Case 07 · clinician

Vertigo with a normal HIT and a normal SVV

Vignette

A 34-year-old woman presents with two days of severe vertigo and nausea. Examination shows down-beating torsional nystagmus that does not change direction with gaze. Horizontal head impulse test is normal in both directions. Hearing is normal. Bucket SVV is +0.5°. cVEMP is absent on the left; oVEMP is preserved bilaterally. Caloric responses are symmetric.

SVV trace

+0.5° ± 1.1°
SVV finding

Within normal limits — utricular function preserved

What is the most likely diagnosis?

← Fluctuating hearing and vertigo over 18 monthsAll casesAsymmetric hearing loss with mild imbalance over two years →
Subjective Visual Vertical

An interactive teaching atlas of Subjective Visual Vertical for the assessment of otolith-graviceptive function — bucket and digital technique, dynamic SVV, normal findings, and the tilt signatures of peripheral and central vestibular disease. Content synthesised from current Bárány Society criteria, peer-reviewed vestibular literature, and standard otoneurology texts.

→ Full references & acknowledgements
Built for

Medical students, ENT / Neurology / Audiology trainees, vestibular therapists, and clinicians who want to teach themselves the language of vertigo.

Concept & design
Dr Prahlada N.B

Karnataka ENT Hospital and Research Centre (R),
Champions Educational and Medical Society (R),
Amogh Foundation, Chitradurga, Karnataka, India

Please share your valuable feedback to:
prahladnb@kenthospitals.com

Disclaimer

For educational purposes only. Not for clinical use. The Subjective Visual Vertical chapter is an instructional resource intended to support learning about SVV and the assessment of otolith-graviceptive function. Clinicians remain completely responsible for the interpretation of findings, the formulation of a differential diagnosis, and any clinical decision. Nothing in this application replaces individualized assessment, hands-on training, expert consultation, or established practice guidelines.

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© 2026 Dr Prahlada N.B · Karnataka ENT Hospital and Research Centre (R) · Champions Educational and Medical Society (R) · Amogh Foundation, Chitradurga, Karnataka, India
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