Subjective visual vertical testing: Influence of preset in pediatric patients

Background Preset angle of subjective visual vertical (SVV) was reportedly playing a role in adult patients, however, this has not been investigated in pediatric patients. Objective To investigate possible impact from the preset of SVV on testing outcome in children. Methods Retrospective review of SVV test results from 127 children with dizziness. These patients were grouped by clinical diagnoses, including vestibular migraine (VM), persistent postural-perceptual dizziness (PPPD), etc. SVV testing outcome, preset angle and direction were compared among these groups. Results In all groups, there was a significant difference in SVV with rightward preset and leftward preset ( p < 0.001). Specifically, patients were more likely to choose SVV tilting to the right in SVV trials with rightward preset but varied with leftward preset. The magnitude of preset angle did not demonstrate a statistically significant impact on the SVV score. Regression analysis with both factors was conducted to quantify the effect of SVV preset on static SVV outcome. Conclusions The direction of preset angle can affect the final static SVV result, with a stronger effect with rightward preset. An equal number of SVV trials in both rightward and leftward preset directions should be used to avoid bias in calculating the mean SVV deviation.