Subjective Visual Vertical Testing in Patients With Chronic Suppurative Otitis Media

Abstract

Objective To analyze the results of the subjective visual vertical test using the “bucket method” in patients with chronic suppurative otitis media (CSOM). Study Design Cross-sectional, controlled study. Setting Outpatient otology clinic in a tertiary care hospital. Subjects and Methods Patients had CSOM, defined as the presence of chronic infection or inflammation of the middle ear cleft, associated with a perforation of the tympanic membrane, frequent or intractable middle ear suppuration, with or without cholesteatoma. Controls were selected using a nonprobability, purposive sampling method. We excluded patients with neurologic or metabolic diseases, cognitive deficits, otosclerosis, vestibular migraine, Ménière’s disease, past use of ototoxic medication, or head and neck cancer. The volunteers were subjected to the subjective visual vertical test using the “bucket method.” The results obtained in our study and control groups were analyzed using nonparametric tests. Results Our study comprised 51 patients with CSOM and 50 controls. In the CSOM group, we observed that 72.5% of the patients had vestibular symptoms in the past year, and 70.5% had abnormalities identified in at least 1 vestibular function test. The subjective visual vertical test revealed that patients with CSOM (with and without cholesteatoma) had significantly higher deviations of the true vertical as compared with controls (CSOM, 3.66°; controls, 0.76°; P < .001). Conclusion Our results revealed that CSOM was associated with high rates of vestibular symptoms, abnormal vestibular function tests, and abnormal subjective vertical visual results.