Quantifying a Learning Curve for Video Head Impulse Test: Pitfalls and Pearls

Objective: The video head impulse test (vHIT) is nowadays a fast and objective method to measure vestibular function. However, its usability is controversial and often considered as a test performed by experts only. We sought to study the learning curve of novices and to document all possible mistakes and pitfalls in the process of learning.Methods: In a prospective cohort observational study, we included 10 novices. We tested their ability to perform correctly horizontal head impulses recorded with vHIT. We assessed vHITs in 10 sessions with 20 impulses per session giving a video instruction after the first session (S1) and individual feedback from an expert for session 2 (S2) up to session 10 (S10). We compared VOR gain, the HIT acceptance rate by the device algorithm, mean head velocity, acceleration, excursion, and overshoot between sessions.Results: A satisfying number of accepted HITs (80%) was reached after an experience of 160 vHITs. Mean head velocity between sessions was always in accepted limits. Head acceleration was too low at the beginning (S1) but improved significantly after the video instruction (p = 0.001). Mean head excursion and overshoot showed a significant improvement after 200 head impulses (p < 0.001 each).Conclusions: We showed that novices can learn to perform head impulses invHIT very fast provided that they receive instructions and feedback from an experienced examiner. Video instructions alone were not sufficient. The most common pitfall was a low head acceleration.

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Vestibular semicircular canal function as detected by video Head Impulse Test (vHIT) is essentially unchanged in people with Parkinson’s disease compared to healthy controls

Journal of Vestibular Research ◽

10.3233/ves-201626 ◽

2021 ◽

pp. 1-9

Author(s):

Kim E. Hawkins ◽

Elodie Chiarovano ◽

Serene S. Paul ◽

Ann M Burgess ◽

Hamish G. MacDougall ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Semicircular Canal ◽

Neurodegenerative Disorder ◽

Vestibular Function ◽

Head Impulse Test ◽

Healthy Controls ◽

Video Head Impulse Test ◽

Head Impulse ◽

Vestibulo Ocular Reflex

BACKGROUND: Parkinson’s disease (PD) is a common multi-system neurodegenerative disorder with possible vestibular system dysfunction, but prior vestibular function test findings are equivocal. OBJECTIVE: To report and compare vestibulo-ocular reflex (VOR) gain as measured by the video head impulse test (vHIT) in participants with PD, including tremor dominant and postural instability/gait dysfunction phenotypes, with healthy controls (HC). METHODS: Forty participants with PD and 40 age- and gender-matched HC had their vestibular function assessed. Lateral and vertical semicircular canal VOR gains were measured with vHIT. VOR canal gains between PD participants and HC were compared with independent samples t-tests. Two distinct PD phenotypes were compared to HC using Tukey’s ANOVA. The relationship of VOR gain with PD duration, phenotype, severity and age were investigated using logistic regression. RESULTS: There were no significant differences between groups in vHIT VOR gain for lateral or vertical canals. There was no evidence of an effect of PD severity, phenotype or age on VOR gains in the PD group. CONCLUSION: The impulsive angular VOR pathways are not significantly affected by the pathophysiological changes associated with mild to moderate PD.

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Vestibular function assessment of Susac syndrome patients by the video head impulse test and cervical vestibular-evoked myogenic potentials

Journal of Vestibular Research ◽

10.3233/ves-200007 ◽

2020 ◽

Vol 30 (6) ◽

pp. 393-399

Author(s):

Yahav Oron ◽

Ophir Handzel ◽

Zohar Habot-Wilner ◽

Keren Regev ◽

Arnon Karni ◽

...

