The Head Impulse Test as a Predictor of Videonystagmography Caloric Test Lateralization According to the Level of Examiner Experience: A Prospective Open-Label Study

We conducted a study to compare how well the head impulse test (HIT), without and with eye-movement recordings, would predict videonystagmographic (VNG) caloric test lateralization when performed by a resident and an experienced otoneurologist. This prospective, open-label, blinded study was conducted in an ambulatory tertiary care referral center. Our study population was made up of 60 patients—29 men and 31 women, aged 20 to 82 years (mean: 56.4 ± 11.4)—with peripheral vestibulopathy who underwent HIT and VNG caloric testing. The HIT was conducted in two protocols: HIT0 and HIT1. The HIT0 was performed with passive brisk movements of the patient's head from the 0° null position to 20° sideways, and the HIT1 was performed toward the center while the null position was a 20° head rotation to the right and to the left. Each protocol was carried out without video eye-movement recordings (HIT0 and HIT1) and with such recordings (rHIT0 and rHIT1). The primary outcome measures were (1) a comparison of the HIT's sensitivity and specificity when performed by the resident and by the experienced otoneurologist and (2) the ability of video-recorded HIT to predict VNG caloric test lateralization. The sensitivity and specificity obtained by the resident were 41 and 81%, respectively, for HIT0 and 41 and 90% for HIT1. The sensitivity and specificity obtained by the experienced otoneurologist were 18 and 89% for HIT0 and 32 and 85% for HIT1. Analysis of the recorded eye-movement clips of the HIT0 and HIT1 obtained by a second experienced otoneurologist found a sensitivity and specificity of 32 and 63% for rHIT0 and 33 and 82% for rHIT1. We conclude that the HIT yields high false-negative rates in predicting significant caloric lateralization. Analysis of the eye-movement recordings was no better than normal testing alone for detecting saccades. The experience of the examining physician had no impact on test performance characteristics.

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The Head Impulse Test as a Predictor of Videonystagmography Caloric Test Lateralization according to the Level of Examiner Experience: A Prospective Open-Label Study

Ear Nose & Throat Journal ◽

10.1177/0145561318097001-204 ◽

2018 ◽

Vol 97 (1-2) ◽

pp. 16-23

Author(s):

Ashraf Awadie ◽

Yehuda Holdstein ◽

Margalit Kaminer ◽

Avi Shupak

Keyword(s):

Eye Movement ◽

Sensitivity And Specificity ◽

Test Performance ◽

Tertiary Care ◽

False Negative ◽

Head Rotation ◽

Head Impulse Test ◽

Caloric Test ◽

Open Label ◽

Head Impulse

We conducted a study to compare how well the head impulse test (HIT), without and with eye-movement recordings, would predict videonystagmographic (VNG) caloric test lateralization when performed by a resident and an experienced otoneurologist. This prospective, open-label, blinded study was conducted in an ambulatory tertiary care referral center. Our study population was made up of 60 patients–29 men and 31 women, aged 20 to 82 years (mean: 56.4 ± 11.4)—with peripheral vestibulopathy who underwent HIT and VNG caloric testing. The HIT was conducted in two protocols: HITO and HIT1. The HITO was performed with passive brisk movements of the patient's head from the 0° null position to 20° sideways, and the HIT1 was performed toward the center while the null position was a 20° head rotation to the right and to the left. Each protocol was carried out without video eye-movement recordings (HITO and HIT1) and with such recordings (rHITO and rHITl). The primary outcome measures were (1) a comparison of the HIT's sensitivity and specificity when performed by the resident and by the experienced otoneurologist and (2) the ability of video-recorded HIT to predict VNG caloric test lateralization. The sensitivity and specificity obtained by the resident were 41 and 81 %, respectively, for HITO and 41 and 90% for HIT1. The sensitivity and specificity obtained by the experienced otoneurologist were 18 and 89% for HITO and 32 and 85% for HIT1. Analysis of the recorded eye-movement clips of the HITO and HITl obtained by a second experienced otoneurologist found a sensitivity and specificity of 32 and 63% for rHITO and 33 and 82% for rHIT1. We conclude that the HIT yields high false-negative rates in predicting significant caloric lateralization. Analysis of the eye-movement recordings was no better than normal testing alone for detecting saccades. The experience of the examining physician had no impact on test performance characteristics.

