A 70-year-old man with progressive unsteadiness and oscillopsia while walking shows bilateral absent caloric responses. Which test is most appropriate to quantify his residual vestibulo-ocular reflex function across physiologic low frequencies?

• A Auditory brainstem response audiometry
• B Repeat bithermal caloric testing with higher flow rates
• C Electrocochleography with tympanic membrane electrode
• D Rotational chair testing with sinusoidal harmonic acceleration ✓

Explanation

Rotational chair testing stimulates both labyrinths simultaneously through natural, low-frequency head rotations and measures VOR gain, phase, and symmetry, making it the standard tool for assessing bilateral vestibular loss and monitoring compensation. Calorics test each ear separately but only at very high, nonphysiologic frequencies, so repeating them adds little information once bilateral absence is documented.

Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.