Repeated video head impulse testing in patients is a stable measure of the passive vestibulo-ocular reflex

Gaze stabilization during head movements is provided by the vestibulo-ocular reflex (VOR). Clinical assessment of this reflex is performed using the video Head Impulse Test (vHIT). To date, the influence of different fixation distances on VOR gain using the vHIT has not been explored. We assessed the effect of target proximity on the horizontal VOR using the vHIT. Firstly, we assessed the VOR gain in 18 healthy subjects with 5 viewing target distances (150, 40, 30, 20, and 10 cm). The gain increased significantly as the viewing target distance decreased. A second experiment on 10 subjects was performed in darkness whilst the subjects were imagining targets at different distances. There were significant inverse relationships between gain and distance for both the real and the imaginary targets. There was a statistically significant difference between light and dark gains for the 20- and 40-cm distances, but not for the 150-cm distance. Theoretical VOR gains for different target distances were calculated and compared with those found in light and darkness. The increase in gain observed for near targets was lower than predicted by geometrical calculations, implying a physiological ceiling effect on the VOR. The VOR gain in the dark, as assessed with the vHIT, demonstrates an enhancement associated with a reduced target distance.

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Vestibulo-ocular reflex and the head impulse test

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2012001200008 ◽

2012 ◽

Vol 70 (12) ◽

pp. 942-944 ◽

Cited By ~ 4

Author(s):

Eliana T. Maranhão ◽

Péricles Maranhão-Filho

Keyword(s):

Diagnostic Method ◽

Vestibular Dysfunction ◽

Head Impulse Test ◽

Emergency Rooms ◽

Brainstem Infarction ◽

Head Impulse ◽

Ocular Reflex ◽

Peripheral Vestibulopathy ◽

Vestibulo Ocular Reflex

The authors highlights the importance of the vestibulo-ocular reflex examination through the head impulse test as a diagnostic method for vestibular dysfunction as well as, and primarily, a bedside semiotic resource capable of differentiating between acute peripheral vestibulopathy and a cerebellar or brainstem infarction in emergency rooms.

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Vestibulo-ocular reflex assessed with Video Head Impulse Test in children with Vestibular Migraine: Our experience

International Journal of Pediatric Otorhinolaryngology ◽

10.1016/j.ijporl.2020.110161 ◽

2020 ◽

Vol 137 ◽

pp. 110161

Author(s):

Rosana Rodríguez-Villalba ◽

Miguel Caballero-Borrego ◽

Vanessa Villarraga ◽

Victoria Rivero de Jesús ◽

Maria Antonia Claveria ◽

...

Keyword(s):

Vestibular Migraine ◽

Head Impulse Test ◽

Video Head Impulse Test ◽

Head Impulse ◽

Ocular Reflex ◽

Vestibulo Ocular Reflex

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Cochlear Implantation Rarely Alters Horizontal Vestibulo-ocular Reflex in Motorized Head Impulse Test

Otology & Neurotology ◽

10.1097/mao.0b013e318277a430 ◽

2013 ◽

Vol 34 (1) ◽

pp. 48-52 ◽

Cited By ~ 18

Author(s):

Topi Jutila ◽

Heikki Aalto ◽

Timo P. Hirvonen

Keyword(s):

Cochlear Implantation ◽

Head Impulse Test ◽

Head Impulse ◽

Ocular Reflex ◽

Vestibulo Ocular Reflex

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Vestibulo-ocular reflex gain and compensatory saccades in three semicircular canals by video head impulse test

Auditory and Vestibular Research ◽

10.18502/avr.v28i1.415 ◽

2019 ◽

Author(s):

Homa Zarrinkoob ◽

Hadi Behzad ◽

Seyed Mehdi Tabatabaee

Keyword(s):

