Comparison of the Efficacy of Video Head Impulse and Bi-Thermal Caloric Tests in Vertigo

Objective: To compare video head impulse test (vHIT) and caloric test efficacy in decompensated and compensated vertigo patients and to further investigate whether vHIT alone can be used as a diagnostic tool in vertigo. Methods: This study included 25 patients diagnosed with vertigo and without any previous history of vertigo or hearing loss before their admission to our clinic. The control group consisted of 16 healthy adult volunteers. Patients were classified into 2 groups, compensated and decompensated. Video head impulse test and caloric tests were performed and the results were compared between the groups. Results: The difference of caloric test values between control-compensated groups and compensated-decompensated groups was statistically significant ( P < .001, Pearson χ2). However, there was no statistically significant difference between the compensated and control groups according to vHIT gain asymmetry values ( P = .087). In the very early stages of the disease with spontaneous nystagmus, the diagnostic significance of vHIT was similar to that of the caloric test. When both sides were compared, vHIT gain asymmetry values were close to the caloric test asymmetry values. In the compensated stage, caloric test was superior to vHIT in differentiating compensated vestibular pathologies. When vHIT sensitivity was evaluated according to the bi-thermal caloric test results, the sensitivity of the vHIT gain asymmetry value was 85.71% and 23.08% for decompensated and compensated patients respectively. Conclusion: In the early decompensated stages of the disease with spontaneous nystagmus, vHIT shows similar diagnostic accuracy to that of the caloric test. Since patients can tolerate vHIT more easily, our results suggest that vHIT can be considered as a primary evaluation method in the early (decompensated) period of the disease and should be preferred over the caloric test during the acute phase. Caloric test is more reliable at the compensated stage. Video head impulse test is inadequate in evaluating the compensated vestibular hypofunctional states after compensation has been restored. Level of Evidence: Level 2b

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Comparision of Video Head Impulse Test Findings Before and After Therapy Maneuvers in Individuals with Benign Paroxysmal Positional Vertigo

10.22541/au.162830507.78469930/v1 ◽

2021 ◽

Author(s):

ERCAN KARABABA ◽

Hacı Hüseyin DERE ◽

Banu MÜJDECİ ◽

Erkan KARATAŞ

Keyword(s):

Benign Paroxysmal Positional Vertigo ◽

Head Impulse Test ◽

Control Group ◽

Study Group ◽

Video Head Impulse Test ◽

Head Impulse ◽

Positional Vertigo ◽

Significant Difference ◽

Before And After ◽

Paroxysmal Positional Vertigo

Purpose: Vestibuloocular reflex (VOR) may be helpful in the diagnosis of Benign Paroxysmal Positional Vertigo (BPPV). Video Head Impulse Test (vHIT) can effectively diagnose VOR deficits in vestibular disorders. Aims: The aim of this study is to investigate the significance of vHIT in determining the efficacy of therapeutic maneuvers in individuals with posterior semicircular canal BPPV. Materials and Methods: The study included 25 patients with posterior SCC BPPV (Study Group) between the ages of 19-65 years, 30 healthy individuals (Control Group). All individuals underwent otorhinolaryngologic examination, audiological evaluation with, videonystagmography and vHIT. The Dizziness Handicap Inventory (DHI) and Visual Analogue Scale (VAS) were administered to the individuals with posterior SCC BPPV for the intensity of dizziness and Modified Epley maneuver was performed 3 times at an interval of 3 days. The vHIT, DHI and VAS were re-administered to these individuals 1 week after improvement was detected in positional nystagmus. Results: There was no significant difference between the study and control groups in terms of vHIT gains for all bilateral SCCs before therapeutic maneuver (p>0.05). In the study group, there was no significant difference between vHIT gains of all bilateral SSCs before and after therapeutic maneuvers (p>0.05). No asymmetry or refixation saccades (overt and covert) were observed in any of the individuals in both groups during all measurements. Compared to before therapeutic maneuvers, there was a significant decrease in dizziness-related disability level assessed by DHI and intensity of dizziness assessed by VAS in the study group after the improvement (p<0.001). Conclusion: It was found that vHIT was not a diagnostic test in BPPV and in terms of evaluating the efficacy of therapeutic maneuvers. Subjective evaluations determining the intensity of dizziness and level of dizziness-related disability in BPPV provided supportive information in diagnosis and in determining the efficacy of therapeutic maneuvers.

