Sensitivity of Romberg Test in Diagnosis of Peripheral Vestibular Disorders in Comparison with Caloric Test: Psychometric Study

Document Type : Original Articles

Authors
Fatemeh Moghadasi-Boroujeni 1
Mansoureh Adel Ghahraman 2
1 Lecturer, Department of Audiology, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
2 Assistant Professor, Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
10.22122/jrrs.v16i0.3633
Abstract
Introduction: Romberg test is one of the balance screening tests. Since this test does not require special equipment, it is widely used in the evaluation of people suffering from balance disorders. This study aimed to determine the sensitivity of the Romberg test for the diagnosis of peripheral vestibular dysfunction compared with the caloric test that is the gold standard for the diagnosis of horizontal semicircular canal/superior vestibular nerve disorders.Materials and Methods: This study was a cross-sectional-comparative study and the sample was selected from those who referred to the audiology clinic of the School of Rehabilitation Sciences, Tehran University of Medical Sciences, Tehran, Iran. Romberg test with closed eyes was performed in 47 people suffering from unilateral or bilateral peripheral vestibular disorders (25 women and 22 men, mean age: 43.80 ± 4.46 years) whose lesion was confirmed by caloric test. The results were recorded in the participants’ history files and the files were reviewed. Chi-square test was used to compare the results. The sensitivity of Romberg test was determined in comparison with their caloric test results.Results: Only 5 participants had abnormal Romberg results, while 35 patients showed unilateral caloric weakness and 12 had bilateral deficits. Therefore, Romberg's sensitivity was 10.64%. There was no significant correlation between Romberg results and duration of disease.Conclusion: Romberg test seems to have low sensitivity in diagnosis of peripheral vestibular disorders. Therefore, vestibular tests with higher sensitivity are recommended for the diagnostic purposes and caloric test may not be replaced by Romberg test.
Keywords
Romberg test
Peripheral vestibular disorders
Caloric test
Sensitivity
  1. Murdin L, Schilder AG. Epidemiology of balance symptoms and disorders in the community: A systematic review. Otol Neurotol 2015; 36(3): 387-92.
  2. Kovacs E, Wang X, Grill E. Economic burden of vertigo: A systematic review. Health Econ Rev 2019; 9(1): 37.
  3. Siddiqi FA, Masood T. Training on Biodex balance system improves balance and mobility in the elderly. J Pak Med Assoc 2018; 68(11): 1655-9.
  4. Smith RM, Marroney N, Beattie J, Newdick A, Tahtis V, Burgess C, et al. A mixed methods randomised feasibility trial investigating the management of benign paroxysmal positional vertigo in acute traumatic brain injury. Pilot Feasibility Stud 2020; 6: 130.
  5. Jacobson GP, McCaslin DL, Piker EG, Gruenwald J, Grantham S, Tegel L. Insensitivity of the "Romberg test of standing balance on firm and compliant support surfaces" to the results of caloric and VEMP tests. Ear Hear 2011; 32(6): e1-e5.
  6. Zamyslowska-Szmytke E, Szostek-Rogula S, Sliwinska-Kowalska M. Bedside examination for vestibular screening in occupational medicine. Int J Occup Med Environ Health 2015; 28(2): 379-87.
  7. Baloh RW, Jacobson KM, Beykirch K, Honrubia V. Static and dynamic posturography in patients with vestibular and cerebellar lesions. Arch Neurol 1998; 55(5): 649-54.
  8. Longridge NS, Mallinson AI. Clinical romberg testing does not detect vestibular disease. Otol Neurotol 2010; 31(5): 803-6.
  9. Hong SK, Park JH, Kwon SY, Kim JS, Koo JW. Clinical efficacy of the Romberg test using a foam pad to identify balance problems: a comparative study with the sensory organization test. Eur Arch Otorhinolaryngol 2015; 272(10): 2741-7.
  10. El-Kashlan HK, Shepard NT, Asher AM, Smith-Wheelock M, Telian SA. Evaluation of clinical measures of equilibrium. Laryngoscope 1998; 108(3): 311-9.
