OMSII Philadelphia College of Osteopathic Medicine Greenacres, Florida
Background and Hypothesis: Peripheral vestibular disorders are widespread affecting approximately 7.4% of individuals over their lifetime, with benign paroxysmal positional vertigo (BPPV) being the most prevalent condition. Notably, Dr. F H. Quix, a renowned Dutch otolaryngologist made a series of observations on the relationship between head and neck position on torsional bodily displacements (Hart, 1983). Building upon Dr. Quix’s findings, we have developed an enhanced version of the Quix test to improve its sensitivity in detecting vestibular disorders. The Quix test is a valuable bedside tool for predicting the side of canalithiasis. Its practicality extends to underserved regions, including rural and low socioeconomic areas, where access to videonystagmography and computerized dynamic posturography may be limited or unavailable. Compared to other conventional vestibular tests conducted at the bedside, we hypothesize that the Quix test will demonstrate superior specificity and sensitivity in detecting peripheral vestibular dysfunction.
Methods: We conducted a randomized controlled trial of 153 individuals at a balance disorders clinic. Each patient underwent a comprehensive battery of assessments, including tests for nystagmus, head impulse test, Romberg, Quix, tandem stance/walk, and a sitting past pointing test. Additionally, further examinations such as Posturography, Dix-Hallpike maneuver, and videonystagmography, were performed.
Results: We defined the presence of vestibular dysfunction as positive findings on the following: vestibular deficiency pattern on DPP, canal paresis evidence by impaired unilateral or bilateral hypofunctioning response to caloric stimulation, or canalithiasis evidence by a positive Dix-Hallpike maneuver. The results showed that the Quix test is a statistically significant predicator of vestibular abnormality (p <.05). The Quix test has a sensitivity of 85.7% in the identification of vestibular dysfunction. Compared to the other tests, the Romberg (p>.05, sensitivity: 75.8%), the past pointing test (p>.05, sensitivity: 17.2%), and the tandem stance (p>0.05, sensitivity: 24.0%) were not statistically significant predicator variables of vestibular abnormality.
Conclusion: Compared to other tests, the Quix exhibits a remarkable sensitivity of 85% in identifying peripheral vestibular dysfunction, making it a superior diagnostic tool. Notably, none of the other neurological tests conducted in this study demonstrated any statistical significance in identifying vestibular dysfunction. By incorporating the Quix test into the evaluation of ‘dizzy’ patients, it has the potential to reduce diagnostic costs and minimize time-consuming efforts. Further, the test can be administered with faculty by mid-level and primary care providers with appropriate training and guidance. The prognosis of BPPV is generally favorable. Treatment involving Canalithic repositioning can improve yield immediate symptom relief by repositioning the displaced otoconia back into the utricle. BPPV, if left untreated can severely disrupt daily activities due to recurrent vertigo attacks. Fortunately, Canalithic repositioning is a relatively quick procedure, typically taking about 15 minutes, and can significantly improve the quality of life for individuals affected by this condition.
Acknowledgement of Research Study Sponsors and IRB: The Institutional Review Board has reviewed and approved our study.