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Vestibular Function ◽

Pure Tone Audiometry ◽

Sensorineural Hearing ◽

Vestibular Evoked Myogenic Potentials ◽

Head Impulse Test ◽

Video Head Impulse Test ◽

Head Impulse ◽

Susac Syndrome

BACKGROUND: Susac syndrome (retino-cochleo-cerebral vasculopathy, SuS) is an autoimmune endotheliopathy characterized by the clinical triad of encephalopathy, branch retinal artery occlusions and sensorineural hearing loss. In contrast to data regarding auditory function, data measuring vestibular function is sparse and the cervical vestibular-evoked myogenic potentials (cVEMPs). OBJECTIVE: To determine whether the video head impulse test (vHIT) can serve as a confirmatory assessment of vestibulocochlear dysfunction in cases of suspected SuS. METHODS: Seven patients diagnosed with SuS underwent pure tone audiometry, a word recognition test, cVEMPs and the vHIT. RESULTS: Five patients were diagnosed with definite SuS, and two with probable SuS. Two patients were asymptomatic for hearing loss or tinnitus, and no sensorineural hearing loss was detected by audiograms. Four patients complained of tinnitus, and three patients reported experiencing vertigo. Three patients had abnormal cVEMPs results. All seven patients’ vHIT results were normal, except for patient #2, who was one of the three who complained of vertigo. The calculated gain of her left anterior semicircular canal was 0.5, without saccades. CONCLUSIONS: This is the first study to describe the results of the vHIT and cVEMPs among a group of patients with SuS. The results suggest that the vHIT should not be the only exam used to assess the function of the vestibular system of SuS patients.

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Acute vertigo in the ENT emergency

Otorinolaryngologie a foniatrie ◽

10.48095/ccorl2021146 ◽

2021 ◽

Vol 70 (3) ◽

pp. 146-155

Author(s):

Václav Albrecht ◽

Lukáš Školoudík ◽

Peter Sila ◽

Jan Mejzlík ◽

Michal Janouch ◽

...

Keyword(s):

Emergency Department ◽

Vestibular Function ◽

Head Impulse Test ◽

Video Head Impulse Test ◽

Head Impulse ◽

Video Assisted ◽

Vestibular Testing ◽

Group A ◽

The Difference ◽

Group B

Summary Introduction: Acute vertigo ranks among the common reasons for visiting the emergency department. The aim of this study was to evaluate the rate of peripheral vestibular syndrome (PVS) in patients with acute vertigo examined at the ENT emergency department and to compare the agreement of physical ENT examination with video-assisted vestibular testing. Methods: Patients eamined at the ENT emergency department from January to December 2019 were evaluated retrospectively. The patients who underwent basic ENT examination without video-assisted vestibular testing form group A. The patients who underwent basic ENT examination which was followed by video head impulse test (vHIT) and videonystagmography in the next four days form group B. Results: A total of 117 patients with acute vertigo were included in group A, PVS was found in 31 patients (27%). In total, 50 patients were included in group B; PVS was found in 15 patients (30%), vestibular neuronitis was diagnosed most often (10 patients). The difference in the diagnosis of PVS by basic ENT examination (27 patients, 54%) and by video-assisted vestibular testing (15 patients, 30%) was statistically significant (P = 0.0030). The gain of the lateral (P = 0.0101) and superior (P = 0.0043) semicircular canal proved to be statistically significant, while vHIT was lower in PVS in comparison to other causes of vertigo. Conclusion: After basic ENT examination, PVS as a cause of acute vertigo was diagnosed in 27%. Video-assisted vestibular testing proved a statistically significant lower incidence of PVS in comparison to basic ENT examination. Accessibility of video- -assisted vestibular testing in the emergency department might allow for higher accuracy in the diagnosis of acute vertigo. Key words acute vertigo – vestibular function tests – video head impulse test – videonystagmography

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Effects of Device on Video Head Impulse Test (vHIT) Gain

Journal of the American Academy of Audiology ◽

10.3766/jaaa.16138 ◽

2017 ◽

Vol 28 (09) ◽

pp. 778-785 ◽

Cited By ~ 15

Author(s):

Kristen L. Janky ◽

Jessie N. Patterson ◽

Neil T. Shepard ◽

Megan L. A. Thomas ◽

Julie A. Honaker

Keyword(s):