High Velocity ◽

Semicircular Canals ◽

Head Impulse Test ◽

Video Head Impulse Test ◽

Low Velocity ◽

Head Impulse ◽

Ocular Reflex ◽

Vestibulo Ocular Reflex ◽

Reflex Gain ◽

The Right

Background and Aim: One of the tools for assessing the vestibulo-ocular reflex (VOR) is using video head impulse test (vHIT). In this test by placing the head at different angles and shaking the head, three semicircular canals of the vestibular system in each ear can be examined separately. The purpose of this study was to investigate the relationship between the low and high velocities of the vHIT test with VOR and its compensatory saccades. Methods: The vHIT test was performed by an examiner in 49 normal individuals aged 23–39 at low and high velocities. All participants had normal hearing, visual, and vestibular systems. Results: Mean gains in the horizontal, anterior and posterior semicircular canals in the right ear respectively were 0.92, 1 and 0.90 and in the left ear 0.93, 0.99 and 0.95 for low velocity and 0.78, 0.92 and 0.79 in the right ear and 0.80, 0.85 and 0.86 in the left ear for high velocity. Also, the number of compensatory saccade at high velocity was higher than those at the low velocity and the latency of compensatory saccade was lower at the higher velocity. Conclusion: In the vHIT test, VOR gain decreases at high velocity that is statistically significant. Also, compensatory saccades are more likely to occur at high velocity with smaller delay. Therefore, high-velocity vHIT test is not recommended for the purpose of examining the VOR gain and compensatory saccade.

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The Effect of Different Head Movement Paradigms on Vestibulo-Ocular Reflex Gain and Saccadic Eye Responses in the Suppression Head Impulse Test in Healthy Adult Volunteers

Frontiers in Neurology ◽

10.3389/fneur.2021.729081 ◽

2021 ◽

Vol 12 ◽

Author(s):

Dmitrii Starkov ◽

Bernd Vermorken ◽

T. S. Van Dooren ◽

Lisa Van Stiphout ◽

Miranda Janssen ◽

...

Keyword(s):

Healthy Subjects ◽

Healthy Adult ◽

Head Movements ◽

Head Impulse Test ◽

Head Impulse ◽

Ocular Reflex ◽

Vestibulo Ocular Reflex ◽

Reflex Gain ◽

Head Impulses ◽

Adult Volunteers

Objective: This study aimed to identify differences in vestibulo-ocular reflex gain (VOR gain) and saccadic response in the suppression head impulse paradigm (SHIMP) between predictable and less predictable head movements, in a group of healthy subjects. It was hypothesized that higher prediction could lead to a lower VOR gain, a shorter saccadic latency, and higher grouping of saccades.Methods: Sixty-two healthy subjects were tested using the video head impulse test and SHIMPs in four conditions: active and passive head movements for both inward and outward directions. VOR gain, latency of the first saccade, and the level of saccade grouping (PR-score) were compared among conditions. Inward and active head movements were considered to be more predictable than outward and passive head movements.Results: After validation, results of 57 tested subjects were analyzed. Mean VOR gain was significantly lower for inward passive compared with outward passive head impulses (p < 0.001), and it was higher for active compared with passive head impulses (both inward and outward) (p ≤ 0.024). Mean latency of the first saccade was significantly shorter for inward active compared with inward passive (p ≤ 0.001) and for inward passive compared with outward passive head impulses (p = 0.012). Mean PR-score was only significantly higher in active outward than in active inward head impulses (p = 0.004).Conclusion: For SHIMP, a higher predictability in head movements lowered gain only in passive impulses and shortened latencies of compensatory saccades overall. For active impulses, gain calculation was affected by short-latency compensatory saccades, hindering reliable comparison with gains of passive impulses. Predictability did not substantially influence grouping of compensatory saccades.

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Vestibulo-Ocular Reflex Function in Adolescents With Sport-Related Concussion: Preliminary Results

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738119865262 ◽

2019 ◽

Vol 11 (6) ◽

pp. 479-485 ◽

Cited By ~ 5

Author(s):

Abdulaziz A. Alkathiry ◽

Anthony P. Kontos ◽

Joseph M. Furman ◽

Susan L. Whitney ◽

Eric R. Anson ◽

...