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Evaluation of a step-by-step approach to frozen section diagnosis in ovarian masses

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i12.39635 ◽

2021 ◽

Vol 12 (12) ◽

pp. 133-139

Author(s):

Ashumi Gupta ◽

Neelam Jain

Keyword(s):

Sensitivity And Specificity ◽

Malignant Tumors ◽

Frozen Section ◽

Tertiary Care ◽

False Negative ◽

Significant Proportion ◽

False Negative Rate ◽

Accurate Diagnosis ◽

Care Hospital ◽

Ovarian Masses

Background: Ovarian cancer forms a significant proportion of cancer-related mortality in females. It is often detected late due to non-specific clinical presentation. Radiology and tumor markers may indicate an ovarian mass. However, exact diagnosis requires pathological evaluation, which may not be possible before surgery. Intraoperative frozen section (FS) is, therefore, an important modality for the diagnosis of ovarian masses. Aims and Objectives: This study was conducted to study step-by-step approach along with diagnostic utility and accuracy of intraoperative FS in diagnosis of ovarian masses. Materials and Methods: Retrospective comparative analysis was done to determine the diagnostic accuracy of FS as compared to routine histopathology in the pathology department of a tertiary care hospital. Diagnostic categorization was done into benign, borderline, and malignant. Overall accuracy, sensitivity, and specificity of FS technique were calculated. Results: Out of 51 cases, FS analysis yielded accurate diagnosis in 94.1% of ovarian masses. Intraoperative FS had a sensitivity of 94.7%, specificity of 96.9%, 3.1% false-positive rate, and 5.3% false-negative rate in malignant tumors. In benign lesions, FS had 91.7% sensitivity and 100% specificity. FS had 75% sensitivity and 96.4% specificity in cases of borderline tumors. Conclusion: FS is a fairly accurate technique for intraoperative evaluation of ovarian masses. It can help in deciding the extent of surgery. It distinguishes benign and malignant tumors in most cases with high sensitivity and specificity. A methodical approach is useful in determining accurate diagnosis on FS diagnosis.

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Role of video-head impulse test in lateralization of vestibulopathy: Comparative study with caloric test

Auris Nasus Larynx ◽

10.1016/j.anl.2016.12.003 ◽

2017 ◽

Vol 44 (6) ◽

pp. 648-654 ◽

Cited By ~ 15

Author(s):

Pona Park ◽

Joo Hyun Park ◽

Ji Soo Kim ◽

Ja-Won Koo

Keyword(s):

Comparative Study ◽

Head Impulse Test ◽

Caloric Test ◽

Video Head Impulse Test ◽

Head Impulse

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Application of videography during head impulse test in children: A possible replacement for the caloric test?

Audiological Medicine ◽

10.1080/16513860903211731 ◽

2009 ◽

Vol 7 (3) ◽

pp. 168-171 ◽

Cited By ~ 1

Author(s):

Erik Ulmer ◽

André Chays ◽

Laurent Seidermann

Keyword(s):

Head Impulse Test ◽

Caloric Test ◽

Head Impulse

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Comparison of Predictive Parameters between the Video Head Impulse Test and Caloric Test

Research in Vestibular Science ◽

10.21790/rvs.2020.19.2.55 ◽

2020 ◽

Vol 19 (2) ◽

pp. 55-61

Author(s):

Chun Han ◽

Seung Won Paik ◽

Hui Joon Yang ◽

Sang Yoo Park ◽

Ji Hyeon Lee ◽

...

Keyword(s):

Head Impulse Test ◽

Caloric Test ◽

Video Head Impulse Test ◽

Head Impulse ◽

Predictive Parameters

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Clinical Usefulness of Video Head Impulse Test-Comparison of Bithermal Caloric Test and Bedside Head Impulse Test

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2017.00689 ◽

2018 ◽

Vol 61 (8) ◽

pp. 403-407

Author(s):

Hong-Ju Kim ◽

Young-Joo Ko ◽

Hyung-Sun Hong ◽

Seung-Chul Lee ◽

Hyun Ji Kim ◽

...

Keyword(s):

Clinical Usefulness ◽

Head Impulse Test ◽

Caloric Test ◽

Video Head Impulse Test ◽

Head Impulse

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Results in caloric test, video head impulse test and inner ear MRI in patients with Ménière’s disease

Auris Nasus Larynx ◽

10.1016/j.anl.2019.06.002 ◽

2020 ◽

Vol 47 (1) ◽

pp. 71-78 ◽

Cited By ~ 3

Author(s):

Koichi Kitano ◽

Tadashi Kitahara ◽

Taeko Ito ◽

Tomoyuki Shiozaki ◽

Yoshiro Wada ◽

...

