The Bucket Test in Patients with Chronic Otitis Media with Cholesteatoma vs Without Cholesteatoma

Introduction: Chronic otitis media may alter vestibular input through inflammatory and structural changes affecting otolith function. The Subjective Visual Vertical (SVV), assessed using the bucket test, provides a simple and reliable bedside measure of utricular pathway integrity. The aim of this study is to evaluate the subjective visual vertical test using the "Bucket test" in patients diagnosed with chronic otitis media with and without cholesteatoma.

Methods: We included patients with chronic otitis media (COM) and healthy volunteers as a control group were recruited from an otolaryngology outpatient clinic from September 2023 to January 2024 in a secondary care center. COM patients were classified into three groups: chronic otitis media with cholesteatoma (COMC), chronic suppurative otitis media with no cholesteatoma (CSOM) and chronic perforation of the tympanic membrane (CPTM). Ten measurements with the Bucket Test were performed, 5 measurements in clockwise and 5 in counterclockwise direction.
Main Outcome Measure(s): The clockwise and counterclockwise measurements obtained with the bucket test; normal values were set to 0 ± 2.

Results: A hundred and twenty-eight patients were included. Sixty-four with chronic otitis media and 64 healthy controls. The counterclockwise measurements were 0.80 ± 0.45 in the control group vs 2.76 ± 1.69 in the COM group (p < 0.001). The clockwise measurements were 1.20 ± 0.59 vs 3.79 ± 1.77 in the control group and COM group respectively (p < 0.001). There was no statistical difference between COMC patients and COM patients without cholesteatoma for counterclockwise and clockwise measurements (p = 0.358 and p = 0.876, respectively).

Conclusions: The Bucket Test is an adequate test to evaluate the vestibular function in patients with COM. COM patients have abnormal results on the SVV, indicating an altered utricular function. In this study no differences were found in SVV between patients with or without cholesteatoma.