Keyword(s):

Vestibular System ◽

Rank Order ◽

Head Impulse Test ◽

Level Of Evidence ◽

Cross Sectional ◽

Horizontal Semicircular Canal ◽

Head Impulse ◽

Ocular Reflex ◽

Impulse Function ◽

Vestibulo Ocular Reflex

Background: Oculomotor impairments, dizziness, and imbalance are common after sports-related concussion (SRC) in adolescents and suggest a relationship between SRC and vestibular system dysfunction. However, it is not clear whether the source of these problems is attributable to the peripheral or central vestibular system. Hypothesis: The video Head Impulse Test (vHIT), which assesses peripheral vestibular function, will show differences in gain between adolescents with and without SRC. Furthermore, there will be an association between vHIT and clinical balance and vestibular/oculomotor testing. Study Design: Cross-sectional study. Level of Evidence: Level 2. Methods: Twenty-five symptomatic adolescents aged between 12 and 19 years with a recent (within 10 days) SRC and 22 healthy controls aged 13 to 20 years were assessed using the vHIT, Balance Error Scoring System (BESS), and Vestibular Ocular Motor Screening (VOMS) tools. The vestibulo-ocular reflex (VOR) gain was calculated independently for right and left head impulses. Independent-samples t tests or Mann-Whitney U tests for nonnormal distributions were used to compare concussed patients and controls on the measures. Spearman rank-order correlations were used to assess the association of vHIT with BESS and VOMS. Results: VOR gain in all adolescents with SRC was greater than 0.8, which is considered within normal limits. VOR gain and BESS scores were not significantly different between groups. Adolescents with SRC had significantly worse VOMS item scores than adolescents without SRC ( P < 0.001). There were no significant correlations among vHIT gain and VOMS or BESS. Conclusion: There was no evidence for dysfunction in the peripheral horizontal semicircular canal function at high rotation speeds (ie, vHIT) after SRC, and vHIT was unrelated to balance and vestibular/oculomotor symptoms and dysfunction. However, adolescents with SRC scored worse on vestibular and oculomotor testing than those without SRC. Vestibular dysfunction and symptoms after SRC may be centrally derived. Clinical Relevance: We do not recommend the assessment of head impulse function in adolescents with SRC unless more definitive signs of peripheral vestibular injury are present. We recommend using the VOMS to assess symptoms of suspected SRC injury in adolescents.

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Ictal downbeat nystagmus in Ménière disease

Neurology ◽

10.1212/wnl.0000000000010653 ◽

2020 ◽

Vol 95 (17) ◽

pp. e2409-e2417

Author(s):

Sun-Uk Lee ◽

Hyo-Jung Kim ◽

Jeong-Yoon Choi ◽

Ji-Soo Kim

Keyword(s):

Semicircular Canals ◽

Vestibular Evoked Myogenic Potentials ◽

Slow Phase ◽

Downbeat Nystagmus ◽

Meniere Disease ◽

Head Impulse ◽

Slow Phase Velocity ◽

Ocular Reflex ◽

Vestibulo Ocular Reflex ◽

Menière Disease

ObjectiveTo determine the mechanism of ictal downbeat nystagmus in Ménière disease (MD), we compared the head impulse gain of the vestibulo-ocular reflex (VOR) for each semicircular canal between patients with (n = 7) and without (n = 70) downbeat nystagmus during attacks of MD.MethodsWe retrospectively analyzed the results of video-oculography, video head-impulse tests, and cervical vestibular-evoked myogenic potentials (VEMPs) in 77 patients with definite MD who were evaluated during an attack.ResultsPure or predominant downbeat nystagmus was observed in 7 patients (9%) with unilateral MD during the attacks. All 7 patients showed spontaneous downbeat nystagmus without visual fixation with a slow phase velocity ranging from 1.5 to 11.2°/s (median 5.4, interquartile range 3.7–8.5). All showed a transient decrease of the head impulse VOR gains for the posterior canals (PCs) in both ears (n = 4) or in the affected ear (n = 3). Cervical VEMPs were decreased in the affected (n = 2) or both ears (n = 2) when evaluated during the attacks. Downbeat nystagmus disappeared along with normalization of the VOR gains for PCs after the attacks in all patients. During the attacks, the head impulse VOR gains for the PC on the affected side were lower in the patients with ictal downbeat nystagmus than in those without (Mann-Whitney U test, p < 0.001), while the gains for other semicircular canals did not differ between the groups.ConclusionDownbeat nystagmus may be observed during attacks of MD due to an asymmetry in the vertical VOR or saccular dysfunction. MD should be considered in recurrent audiovestibulopathy and ictal downbeat nystagmus.

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