Clinical Romberg Testing Does Not Detect Vestibular Disease

Objective: To evaluate the effectiveness of tandem Romberg and tandem walking testing at detecting vestibular disease and to increase the difficulty of these standard screening assessments in an attempt to try and make them more effective in the clinical office setting. Study Design and Setting: A prospective study in a tertiary and quaternary care neuro-otology clinic comparing performance on tandem Romberg and tandem walking between patients with vestibular disease and controls matched for age and sex. Results: Making the tandem Romberg test and tandem walking tests more difficult for patients was not helpful because it also made the tests more difficult to perform for controls with no symptoms of vestibular disease. When comparing a young and an old cohort, there was a significant difference in performance. Conclusion: Our techniques of sharpening and sensitizing tandem Romberg and tandem walking tests were not useful at delineating vestibular disease, and age itself may be a confound that mimics the effects of balance system disease. Significance: The tandem Romberg and tandem walking tests, despite being in widespread clinical use as office screening tests, may not be effective at determining the presence of newly developed vestibular disease.