Does High‐Frequency Pseudo‐random Rotational Chair Testing Increase the Diagnostic Yield of the ENG Caloric Test in Detecting Bilateral Vestibular Loss in the Dizzy Patient?

Objectives To assess the incremental diagnostic yield of testing vestibulo‐ocular (VOR) gain with high‐frequency pseudo‐random rotational chair (PsRRC) over testing with bithermal electronystagmography caloric tests in the dizzy patient, particularly in detecting bilateral vestibular loss. Patients and Methods One hundred ninety‐eight patients presenting with dizziness underwent PsRRC and caloric testing. The VOR gain on PsRRC was measured at 0.32 to 5.0 Hz, with gain categorized as normal or decreased. PsRRC results were compared with caloric responses, also categorized as normal, or into graded categories of unilateral or bilateral vestibular loss. Results Reduced PsRRC gain was found in 29 (15%) patients, and reduced caloric tests responses in 70 (35%), with 25 (13%) having bilateral loss. Of patients with reduced chair gain, 25 of 29 (86%) demonstrated bilateral caloric loss. PsRRC gain was normal in most patients with unilateral caloric weakness, but was decreased in all patients with bilateral caloric weakness. The probability of a patient with completely normal caloric responses having an abnormal rotation chair in this study group was under 1% (1 of 128). Conclusions PsRRC testing does not offer much additional diagnostic benefit when caloric responses are normal. It is useful in specific conditions, such as unilateral caloric loss for which the patient is not compensating, borderline caloric loss when traditional water caloric tests cannot be used, or for monitoring progressive bilateral vestibular loss.