Keyword(s):

Inner Ear ◽

Meniere’S Disease ◽

Head Impulse Test ◽

Caloric Test ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Video Head Impulse Test ◽

Menière's Disease ◽

Head Impulse ◽

Ménière's Disease

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Diagnostic Bedside Vestibuloocular Reflex Evaluation in the Setting of a False Negative Fistula Test in Cholesteatoma of the Middle Ear

Case Reports in Otolaryngology ◽

10.1155/2017/2919463 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5

Author(s):

Ricardo D’Albora ◽

Ligia Silveira ◽

Sergio Carmona ◽

Nicolas Perez-Fernandez

Keyword(s):

Middle Ear ◽

Semicircular Canal ◽

False Negative ◽

Case Series ◽

Mass Effect ◽

Head Impulse Test ◽

Vestibuloocular Reflex ◽

Suppurative Otitis Media ◽

Head Impulse ◽

Rule Out

Background. False negative fistula testing in patients with chronic suppurative otitis media is a dilemma when proceeding to surgery. It is imperative to rule out a dead labyrinth or a mass effect secondary to the cholesteatoma in an otherwise normally functioning inner ear. We present a case series of three patients in whom a bedside vestibuloocular reflex (VOR) evaluation using a head impulse test was used successfully for further evaluation prior to surgery. Results. In all three cases with a false negative fistula test we were able to further evaluate at the bedside and were not only able to register the abnormal VOR but also localize its deterioration to a particular semicircular canal eroded by the fistula. Conclusion. Vestibuloocular reflex evaluation is mandatory in patients with suspected labyrinthine fistula due to cholesteatoma of the middle ear before proceeding to surgery. We demonstrate successful use of a bedside head impulse test for further evaluation prior to surgery in patients with false negative fistula test.

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Sensitivity and specificity of vestibular bed-side examination in detecting VIII cranial nerve schwannoma with sensorineural sudden unilateral hearing loss as presenting symptom

Acta Otorhinolaryngologica Italica ◽

10.14639/0392-100x-1284 ◽

2017 ◽

Vol 37 (4) ◽

pp. 336-340

Author(s):

L. Califano ◽

F. Salafia ◽

M.G. Melillo ◽

S. Mazzone

Keyword(s):

Hearing Loss ◽

Sensitivity And Specificity ◽

Cranial Nerve ◽

Head Impulse Test ◽

Unilateral Hearing Loss ◽

Head Impulse ◽

Sono Stati

Gli obiettivi dello studio sono stati: identificare segni di sofferenza vestibolare attraverso un protocollo di bed-side examination in caso di ipoacusia improvvisa monolaterale senza segni clinici di sofferenza vestibolare; proporre i risultati della bed side examination vestibolare come criterio per lesecuzione mirata della RMN per i canali acustici interni in caso di sospetto di neurinoma dell VIII nervo cranico. Sono stati valutati 96 pazienti, 52 uomini e 44 donne, con ipoacusia improvvisa neurosensoriale monolaterale che non presentavano né vertigine né nistagmo spontaneo. Sono stati eseguiti: esame audiometrico tonale, esame impedenzometrico con test di Anderson per la ricerca di adattamento, Head Shaking Test, Test Vibratorio, Head Impulse Test, Test di iperventilazione, ricerca del nistagmo posizionale in posizione supina e nei decubiti laterali; lABR è stato eseguito nei pazienti con segni di sofferenza vestibolare se con soglia tonale ai toni acuti migliore di 70 dB nHL; tutti i pazienti con ipoacusia improvvisa hanno eseguito RMN con gadolinio per i canali acustici interni. Segni di sofferenza vestibolare sono stati identificati in 22/96 pazienti (22.9%) e la RMN ha evidenziato la presenza di schwannoma dell VIII nervo cranico in 5/96 casi (5.2%), tutti con segni di sofferenza vestibolare evidenziati alla vestibular bed-side examination. I nostri dati hanno evidenziato che gli schwannomi dell VIII nervo cranico sono stati individuati solo nei casi di ipoacusia improvvisa monolaterale con segni di deficit vestibolare omolaterale. Lindicazione alla RMN con gadolinio può quindi essere limitata solo a questi casi, con evidente beneficio organizzativo ed economico.

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