Semin Hear 2009; 30(4): 281-286
DOI: 10.1055/s-0029-1241128
© Thieme Medical Publishers

Subjective Visual Vertical Test

Faith W. Akin1 , 2 , Owen D. Murnane1 , 2
  • 1VA Medical Center, Audiology (126), Mountain Home, Tennessee
  • 2Department of Communicative Disorders, East Tennessee State University, Johnson City, Tennessee
Further Information

Publication History

Publication Date:
21 October 2009 (online)


The otoliths are vestibular organs that act as gravito-inertial force sensors and contribute to the perception of spatial orientation (earth verticality). The subjective visual vertical (SVV) is a psychophysical measure of the angle between perceptual vertical and true (gravitational) vertical. The otoliths contribute to the estimation of the physical vertical orientation, and individuals with normal vestibular function align the SVV within 2 degrees of true vertical (0 degrees). Impaired SVV has been documented in patients with unilateral vestibular disorders. Most research has focused on measuring the static SVV (head upright and stationary); however, more recently, methods have been developed to measure the SVV during stimulation of the otolith organs using on-axis yaw rotation (bilateral centrifugation), off-axis eccentric rotation (unilateral centrifugation), or head tilt for tests of bilateral or unilateral otolith function. The SVV test may be a useful method to assess utricular function in patients complaining of dizziness and/or imbalance and identify stages of recovery for otolith involvement.


  • 1 Neal E. Visual localization of the vertical.  Am J Psychol. 1926;  37 287-291
  • 2 Witkin H A, Asch S E. Studies in space orientation; perception of the upright in the absence of a visual field.  J Exp Psychol. 1948;  38(5) 603-614
  • 3 Friedmann G. The judgement of the visual vertical and horizontal with peripheral and central vestibular lesions.  Brain. 1970;  93(2) 313-328
  • 4 Böhmer A, Rickenmann J. The subjective visual vertical as a clinical parameter of vestibular function in peripheral vestibular diseases.  J Vestib Res. 1995;  5(1) 35-45
  • 5 Tribukait A, Bergenius J, Brantberg K. The subjective visual horizontal for different body tilts in the roll plane: characterization of normal subjects.  Brain Res Bull. 1996;  40(5-6) 375-381 381-383
  • 6 Gómez García A, Jáuregui-Renaud K. Subjective assessment of visual verticality in follow-up of patients with acute vestibular disease.  Ear Nose Throat J. 2003;  82(6) 442-444, 446
  • 7 Kobayashi H, Hayashi Y, Higashino K et al.. Dynamic and static subjective visual vertical with aging.  Auris Nasus Larynx. 2002;  29(4) 325-328
  • 8 Kumagami H, Sainoo Y, Fujiyama D et al.. Subjective visual vertical in acute attacks of Ménière's disease.  Otol Neurotol. 2009;  30(2) 206-209
  • 9 Böhmer A, Mast F. Chronic unilateral loss of otolith function revealed by the subjective visual vertical during off center yaw rotation.  J Vestib Res. 1999;  9(6) 413-422
  • 10 Halmagyi G, Curthoys I. Otolith function tests. In: Herdman SJ Vestibular Rehabilitation. 3rd ed. Philadelphia, PA; FA Davis 2007: 144-161
  • 11 Curthoys I S, Dai M J, Halmagyi G M. Human ocular torsional position before and after unilateral vestibular neurectomy.  Exp Brain Res. 1991;  85(1) 218-225
  • 12 Vibert D, Häusler R, Safran A B. Subjective visual vertical in peripheral unilateral vestibular diseases.  J Vestib Res. 1999;  9(2) 145-152
  • 13 Goto F, Kobayashi H, Saito A et al.. Compensatory changes in static and dynamic subjective visual vertical in patients following vestibular schwanoma surgery.  Auris Nasus Larynx. 2003;  30(1) 29-33
  • 14 Min K K, Ha J S, Kim M J, Cho C H, Cha H E, Lee J H. Clinical use of subjective visual horizontal and vertical in patients of unilateral vestibular neuritis.  Otol Neurotol. 2007;  28(4) 520-525
  • 15 Dieterich M, Brandt T. Ocular torsion and tilt of subjective visual vertical are sensitive brainstem signs.  Ann Neurol. 1993;  33(3) 292-299
  • 16 Mossman S, Halmagyi G M. Partial ocular tilt reaction due to unilateral cerebellar lesion.  Neurology. 1997;  49 491-493
  • 17 Helling K, Schönfeld U, Scherer H, Clarke A H. Testing utricular function by means of on-axis rotation.  Acta Otolaryngol. 2006;  126(6) 587-593
  • 18 Wetzig J, Reiser M, Martin E, Bregenzer N, von Baumgarten R J. Unilateral centrifugation of the otoliths as a new method to determine bilateral asymmetries of the otolith apparatus in man.  Acta Astronaut. 1990;  21(6-7) 519-525
  • 19 Clarke A H, Schönfeld U, Hamann C, Scherer H. Measuring unilateral otolith function via the otolith-ocular response and the subjective visual vertical.  Acta Otolaryngol Suppl. 2001;  545 84-87
  • 20 Smith S T, Curthoys I S, Moore S T. The human ocular torsion position response during yaw angular acceleration.  Vision Res. 1995;  35(14) 2045-2055
  • 21 Pavlou M, Wijnberg N, Faldon M E, Bronstein A M. Effect of semicircular canal stimulation on the perception of the visual vertical.  J Neurophysiol. 2003;  90(2) 622-630
  • 22 Clarke A H, Schönfeld U, Helling K. Unilateral examination of utricle and saccule function.  J Vestib Res. 2003;  13(4-6) 215-225
  • 23 Ernst A, Basta D, Seidl R O, Todt I, Scherer H, Clarke A. Management of posttraumatic vertigo.  Otolaryngol Head Neck Surg. 2005;  132(4) 554-558
  • 24 Basta D, Todt I, Scherer H, Clarke A, Ernst A. Postural control in otolith disorders.  Hum Mov Sci. 2005;  24(2) 268-279

Faith W AkinPh.D. 

Director, VA Medical Center

Audiology (126), Mountain Home, TN 37684