Subjective Visual Vertical Testing in Patients With Chronic Suppurative Otitis Media

Rafael da Costa Monsanto, Ana Luiza Papi Kasemodel, Andreza Tomaz, Norma de Oliveira Penido

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objective: To analyze the results of the subjective visual vertical test using the “bucket method” in patients with chronic suppurative otitis media (CSOM). Study Design: Cross-sectional, controlled study. Setting: Outpatient otology clinic in a tertiary care hospital. Subjects and Methods: Patients had CSOM, defined as the presence of chronic infection or inflammation of the middle ear cleft, associated with a perforation of the tympanic membrane, frequent or intractable middle ear suppuration, with or without cholesteatoma. Controls were selected using a nonprobability, purposive sampling method. We excluded patients with neurologic or metabolic diseases, cognitive deficits, otosclerosis, vestibular migraine, Ménière’s disease, past use of ototoxic medication, or head and neck cancer. The volunteers were subjected to the subjective visual vertical test using the “bucket method.” The results obtained in our study and control groups were analyzed using nonparametric tests. Results: Our study comprised 51 patients with CSOM and 50 controls. In the CSOM group, we observed that 72.5% of the patients had vestibular symptoms in the past year, and 70.5% had abnormalities identified in at least 1 vestibular function test. The subjective visual vertical test revealed that patients with CSOM (with and without cholesteatoma) had significantly higher deviations of the true vertical as compared with controls (CSOM, 3.66°; controls, 0.76°; P <.001). Conclusion: Our results revealed that CSOM was associated with high rates of vestibular symptoms, abnormal vestibular function tests, and abnormal subjective vertical visual results.

Original languageEnglish (US)
Pages (from-to)1018-1024
Number of pages7
JournalOtolaryngology - Head and Neck Surgery (United States)
Issue number5
StatePublished - Nov 1 2020
Externally publishedYes

Bibliographical note

Funding Information:
Funding source: Rafael da Costa Monsanto received a scholarship from the Coordenação de Aperfeiçoamento Pessoal de Nível Superior (CAPES).

Publisher Copyright:
© American Academy of Otolaryngology–Head and Neck Surgery Foundation 2020.


  • chronic otitis media
  • chronic suppurative otitis media
  • subjective vertical visual
  • vestibular function tests
  • vestibular symptoms


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