Learning Objectives:

1. A proportion of patients with chronic middle ear pathology develop a vestibular deficit.

2. Standard vestibular testing is often not appropriate for this cohort as middle ear dysfunction precludes assessment.

3. VHIT and BC-VEMPs bypass the middle ear and such can be used to determine underlying function relating to all five aspects of the vestibular system.

Introduction: It is well established that middle ear diseases such as cholesteatoma and otosclerosis can impair hearing as a result of damage to the ossicular chain or the cochlear itself. Given the underlying pathophysiology it is entirely plausible that the disease processes can also impair labyrinthine function. To date it has been difficult to assess the impact on the vestibular system as the traditional test battery cannot be used, however the recent advent of new tests which bypass the middle ear have made this an a new exciting possibility.

Methods: A total of 28 patients awaiting middle ear surgery were recruited from two tertiary otology centres. All patients underwent Video Head Impulse Testing (VHIT) of all three semicircular canals on the affected and non-affected sides. Bone Conduction Vestibular Evoked Myogenic Potentials (BC-VEMPs) were also conducted to assess bilateral otolithic function.

Results: The vestibular testing results of the 28 patients will be presented. The results of the diseased side and the contralateral side are separated considered and a correlation will be made with the cochlear function.

Conclusions: In this study we have shown how VHIT and VEMP testing can be successfully be used to assess the labyrinthine function of patients with middle ear disease. The tests are non-invasive and are quick to perform opening the possibility of being done routinely in this cohort. Furthermore these patients can be assessed post-operatively and the results compared to baseline to check for any iatrogenic or disease specific vestibular dysfunction.