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Peripheral Vestibulopathy Presenting as Acute Vertigo and Spontaneous Nystagmus with Negative Video Head Impulse Test

Otolaryngology ◽

10.1177/0194599818825458 ◽

2019 ◽

Vol 160 (5) ◽

pp. 894-901

Author(s):

Jung-Yup Lee ◽

Chang-Hee Kim ◽

Jin Su Park ◽

Min-Beom Kim

Keyword(s):

Meniere’S Disease ◽

Spontaneous Nystagmus ◽

Head Impulse Test ◽

Caloric Test ◽

Ménière’S Disease ◽

Video Head Impulse Test ◽

Menière's Disease ◽

Head Impulse ◽

Lesion Side ◽

Ménière's Disease

Objective To analyze acute vertigo showing spontaneous nystagmus with negative video head impulse test (vHIT). Study Design Retrospective chart analysis. Setting Tertiary referral hospital. Subjects and Methods Over 16 months, 155 patients were identified with acute vertigo with spontaneous nystagmus. Of these 155, 30 (19.4%) were enrolled in this study because they did not show gain loss or catch-up saccades in both sides of the horizontal vHIT. Results of vestibular function tests (videonystagmography, horizontal vHIT, caloric test, and cervical vestibular-evoked myogenic potential [cVEMP]) and pure tone audiometry were analyzed. For all cases, magnetic resonance imaging with diffusion-weighted imaging was checked. Results Patients consisted of 17 with Ménière’s disease and 7 with sudden sensorineural hearing loss with vertigo (SSNHL_V), and only 3 patients were finally diagnosed as having acute vascular stroke. Except for the loss of hearing on the lesion side, the direction of nystagmus or cVEMP asymmetry showed very different results. All 7 patients with SSNHL_V did not have canal paresis in the caloric test, but cVEMP amplitude was smaller on the lesion side for 6 patients. Conclusions For patients with acute vertigo presenting spontaneous nystagmus with negative horizontal vHIT, it is important not only to focus on the diagnosis of acute vascular stroke but also to evaluate hearing because of the high possibility of Ménière’s disease or SSNHL_V.

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Viewing Target Distance Influences the Vestibulo-Ocular Reflex Gain when Assessed Using the Video Head Impulse Test

Audiology and Neurotology ◽

10.1159/000493845 ◽

2018 ◽

Vol 23 (5) ◽

pp. 285-289 ◽

Cited By ~ 2

Author(s):

Patricia Castro ◽

Sara Sena Esteves ◽

Florencia Lerchundi ◽

David Buckwell ◽

Michael A. Gresty ◽

...

Keyword(s):

Head Movements ◽

Target Distance ◽

Head Impulse Test ◽

Video Head Impulse Test ◽

Gaze Stabilization ◽

Head Impulse ◽

Ocular Reflex ◽

Significant Difference ◽

Vestibulo Ocular Reflex ◽

Reflex Gain

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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Bilateral Vestibular Hypofunction in the Time of the Video Head Impulse Test

Audiology and Neurotology ◽

10.1159/000504286 ◽

2019 ◽

Vol 25 (Suppl. 1-2) ◽

pp. 72-78

Author(s):

Nicolás Pérez-Fernández ◽

Laura Alvarez-Gomez ◽

Raquel Manrique-Huarte

Keyword(s):

Head Impulse Test ◽

Video Head Impulse Test ◽

Test Results ◽

Bilateral Vestibulopathy ◽

Similar Time ◽

Head Impulse ◽

Vestibular Hypofunction ◽

Number Of Patients ◽

Significant Difference ◽

Bilateral Vestibular Hypofunction

Objectives: Bilateral vestibulopathy is a clinical syndrome in which laboratory testing plays a crucial diagnostic role. We aimed to establish the frequency of detection of that finding in a tertiary level hospital considering the new methods of laboratory vestibular examination nowadays in use, with respect to the conventional caloric and rotatory chair test approaches. Design: Two similar time periods (5 years) were retrospectively evaluated, and the demographic, clinical data and test results from 4,576 patients were reviewed. In the first period, the diagnosis was based on caloric and rotatory chair tests and, in the second, on the video head impulse test. Results: Of the patients included, 3.77% in the first period and 4.58% in the second met the criteria for bilateral vestibular hypofunction; there was no significant difference between both periods. Conclusions: The functional vestibular evaluation to detect bilateral deficiency makes no significant difference to the number of patients diagnosed with a bilateral vestibulopathy. New diagnostic categories probably depend not only on the availability and accessibility of complete vestibular and visual-vestibular evaluation, but also on recent advances in defining vestibular disorders. Bilateral vestibular hypofunction manifests with very different patterns. Progress in more detailed definition (clinical and laboratory) is needed, in particular when all 6 semicircular canals and both maculae are available for testing.

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