Real-Life Performance of Video Ocular Counter-Roll: Toward a Paradigm Change in Vestibular Screening Method

Introduction: The purpose of this study was to present our real-life experience using the video ocular counter role test (vOCR) in assessing vestibular dysfunction compared to caloric testing and to evaluate the clinical applicability of vOCR.

Methods: This was a retrospective study on patients who underwent vOCR between 2021 and 2023, divided into 3 groups: unilateral vestibular hypofunction, bilateral vestibular hypofunction, and healthy. Data included demographics, clinical diagnosis, and vestibular assessment of caloric and vOCR tests. The correlation between caloric testing and vOCR was evaluated. A two-step approach was employed to analyze vOCR results: the average vOCR measurement for assessing bilateral vestibular dysfunction and the vOCR asymmetry ratio (AR) to determine unilateral dysfunction.

Results: A total of 134 patients were included (mean age of 54.29 [±16.92] years). In the caloric test, 10.4% were diagnosed with bilateral vestibular hypofunction, 32.8% with unilateral vestibular hypofunction, and 56.7% with normal results. A significant correlation was found between the caloric test and vOCR (r = 0.4, p < 0.001). Using the two-step method, sensitivity and specificity for detecting bilateral dysfunction were 92.5% and 85.7%, respectively (AUC 95.1, p < 0.001). In the second step, utilizing the vOCR AR to differentiate unilateral dysfunction from healthy patients, the sensitivity and specificity were 97.7% and 63.2%, respectively (AUC 79.2, p < 0.001).

Conclusions: Our study demonstrates the potential of vOCR in diagnosing general vestibular dysfunction in addition to otolith dysfunction, suggesting its significant clinical application. The use of vOCR could be integrated into the process of vestibular evaluation, simplifying it and serving as a fast and reliable screening tool.