000379:methods / Q000592:standards*; D014725:Vestibular Nerve / Q000503:physiopathology