ABSTRACT
The otoliths are vestibular organs that act as gravito-inertial force sensors and
contribute to the perception of spatial orientation (earth verticality). The subjective
visual vertical (SVV) is a psychophysical measure of the angle between perceptual
vertical and true (gravitational) vertical. The otoliths contribute to the estimation
of the physical vertical orientation, and individuals with normal vestibular function
align the SVV within 2 degrees of true vertical (0 degrees). Impaired SVV has been
documented in patients with unilateral vestibular disorders. Most research has focused
on measuring the static SVV (head upright and stationary); however, more recently,
methods have been developed to measure the SVV during stimulation of the otolith organs
using on-axis yaw rotation (bilateral centrifugation), off-axis eccentric rotation
(unilateral centrifugation), or head tilt for tests of bilateral or unilateral otolith
function. The SVV test may be a useful method to assess utricular function in patients
complaining of dizziness and/or imbalance and identify stages of recovery for otolith
involvement.
KEYWORDS
Vestibular - otolith organs - utricle - subjective visual vertical
REFERENCES
- 1
Neal E.
Visual localization of the vertical.
Am J Psychol.
1926;
37
287-291
- 2
Witkin H A, Asch S E.
Studies in space orientation; perception of the upright in the absence of a visual
field.
J Exp Psychol.
1948;
38(5)
603-614
- 3
Friedmann G.
The judgement of the visual vertical and horizontal with peripheral and central vestibular
lesions.
Brain.
1970;
93(2)
313-328
- 4
Böhmer A, Rickenmann J.
The subjective visual vertical as a clinical parameter of vestibular function in peripheral
vestibular diseases.
J Vestib Res.
1995;
5(1)
35-45
- 5
Tribukait A, Bergenius J, Brantberg K.
The subjective visual horizontal for different body tilts in the roll plane: characterization
of normal subjects.
Brain Res Bull.
1996;
40(5-6)
375-381
381-383
- 6
Gómez García A, Jáuregui-Renaud K.
Subjective assessment of visual verticality in follow-up of patients with acute vestibular
disease.
Ear Nose Throat J.
2003;
82(6)
442-444, 446
- 7
Kobayashi H, Hayashi Y, Higashino K et al..
Dynamic and static subjective visual vertical with aging.
Auris Nasus Larynx.
2002;
29(4)
325-328
- 8
Kumagami H, Sainoo Y, Fujiyama D et al..
Subjective visual vertical in acute attacks of Ménière's disease.
Otol Neurotol.
2009;
30(2)
206-209
- 9
Böhmer A, Mast F.
Chronic unilateral loss of otolith function revealed by the subjective visual vertical
during off center yaw rotation.
J Vestib Res.
1999;
9(6)
413-422
- 10 Halmagyi G, Curthoys I.
Otolith function tests. In: Herdman SJ Vestibular Rehabilitation. 3rd ed. Philadelphia, PA; FA Davis 2007:
144-161
- 11
Curthoys I S, Dai M J, Halmagyi G M.
Human ocular torsional position before and after unilateral vestibular neurectomy.
Exp Brain Res.
1991;
85(1)
218-225
- 12
Vibert D, Häusler R, Safran A B.
Subjective visual vertical in peripheral unilateral vestibular diseases.
J Vestib Res.
1999;
9(2)
145-152
- 13
Goto F, Kobayashi H, Saito A et al..
Compensatory changes in static and dynamic subjective visual vertical in patients
following vestibular schwanoma surgery.
Auris Nasus Larynx.
2003;
30(1)
29-33
- 14
Min K K, Ha J S, Kim M J, Cho C H, Cha H E, Lee J H.
Clinical use of subjective visual horizontal and vertical in patients of unilateral
vestibular neuritis.
Otol Neurotol.
2007;
28(4)
520-525
- 15
Dieterich M, Brandt T.
Ocular torsion and tilt of subjective visual vertical are sensitive brainstem signs.
Ann Neurol.
1993;
33(3)
292-299
- 16
Mossman S, Halmagyi G M.
Partial ocular tilt reaction due to unilateral cerebellar lesion.
Neurology.
1997;
49
491-493
- 17
Helling K, Schönfeld U, Scherer H, Clarke A H.
Testing utricular function by means of on-axis rotation.
Acta Otolaryngol.
2006;
126(6)
587-593
- 18
Wetzig J, Reiser M, Martin E, Bregenzer N, von Baumgarten R J.
Unilateral centrifugation of the otoliths as a new method to determine bilateral asymmetries
of the otolith apparatus in man.
Acta Astronaut.
1990;
21(6-7)
519-525
- 19
Clarke A H, Schönfeld U, Hamann C, Scherer H.
Measuring unilateral otolith function via the otolith-ocular response and the subjective
visual vertical.
Acta Otolaryngol Suppl.
2001;
545
84-87
- 20
Smith S T, Curthoys I S, Moore S T.
The human ocular torsion position response during yaw angular acceleration.
Vision Res.
1995;
35(14)
2045-2055
- 21
Pavlou M, Wijnberg N, Faldon M E, Bronstein A M.
Effect of semicircular canal stimulation on the perception of the visual vertical.
J Neurophysiol.
2003;
90(2)
622-630
- 22
Clarke A H, Schönfeld U, Helling K.
Unilateral examination of utricle and saccule function.
J Vestib Res.
2003;
13(4-6)
215-225
- 23
Ernst A, Basta D, Seidl R O, Todt I, Scherer H, Clarke A.
Management of posttraumatic vertigo.
Otolaryngol Head Neck Surg.
2005;
132(4)
554-558
- 24
Basta D, Todt I, Scherer H, Clarke A, Ernst A.
Postural control in otolith disorders.
Hum Mov Sci.
2005;
24(2)
268-279
Faith W AkinPh.D.
Director, VA Medical Center
Audiology (126), Mountain Home, TN 37684
Email: Faith.akin@va.gov