Evaluation of a bedside test of utricular function – the bucket test – in older individuals

Abstract

Conclusion: As a bedside test of subjective visual vertical (SVV), the ‘bucket test’ has a role as a viable and cost-effective clinical test of unilateral utricular dysfunction in older individuals. Objective: To investigate whether the bucket test as a test of the SVV is a valid bedside test of utricular function in older individuals. Methods: This was a diagnostic validation study at a tertiary academic medical center. Vestibular function was evaluated using sound-evoked cervical and tap-evoked ocular vestibular evoked myogenic potential (cVEMP and oVEMP, respectively) asymmetry ratios, the bucket test of SVV, and the Dizziness Handicap Index (DHI), in 51 older individuals aged 70–95 years. Results: Bucket test scores are correlated in both magnitude and direction with utricle-selective tap-evoked oVEMP asymmetry ratios, but not with sound-evoked cVEMP asymmetry ratios, which are saccule-selective, or with the DHI. Receiver operating characteristics analysis suggests that the bucket test is more specific than sensitive for utricular dysfunction, and a bucket test SVV score of 2° may maximize diagnostic yield relative to the currently accepted score of 3.

Keywords::

• Ocular vestibular-evoked myogenic potential
• subjective visual vertical
• bucket test
• utricle

Acknowledgments

Support for this work was provided by the American Neurotology Society (Y.A.), the American Otological Society (Y.A.), and the Johns Hopkins Older Americans Independence Center (Y.A.). The authors would like to acknowledge Professor Ian S. Curthoys PhD, for his valuable input on this manuscript.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.