Prospective study on Otolith Dysfunction in Vertigo: Clinical Correlation with Subjective Visual Vertical

Otolith dysfunction is a term for problems with the otolith organs (saccule and utricle). Patients with dizziness show abnormal findings in otolith function tests despite semicircular canal (SCC) function being normal. It has also been reported that patients with abnormal otolith function lab findings have a greater likelihood of swaying or rocking type or floating dizziness. There is no consensus on symptom definition and diagnostic criteria, standardized tests for assessment of otolith dysfunction, so leading to delay in identification cause for vertigo and treatment. To study the clinical presentation of individuals with otolith dysfunction and its clinical correlation with Subjective Visual Vertical (SVV) in peripheral vestibular disorder. Prospective study. Detailed history, neuro-otological evaluation was done after initial calibration for each patient. Subjective visual Vertical (SVV) (static, clock wise, anti-clock wise), Dynamic visual acuity, Cranio-corporography, Video-nystagmogram, test for Saccades, Positional test for all the 3 semi-circular canals (lateral, posterior, anterior), Dizziness Handicap Inventory (DHI) were recorded on day of testing, one month and 6 months and analyzed for 21 patients who had only SVV abnormality. The treatment was combination of methylcobalamain 1500 mg for patients with low vitamin B 12 levels, estilopram for patients with anxiety and vestibular rehabilitation exercises (VRT) for all patients. The common age group in our study was between 51-60 years in 9 patients, followed by 41-50 years in 5 patients. The duration of symptoms was less than one minute in 13 patients, the duration was less than 2 hours in 8 patients. The type of vertigo experienced was spin/ rotation sensation in 13 patients, unsteadiness in 5 patients, pushing sensation in 2, sensation of fall in1 patient. The abnormality in SVV was static and anticlockwise in 8 patients, followed by static, clockwise and anticlockwise in 7 patients. The DHI improvement was present in all 21 patients at the end of 6 months, with 15 patients having DHI below 10 and 11-20 in 5 patients. Thus, Subjective visual Vertical (SVV) can be a reliable marker for diagnosing isolated otolith dysfunction provided all other tests are normal.