Doettl SM (2017) Peripheral Vestibular Evaluation - A New Horizon. Int J Clin Exp Otolaryngol. 3(1e), 1-3. 1 OPEN ACCESS http://scidoc.org/IJCEO.php International Journal of Clinical & Experimental Otolaryngology (IJCEO) ISSN 2572-732X Peripheral Vestibular Evaluation - A New Horizon Editorial Doettl SM * Associate Professor, The University of Tennessee Health Science Center, College of Health Professions, Department of Audiology and Speech Pathol- ogy, Knoxville, TN, USA. Vertigo, imbalance, and dizziness are reported with a 1-year prevalence in the adult population of 48.3%, 39.1%, and 35.6% respectively [1]. Falls in the elderly represent 2.8 million emergency departments visits each year [2]. Reportedly, 5-8% of children will experience vertigo in the general population [3-5]. These statistics exemplify a signiicant public health issue with signiicant implications across populations. There is universal agreement that any investigation for reported vertigo, imbalance, and dizziness begins with a thorough medical evaluation. Regardless of the patient population or presenting symptoms it is imperative to irst determine if any acute or chronic underlying medical conditions exist. This is, of course, not a simple task as the sheer number of possible pathologies resulting in vertigo, dizziness, and imbalance is daunting. Often, quantitative evaluations can be quite valuable in guiding medical management decisions. Peripheral vestibular evaluation speciically can provide quantitative information as part of the overall medical evaluation for patients reporting vertigo, dizziness, and/or imbalance. Electronystagmography (ENG), videonystagmography (VNG) and rotary chair testing (RCT) comprise a typical peripheral vestibular evaluation. Electrophysiologic measures such as auditory brainstem response (ABR) and electrocochleography (ECOG) may also be useful in the evaluation of select peripheral vestibular disorders. These protocols, in the absence of additional techniques, provide information about peripheral vestibular function and in many cases, prove effective and eficient. Of course, these techniques also have inherent challenges that can limit their overall effectiveness across a wide range of populations in both the clinic and in the scientiic community. When assessing for peripheral vestibular hypofunction, either to conirm or rule out dysfunction, ENG/VNG and RCT only assess the horizontal semicircular canals (SCCs) and the superior division of vestibular nerve of the VIII cranial nerve. Additionally, caloric irrigation is an evaluation of non-physiologic low-frequency stimulation of the horizontal SCCs with RCT representing low- to mid-frequency stimulation. Neither caloric irrigation or RCT provide high-frequency stimulation. ABR evaluations can be quite valid for use in assessing patients for acoustic neuroma/ vestibular schwannoma (AN/VS), however imaging studies can also conirm AN/VS and it is exceedingly rare, reported to occur with 19 tumors per million per annually [6]. ECOG testing, used speciically in cases of suspected Meniere’s disease (MD), can be technically challenging and has been reported, when using extra tympanic measurement, to have poor sensitivity (71%), and especially in the early symptomatic period [7, 8]. When positive indings suggesting peripheral vestibular dysfunction are noted using these techniques they are quite valuable to proper diagnoses and management. However, due to the above noted factors these tests with negative indings for peripheral vestibular dysfunction can result in false negative indings and/or the inability to conidently rule-out dysfunction. Peripheral vestibular evaluation technology has advanced, improving the ability to fully assess the peripheral vestibular system. Speciically, Video Head Impulse Testing (VHIT) and Vestibular Evoked Myogenic Potentials (VEMPs) have been added to the vestibular test battery. These tests have expanded the available information to include high-frequency stimulation, the function of the posterior SCCs, anterior SCCs, inferior division of the vestibular nerve of the VIII cranial nerve, the saccule, and the utricle. These tests combined with the traditional vestibular test battery allow for a more complete peripheral vestibular evaluation to either conirm peripheral dysfunction or rule-out vestibular involvement. The VHIT utilizes video-oculography to allow for recording and detailed analysis of the vestibular-ocular relex (VOR) for gain and catch-up saccades with high-frequency stimulation for all 6 semicircular canals independently [9-11]. VHIT provides the only clinically available method for assessing the posterior and anterior SCCs in a quantitative manner. VEMP evaluations (cervical and ocular) provide an evaluation of saccule and the inferior division of the vestibular nerve of the VIII cranial nerve and utricle and *Corresponding Author: Steven M. Doettl, Au.D., CCC-A, Associate Professor, The University of Tennessee Health Science Center, College of Health Professions, Department of Audiology and Speech Pathology, Knoxville, TN 37996, USA. E-mail: sdoettl@uthsc.edu Received: June 15, 2017 Published: June 21, 2017 Citation: Doettl SM (2017) Peripheral Vestibular Evaluation - A New Horizon. Int J Clin Exp Otolaryngol. 3(1e), 1-3. doi: http://dx.doi.org/10.19070/2572-732X-170002e Copyright: Doettl SM © 2017. 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