title: Utility of Stepping, Walking, and Head Impulses for Screening Patients for Vestibular Impairments.
abstract: To determine if some common screening tests predict scores on detailed, objective diagnostic tests of the vestibular system.
  
  
  
  Sixty patients with vestibular disorders were compared with 60 asymptomatic controls.
  
  
  
  Vestibular diagnostic laboratory, tertiary care center.
  
  
  
  Subjects were screened with head impulse tests, Fukuda stepping tests while walking and marching in place, and tandem walking tests with eyes open and closed. All subjects underwent bithermal caloric tests and Dix-Hallpike maneuvers; patients underwent low-frequency sinusoidal tests of the vestibulo-ocular reflex in darkness and cervical vestibular evoked myogenic potentials.
  
  
  
  On tandem walking tests, patients differed significantly from controls, but receiver operating characteristic scores were < 0.80. On Fukuda tests, patients turned significantly more than controls for walking but not marching, but receiver operating characteristic values were considerably less than 0.80. On head impulse tests, patients with bithermal caloric weakness (≥20% and <60%) did not differ from controls, but patients with severe bithermal caloric weakness (≥60%) differed significantly from controls. Receiver operating characteristic values were >0.80 only for subjects with severe bithermal caloric weakness and were highest, at 0.88, for subjects with severe weakness and age ≥ 60 years.
  
  
  
  The Fukuda test is a poor screening test because it does not correlate well with objective test findings. Tandem walking is best used for screening older patients for vestibular disorders. Positive findings on a head impulse test are probably consistent with severe peripheral vestibular impairment and may be most useful in older patients. In younger patients with vertigo, negative results on head impulse tests may not be informative.
authors.affiliation: Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA hcohen@bcm.edu.
authors.forename: Helen S
authors.initials: HS
authors.lastname: Cohen
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Haleh
authors.initials: H
authors.lastname: Sangi-Haghpeykar
authors.affiliation: Division of Otoneurology, Department of Otolaryngology-Head and Neck Surgery, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Natalia A
authors.initials: NA
authors.lastname: Ricci
authors.affiliation: Baylor College of Medicine, Houston, Texas, USA.
authors.forename: June
authors.initials: J
authors.lastname: Kampangkaew
authors.affiliation: Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Williamson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002150:Caloric Tests; D016022:Case-Control Studies; D005260:Female; D064087:Head Impulse Test / Q000379:methods; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010808:Physical Examination; D004856:Postural Balance; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D015837:Vestibular Diseases / Q000175:diagnosis* / Q000503:physiopathology; D014724:Vestibular Function Tests; D016138:Walking
keywords: Fukuda stepping test; diagnosis; head impulse test; tandem walking; vestibular system