Videonystagmography versus Posturography in Diagnosis of Dizziness in Elderly Population Hesham Kozou, MD* Audiology Unit, Otorhinolaryngology Department, Alexandria School of Medicine, Alexandria, Egypt. BACKGROUND Presbystasis, which is the disequilibrium of aging, is a group of disorders that affect the mobility of a large number of elderly persons. Due to the degeneration of the vestibular, proprioceptive, and visual senses, the ability to walk and drive can be reduced to the point of incapacitation. Although attempts have been made to categorize presbystasis as a single specific entity, a large number of vestibular disorders are seen in elderly patients. These include vascular disease, Ménière's disease, benign positional vertigo, and adaptation deficits. Belal and Glorig reviewed clinical findings in 740 elderly patients having dizziness. They revealed a specific cause for dizziness in only 21% of the cases. The remaining 79% of patients were diagnosed as primary presbystasis. The present study aimed to evaluate the diagnostic value of videonystagmography versus posturography in presbystasis. SUBJECTS AND METHODS Forty elderly patients complaining of dizziness and dysequilibriym were evaluated. The test battery included: bed-side postural assessment; computerized dynamic posturography (CDP); pure tone audiometry; auditory brainstem response (ABR) and videonystagmography (VNG). Figure 1. Eguitest used for Computerized Dynamic Posturography. RESULTS The results of VNG were analyzed and compared to the CDP results in the view of the clinical profiles of the patients. The results of different VNG subtests were not concordant with each other and a unified pattern for VNG results in the elderly population is not present (Table I). Table II. Results of different posturography Table I. Results of different VNG subtests in the study sensory analysis in the study population. population Subtest Spontaneous Gaze Pursuit Saccade Optokinetic Caloric Normal 20% 70% 12.5% Abnormal Equivocal 80% 27.5% 2.5 Low gain 70% Cog wheel 17.5% 67.5% 32.5% 50% Asymmetrical 50% symmetrical 35% 57.5% 7.5% not done Subtest Somatosensory Visual Vestibular Preference Average Percentage of Normal 92 60 36 80 INTERPRETATION Dizziness in elderly should be considered as a special category of dizziness differing from other types of dizziness. CDP was more sensitive than VNG in detection of the cause of dizziness in those with undifferentiated balance complaints (Table II). However, VNG was more able to identify the anatomical level and laterality of the vestibular lesion. Information from VNG can assist with the lesion localization. For information regarding the functional status of a patient, posturography is more useful. The value of doing both tests appears to be useful in symptomatic cases with normal or borderline VNG findings. Figure 2. Posturography results of Sensory organization test for one elderly patient showing a clear vestibular deficit. Figure 3. Result of caloric test of one patient showing right caloric weakness. REFERENCES Belal A Jr, Glorig A. Dysequilibrium of ageing (presbyastasis). J Laryngol Otol. 1986 Sep;100(9):1037-41. Borah D, Wadhwa S, Singh U, Yadav SL, Bhattacharjee M, Sindhu V. Age related changes in postural stability. Indian J Physiol Pharmacol. 2007 Oct-Dec;51(4):395-404. Horak FB, Shupert CL, Mirka A. Components of postural dyscontrol in the elderly: a review. Neurobiol Aging. 1989 NovDec;10(6):727-38. Oas JG. Benign paroxysmal positional vertigo: a clinician's perspective. Ann N Y Acad Sci. 2001 Oct;942:201-9. Whipple R, Wolfson L, Derby C, Singh D, Tobin J. Altered sensory function and balance in older persons. J Gerontol. 1993 Sep;48 Spec No:71-6.