  11. Honaker JA, Janky KL, Patterson JN, Shepard NT. Modified head shake sensory organization test: Sensitivity and specificity. Gait Posture 2016; 49: 67-72.
  12. Wang Y, Wang L, Jing Y, Yu L, Ye F. Association between hearing characteristics/prognosis and vestibular function in sudden sensorineural hearing loss with vertigo. Front Neurol 2020; 11: 579757.
  13. Park P, Park JH, Kim JS, Koo JW. Role of video-head impulse test in lateralization of vestibulopathy: Comparative study with caloric test. Auris Nasus Larynx 2017; 44(6): 648-54.
  14. Beynon GJ, Jani P, Baguley DM. A clinical evaluation of head impulse testing. Clin Otolaryngol Allied Sci 1998; 23(2): 117-22.
  15. Ishak WS, Zhao F, Stephens D, Culling J, Bai Z, Meyer-Bisch C. Test-retest reliability and validity of Audioscan and Bekesy compared with pure tone audiometry. Audiol Med 2011; 9(1): 40-6.
  16. Sutherland JE, Campbell K. Immitance audiometry. Prim Care 1990; 17(2): 233-47.
  17. Maclennan-Smith F, Swanepoel dW, Hall JW 3rd. Validity of diagnostic pure-tone audiometry without a sound-treated environment in older adults. Int J Audiol 2013; 52(2): 66-73.
  18. Jorgensen MB, Skotte JH, Holtermann A, Sjogaard G, Petersen NC, Sogaard K. Neck pain and postural balance among workers with high postural demands - a cross-sectional study. BMC Musculoskelet Disord 2011; 12: 176.
  19. Guccione AA, Avers D, Wong R. Geriatric physical therapy. Philadelphia, PA: Elsevier Health Sciences; 2011.
  20. Khasnis A, Gokula RM. Romberg's test. J Postgrad Med 2003; 49(2): 169-72.
  21. Kesser BW, Gleason AT. Dizziness and vertigo across the lifespan. Elsevier Health Sciences; 2018.
  22. Lee IS, Park HJ, Shin JE, Jeong YS, Kwak HB, Lee YJ. Results of air caloric and other vestibular tests in patients with chronic otitis media. Clin Exp Otorhinolaryngol 2009; 2(3): 145-50.
  23. Ver MLP, Gum JL, Glassman SD, Carreon LY. Assessment of standing balance in normal versus cervical spondylotic myelopathy patients. North American Spine Society Journal 2020; 3: 100023.
  24. Han C, Paik S, Yang H, Park S, Lee JH, Seo YJ. Comparison of predictive parameters between the video head impulse test and caloric test. Res Vestib Sci 2020; 19: 55-61.
  25. Schmal F. Effective diagnostics for vertigo, dizziness and equilibrium disorders. HNO 2020; 68(9): 703-16.
  26. Black FO. What can posturography tell us about vestibular function? Ann N Y Acad Sci 2001; 942: 446-64.
  27. Herdman SJ, Clendaniel R. Vestibular Rehabilitation. Philadelphia, PA: F. A. Davis; 2014.
  28. Nowak MK. Visual and vestibular involvement in postural deficits following concussion. J Neurophysiol 2018; 120(2): 391-3.
  29. Stankiewicz T, Gujski M, Niedzielski A, Chmielik LP. Virtual reality vestibular rehabilitation in 20 patients with vertigo due to peripheral vestibular dysfunction. Med Sci Monit 2020; 26: e930182.
  30. Rassaian N, Sadeghi NG, Sabetazad B, McNerney KM, Burkard RF, Sadeghi SG. Using unidirectional rotations to improve vestibular system asymmetry in patients with vestibular dysfunction. J Vis Exp 2019; (150).
  31. Ito T, Tatsumi K, Takimoto Y, Nishimura T, Imai T, Yamanaka T, et al. Vestibular Compensation after Vestibular Dysfunction Induced by Arsanilic Acid in Mice. Brain Sci 2019; 9(11).
  32. Rassaian N, Sadeghi NG, Sabetazad B, McNerney KM, Burkard RF, Sadeghi SG. Using unidirectional rotations to improve vestibular system asymmetry in patients with vestibular dysfunction. J Vis Exp 2019; (150).
  33. Precht W, Dieringer N. Neuronal events paralleling functional recovery (compensation) following peripheral vestibular lesions. Rev Oculomot Res 1985; 1: 251-68.
  34. Llinas R, Walton K. Vestibular compensation: A distributed property of the central nervous system. In: Asunama H, Wilson VJ, editors. Integration in the nervous system. Tokyo, Japan: Shoin; 1979. p. 145-66.

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