A Deeper Look at SVINT: A Powerful, Underused Tool in Vestibular Assessment

Jul 01, 2025

At North 49, I’ve been incredibly fortunate to learn from many brilliant clinicians throughout my career and I see it as part of my responsibility to share what I’ve learned along the way. My goal is that these blogs are a means of reviewing what I have learned and assist in supporting your journey by offering practical, evidence-based insights.

This blog, however, is a little different.

It’s a summary of a doctoral project by someone I’ve had the honour of working with for several years: Nycole Pataki. Nycole recently relocated from Saskatchewan to Arizona with her family and asked if I’d read her doctoral project. After doing so, I knew this work deserved a broader audience. With her permission, we’ve repackaged it into this blog to highlight the main findings and clinical implications.

If you assess or treat patients with vestibular dysfunction, this is one to bookmark.

What is SVINT?

The Skull Vibration-Induced Nystagmus Test (SVINT) is a quick, safe, and well-tolerated bedside test that can reveal vestibular asymmetry. The test uses a 100 Hz bone-conducted vibration applied to the mastoid and vertex. In individuals with significant vestibular deficits, this vibration triggers a predictable nystagmus response that can aid in differential diagnosis.

In healthy individuals: Typically no significant nystagmus response.
In those with vestibulopathy: Predictable direction and presence of nystagmus based on pathology.

Why SVINT Matters

SVINT fills an important gap. While other bedside tests (like HIT, HST, or caloric testing) assess different frequency ranges of the vestibular system, SVINT specifically targets the high-frequency spectrum of the vestibulo-ocular reflex (VOR). It’s also a global vestibular test, stimulating semicircular canals and otolithic organs (utricle and saccule) simultaneously.

Notably:

It’s not influenced by vestibular compensation, making it especially useful in chronic cases.
It detects vestibular asymmetry, regardless of whether a patient feels "recovered."
It’s especially useful in direct access settings like physiotherapy, where patients may present before ever seeing a specialist.

Key Findings by Condition

1. Unilateral Vestibular Loss (UVL)

Total UVL: SVINT is highly sensitive (up to 100%). Nystagmus beats away from the lesion.
Partial UVL: Less consistent; sensitivity drops to 58–60%, and direction of nystagmus may vary.

2. Superior Canal Dehiscence (SCD)

SVINT often elicits nystagmus toward the affected side, especially with vertex stimulation.
Positivity ranges from 67–100% depending on frequency and site.
May be as sensitive as or more sensitive than VEMPs in some patients.

3. Meniere’s Disease (MD)

SVINT is more likely to be positive near an acute attack or in more advanced stages.
Positivity ranges from 28–71%.
Nystagmus usually beats away from the affected ear, but this is inconsistent.

4. Vestibular Migraine (VM)

SVINT is generally negative, helping differentiate from MD.
Positivity as low as 6% in VM patients.

5. Vestibular Schwannoma (VS)

Positivity increases with tumour size/severity.
Direction of nystagmus is variable, though some studies report it beats away from the lesion.

6. Following Intratympanic Gentamicin

SVINT can track degree of deafferentation over time.
Nystagmus typically beats away from the affected side.

7. BPPV and Bilateral Vestibular Loss

BPPV: SVINT generally negative unless other vestibular conditions are present.
Bilateral loss: SVINT typically negative, as symmetry masks the deficit.

How to Perform SVINT

Equipment:

Vibrator delivering 100 Hz at 0.02–0.21 mm amplitude
Frenzel goggles or video nystagmography

Procedure:

Apply vibration to both mastoids and the vertex, ~10 seconds each.
Observe for nystagmus (must start/stop with vibration, >2.5°/s, reproducible).
Repeat for reliability.

Interpretation:

Direction and presence of nystagmus should be correlated with clinical history and other findings.

Clinical Pearls

SVINT is simple, portable, and powerful—ideal for vestibular therapists in any setting.
It’s especially valuable in direct access and screening roles, where quick differentiation is needed.
SVINT is most reliable in UVL and SCD, but also provides clinical value in MD and post-gentamicin cases.
Like all tests, it should never be used in isolation. Always correlate with history, other bedside tests, and advanced diagnostics where available.

Final Thoughts

Nycole’s project is an excellent reminder that innovation doesn’t always require new and expensive technology. Sometimes it just means applying well-researched tools more effectively. SVINT may not yet be standard in all vestibular evaluations, but given its diagnostic value, perhaps it should be.

Thanks again to Nycole for allowing us to share this and for the impact you’ve had on our patients and team. Arizona is fortunate to have you.

If you’d like more resources like this, sign up for our monthly email blast or check out the free video resources on our YouTube channel.

To read more about SVINT and where we bought a handheld vibrator for $35 click HERE.

To review a video outlining how to perform the test and view what a positive test looks like click HERE.

References

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