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.
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