Reference

Glossary

Searchable terminology with aliases and cross-references.

Subjective Visual Vertical (SVV)(SVV, visual vertical)
The angle a person perceives as upright when adjusting a luminous line in an otherwise dark environment. Reflects central integration of otolith (graviceptive) input, ocular counter-roll, and visual cues. Normal range in healthy adults is roughly ±2° from true earth-vertical.

See also: Subjective Visual Horizontal (SVH), Ocular Tilt Reaction (OTR), Utricle

Subjective Visual Horizontal (SVH)(SVH)
Same paradigm as SVV but with the perceived horizontal axis. Test–retest reliability and disease sensitivity are comparable to SVV; the two are typically orthogonal and used interchangeably in most labs.

See also: Subjective Visual Vertical (SVV)

Utricle
Horizontally-oriented otolith organ that senses linear acceleration in the earth-horizontal plane and head tilt in the roll plane. The dominant graviceptor in upright stance; SVV tilt after unilateral vestibular loss is largely a utricular signal.

See also: Saccule, Ocular Tilt Reaction (OTR), Subjective Visual Vertical (SVV)

Saccule
Vertically-oriented otolith organ sensing vertical linear acceleration (e.g., gravity along the long axis of the body). Primary afferent target for cVEMP. Contributes less to SVV than the utricle.

See also: Utricle, Vestibular Evoked Myogenic Potential (VEMP)

Ocular Tilt Reaction (OTR)(OTR)
Triad of head tilt, skew deviation, and ocular counter-roll, all toward the same side. Indicates a lesion of the graviceptive pathway from the utricle to the interstitial nucleus of Cajal. SVV tilts toward the lower (hypotropic) eye in peripheral and pontomedullary lesions; tilts to the contralesional side in pontomesencephalic lesions above the decussation.

See also: Subjective Visual Vertical (SVV), Interstitial nucleus of Cajal (INC), Skew deviation

Skew deviation
Vertical misalignment of the eyes arising from imbalance of otolith input. One eye is hypertropic, the other hypotropic. Part of the ocular tilt reaction.

See also: Ocular Tilt Reaction (OTR)

Interstitial nucleus of Cajal (INC)(INC)
Midbrain integrator for vertical and torsional eye position, located in the rostral midbrain near the rostral interstitial nucleus of the medial longitudinal fasciculus. Lesions cause contraversive OTR and SVV tilt.

See also: Ocular Tilt Reaction (OTR)

Graviception
The neural sense of gravity. Combines otolith afferents, somatosensory cues (truncal graviceptors), and visual cues; integrated in the brainstem, cerebellum, thalamus, and parieto-insular vestibular cortex.

See also: Subjective Visual Vertical (SVV), Utricle

Bucket test
Low-cost SVV paradigm: the patient looks into a bucket with a vertical line drawn inside the rim, eliminating external visual cues. The examiner rotates the bucket from a tilted starting position until the patient calls the line vertical. Validated against laboratory SVV with ~1° agreement.

See also: Subjective Visual Vertical (SVV)

Vestibular Evoked Myogenic Potential (VEMP)(VEMP, cVEMP, oVEMP)
Short-latency myogenic reflex to high-intensity sound or vibration; cVEMP probes saccule→inferior vestibular nerve→SCM, oVEMP probes utricle→superior vestibular nerve→inferior oblique. Companion test to SVV for otolith function.

See also: Saccule, Utricle

Wallenberg syndrome(lateral medullary syndrome)
Lateral medullary stroke producing ipsiversive OTR and ipsilesional SVV tilt (often large, 5–15°). Classic localiser for vestibular nuclei involvement.

See also: Ocular Tilt Reaction (OTR), Subjective Visual Vertical (SVV)

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.

© 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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