On rotatory chair testing in a patient with suspected bilateral vestibular loss, which pattern is expected?

• A Reduced gain at all frequencies with preserved phase
• B Directional preponderance greater than 30%
• C Reduced gain at low frequencies with abnormal phase lead and absent vestibulo-ocular reflex ✓
• D Asymmetric caloric responses bilaterally

Explanation

Rotatory chair testing in bilateral vestibular loss shows reduced VOR gain predominantly at low frequencies, with an abnormal phase lead and absent vestibulo-ocular reflex. This pattern distinguishes bilateral loss from unilateral loss, where gain may be preserved at high frequencies. Directional preponderance and caloric asymmetry are features of unilateral, not bilateral, loss.

Reference: Cummings Otolaryngology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.