Dizziness and vertigo are common complaints in otolaryngology and neurology clinics, with objective vestibular testing central to accurate diagnosis and management. The two most widely used tools, vHIT and caloric testing, each have notable limitations: vHIT assesses high-frequency function but depends heavily on operator skill, while caloric testing covers ultra-low frequencies but has poor tolerability in some patients. Neither covers the mid-frequency physiological range or fully evaluates bilateral vestibular synergy and central compensation, leaving a clear gap in routine clinical care.
The rotational chair test is a non-invasive, computer-controlled assessment delivering precise, reproducible 0.01–0.64 Hz mid-to-low frequency stimuli to both horizontal semicircular canals to measure vestibulo-ocular reflex function. Already recommended by Bárány Society guidelines for bilateral vestibulopathy and presbyvestibulopathy, its full clinical value and standardized workflow had not been systematically consolidated before this review. The test uses two standard rotational paradigms, with core metrics including gain, phase, symmetry and time constant to distinguish peripheral vestibular injury from central dysfunction, and is well tolerated by children and patients unable to undergo caloric testing.
Across vestibular disorders, the test offers unique diagnostic value. For bilateral vestibulopathy and age-related presbyvestibulopathy, it detects residual function even when caloric testing shows no response, supporting prognostic evaluation and rehabilitation planning. In acute unilateral vestibular injury, it can identify low-frequency lesions missed by vHIT, while tracking central compensation progress to differentiate temporary symptom relief from true functional recovery. It also picks up subtle deficits in children with hearing loss, inner ear malformations, cochlear implant recipients, and patients with Ménière’s disease, vestibular migraine or persistent postural-perceptual dizziness, providing objective evidence for functional disorders that are hard to characterize with standard exams. Beyond diagnosis, it supports vestibular physiology research, assesses impairment in non-vestibular conditions like cerebrovascular disease, and guides personalized precision rehabilitation.
The authors note key limitations: the test cannot lateralize unilateral lesions on its own, equipment costs are relatively high, and standardized age-stratified normative data remain scarce. Results should be interpreted alongside patient history and other exams, not used as a standalone diagnostic tool. The team calls for larger multicenter studies to establish uniform reference ranges, and suggests AI-assisted result interpretation and cloud-based diagnostic systems could expand access, especially in primary care, evolving the tool from a standalone test into an integrated digital diagnostic and therapeutic platform.
“Standardizing rotational chair testing and expanding its clinical use will help fill longstanding gaps in vestibular assessment,” the authors stated. “For patients with bilateral dysfunction, age-related decline or hard-to-diagnose conditions, this modality brings us closer to more accurate, personalized care for dizziness and vertigo.”
The work titled “ Advances in the Clinical Application of Rotational ChairTesting for the Diagnosis and Management of VestibularDisorders ”, was published on ENT Discovery (published on J un 2 4 , 2026) .
ENT Discovery
Experimental study
Not applicable
Advances in the Clinical Application of Rotational Chair Testing for the Diagnosis and Management of Vestibular Disorders
24-Jun-2026