PP1402 - Variability in Vestibular Testing: Which Protocols and Normative Values Are Clinicians Using?

Abstract:
This study aims to compare testing protocols and normative values used in vestibular analysis across audiological settings in the United States, highlighting the lack of a universally accepted standard. Clinicians often depend on their own normative data or existing literature, leading to inconsistencies in tests such as spontaneous nystagmus, headshake, positional testing, caloric testing, vHIT, cVEMP, SCDS screening, and rotary chair testing. These inconsistencies can confuse clinicians and patients, resulting in incorrect interpretations, inappropriate treatments, and increased healthcare costs from repeated testing. Establishing standardized vestibular testing protocols is essential for ensuring consistent care, improving diagnostic accuracy, and enhancing patient outcomes.

Summary:
Objectives
Our study aims to examine and compare the testing protocols and normative values used by clinicians in vestibular analysis across audiological settings in the United States, highlighting the absence of a universally accepted standard. By comparing these vestibular normative values, we hope to identify trends and discrepancies, as well as improve diagnostic accuracy and patient outcomes in vestibular testing and treatment.

Rationale/Purpose
Clinicians frequently depend on their own normative data or select from existing literature, resulting in variability across tests such as spontaneous nystagmus, headshake testing, caloric testing, vHIT measurements, cVEMP assessments, SCDS screening, and rotary chair testing. These inconsistencies can lead to confusion among clinicians and patients, resulting in misinterpretations of vestibular function. This study underscores the urgent need for standardized guidelines in vestibular assessment to facilitate accurate diagnoses and appropriate treatment plans.

Design
This study will be conducted via an online survey distributed to audiologists across the United States through email and social media platforms, including Facebook groups such as Audiology Happy Hour, Audiology Antics and Anecdotes - for All Hearing Professionals, and the NSU Audiology Group. The survey is anonymous and takes approximately 20 minutes to complete. The survey is designed to capture detailed information about current testing practices, including specific protocols and normative values utilized by clinicians in different settings. It includes skip logic; therefore, the number of questions may vary for the survey participants.

Results
Preliminary data study reveals significant discrepancies in testing protocols and normative values across various audiological practices. For example, monothermal caloric unilateral weakness shows values ranging from 0-28% and bithermal calorics range from 5-28%; this is with published normative data. By documenting these variations, it aims to demonstrate the need for standardization to improve diagnostic accuracy, reduce unnecessary healthcare costs, and enhance patient outcomes for individuals with vestibular disorders. Data is still currently being collected.

Conclusions
Establishing standardized vestibular testing protocols and normative values is essential for ensuring consistent, high-quality care across all clinical settings. This standardization will improve diagnostic precision and reduce variability in interpretations, leading to more timely and appropriate treatment for patients. 

Importance of Work
The study addresses a critical issue in audiology, emphasizing the need for uniform best practices in vestibular assessment. This study potentially will impact more than clinical practice, as standardized protocols can enhance the education of doctor of audiology students and enable better comparisons across research studies.