Assessment: Vestibular Testing Techniques in Adults and Children

Overview. Neurologists are frequently called upon to evaluate patients with vertigo and dizziness and, in some cases, to make sense of abnormal vestibular tests. Consequently, it is useful to have some familiarity with the methods used to test vestibular function. The vestibulo-ocular reflex (VOR) is a reflex that acts at short latency to generate eye movements that compensate for head rotations in order to preserve clear vision during locomotion. The VOR is the most accessible gauge of vestibular function. Evaluating the VOR requires application of a vestibular stimulus and measurement of the resulting eye movements. This report reviews the advantages and limitations of the methods of stimulating the vestibular system: caloric irrigation, rotational chair testing, and auto-rotational testing. Vestibular testing in children is given additional consideration because of the paucity of recent reviews on the topic. This report will not address eye movement recording techniques, the neurophysiology of the VOR, which is reviewed elsewhere, or interpretation of nystagmus.