Advances in Testing – There is more to the vestibular system than the horizontal semi-circular canal

Contact Name: Jas Sandhu

Contact Email: jas.sandhu@nhs.net

Dr Jas Sandhu (Academic Foundation Doctor) started his career as a physical scientist, gaining MPhys and PhD degrees in Physics from the Universities of Southampton and Cambridge respectively. He returned to Southampton to complete his MSc in Audiology before moving to the RSCH in Brighton where he underwent his clinical training. He has published several seminal papers on ocular VEMPs and is faculty member of several international balance courses. He is currently working for University of Sheffield Teaching Hospitals trust as an Academic Foundation Doctor (General Surgery). He has a specialist interest in vestibular disorders and his research is primarily focused on developing the cervical and ocular versions of the Vestibular Evoked Myogenic Potential (VEMP).

Patients presenting with imbalance and dizziness often undergo a battery of audiovestibular tests that are designed to determine the functional state of the hearing and balance organs. Traditionally the vestibular system has been probed using the bithermal caloric test. Despite the fact that it is often poorly tolerated by patients and only provides low frequency information relating to the lateral semicircular canal, it has retained its position as the cornerstone of vestibular assessment.

Recent advances in basic research and technology have provided clinicians with a number of new methods for determining vestibular function. These include video head-impulse testing (of all three canals), cervical VEMPs and ocular VEMPs. Combining these new techniques with the established repertoire now allows the possibility to more fully establish sites of lesion, which can help in shaping management strategies.

Despite the advent of these new assessment methods, there remains an inertia associated with integrating them into clinical practice. There are many reasons for this including, financial issues, training needs as well as scepticism of their clinical value. In this paper we will discuss these new methods and the latest evidence relating to their scientific underpinning as well as their clinical usefulness.

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