The Video Ocular Counter-Roll Test: Validation for Vestibular Dysfunction Diagnosis in Clinical Practice

Objective: The video ocular counter-roll (vOCR) test is a novel method that uses video-oculography (VOG) goggles to detect vestibular dysfunction, potentially offering a simpler alternative to current vestibular function tests. In this study, we aim to compare the vOCR test with the caloric test for diagnosing vestibular dysfunction and to assess its clinical applicability. Study Design: A retrospective cohort study. Setting: A tertiary academic referral center. Methods: This retrospective study included all patients who underwent both vOCR and caloric tests during the same visit between 2021 and 2023. The patients were divided into 3 groups based upon caloric response: unilateral vestibular hypofunction (UVH), bilateral vestibular hypofunction (BVH), and normal. The vOCR test was performed with a 30° head tilt to both sides. Sensitivity, specificity, and area under the curve (AUC) were calculated for vOCR performance. The 2-step approach employed for utilizing the vOCR test included the average vOCR measurement for diagnosing BVH followed by the vOCR asymmetry ratio (AR) to UVH. Results: In total, 134 patients were included in the study, with 14 (10.5%) diagnosed with bilateral vestibular hypofunction (BVH), 44 (32.8%) with unilateral vestibular hypofunction (UVH), and 76 (56.7%) exhibiting normal vestibular function based on caloric testing. A vOCR cutoff value of 3.2° demonstrated sensitivity and specificity of 92.5% and 85.7%, respectively, for detecting BVH (AUC 95.1%, P <.001). An AR of 0.12 showed sensitivity and specificity of 97.7% and 63.2%, respectively, for detecting UVH (AUC 79.2%, P <.001). vOCR measurements differed significantly across all 3 groups (P <.001). In the UVH group, the vOCR angles were consistently smaller on the hypofunction side, suggesting laterality. Conclusion: vOCR diagnoses vestibular dysfunction with high sensitivity and specificity compared to the caloric test. Incorporating vOCR into the vestibular testing battery could enhance diagnostic efficiency and patient comfort.