Evaluation of a bedside test of utricular function-the bucket test-in older individuals

Conclusion: As a bedside test of subjective visual vertical (SVV), the 'bucket test' has a role as a viable and cost-effective clinical test of unilateral utricular dysfunction in older individuals. Objective: To investigate whether the bucket test as a test of the SVV is a valid bedside test of utricular function in older individuals. Methods: This was a diagnostic validation study at a tertiary academic medical center. Vestibular function was evaluated using sound-evoked cervical and tap-evoked ocular vestibular evoked myogenic potential (cVEMP and oVEMP, respectively) asymmetry ratios, the bucket test of SVV, and the Dizziness Handicap Index (DHI), in 51 older individuals aged 70-95 years. Results: Bucket test scores are correlated in both magnitude and direction with utricle-selective tap-evoked oVEMP asymmetry ratios, but not with sound-evoked cVEMP asymmetry ratios, which are saccule-selective, or with the DHI. Receiver operating characteristics analysis suggests that the bucket test is more specific than sensitive for utricular dysfunction, and a bucket test SVV score of 2° may maximize diagnostic yield relative to the currently accepted score of 3.