Normal Control ◽

Vestibular Function ◽

Head Impulse Test ◽

Video Head Impulse Test ◽

Vestibular Loss ◽

Directional Bias ◽

Horizontal Canal ◽

Head Impulse ◽

Control Subjects ◽

Bilateral Vestibular Loss

AbstractNumerous video head impulse test (vHIT) devices are available commercially; however, gain is not calculated uniformly. An evaluation of these devices/algorithms in healthy controls and patients with vestibular loss is necessary for comparing and synthesizing work that utilizes different devices and gain calculations.Using three commercially available vHIT devices/algorithms, the purpose of the present study was to compare: (1) horizontal canal vHIT gain among devices/algorithms in normal control subjects; (2) the effects of age on vHIT gain for each device/algorithm in normal control subjects; and (3) the clinical performance of horizontal canal vHIT gain between devices/algorithms for differentiating normal versus abnormal vestibular function.Prospective.Sixty-one normal control adult subjects (range 20–78) and eleven adults with unilateral or bilateral vestibular loss (range 32–79).vHIT was administered using three different devices/algorithms, randomized in order, for each subject on the same day: (1) Impulse (Otometrics, Schaumberg, IL; monocular eye recording, right eye only; using area under the curve gain), (2) EyeSeeCam (Interacoustics, Denmark; monocular eye recording, left eye only; using instantaneous gain), and (3) VisualEyes (MicroMedical, Chatham, IL, binocular eye recording; using position gain).There was a significant mean difference in vHIT gain among devices/algorithms for both the normal control and vestibular loss groups. vHIT gain was significantly larger in the ipsilateral direction of the eye used to measure gain; however, in spite of the significant mean differences in vHIT gain among devices/algorithms and the significant directional bias, classification of “normal” versus “abnormal” gain is consistent across all compared devices/algorithms, with the exception of instantaneous gain at 40 msec. There was not an effect of age on vHIT gain up to 78 years regardless of the device/algorithm.These findings support that vHIT gain is significantly different between devices/algorithms, suggesting that care should be taken when making direct comparisons of absolute gain values between devices/algorithms.

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Head position and increased head velocity to optimize video head impulse test sensitivity

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-016-3979-4 ◽

2016 ◽

Vol 273 (11) ◽

pp. 3595-3602 ◽

Cited By ~ 5

Author(s):

Young Joon Seo ◽

Yoon Ah Park ◽

Tae Hoon Kong ◽

Mi Ran Bae ◽

Sung Huhn Kim

Keyword(s):

Head Position ◽

Head Impulse Test ◽

Video Head Impulse Test ◽

Head Impulse ◽

Head Velocity ◽

Test Sensitivity

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Comparison of two systems for the video head impulse test (vHIT) for the lateral semicircular canal: description of results from normal and pathological subjects

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x-anp-2020-0301 ◽

2021 ◽

Vol 79 (7) ◽

pp. 571-578

Author(s):

Lilian Felipe

Keyword(s):

Objective Assessment ◽

Semicircular Canals ◽

Small Sample ◽

Head Impulse Test ◽

Functional Evaluation ◽

Video Head Impulse Test ◽

Vestibular Disorder ◽

Head Impulse ◽

Two Systems ◽

Head Impulses

ABSTRACT Background: The video head impulse test (vHIT) is a recent technique for functional evaluation of semicircular canals (SSCs). The vHIT examines eye movements at high frequencies of stimulation and provides an objective assessment of the functioning of the high-frequency domain of the vestibular system. Objective: To describe the results from vHIT performed using two systems. Methods: All subjects were evaluated through an audiological and otoneurological battery of tests and were diagnosed as normal or abnormal by an otorhinolaryngologist. The results from two systems: 1. ICS Impulse (Otometrics/Natus, Denmark) and 2. EyeSeeCam (InterAcoustics, Denmark) were recorded. The same operator delivered every impulse to every subject. The head impulses were performed while the operator was standing behind the subject, using both hands on the top of the subject’s head, well away from the goggles strap and forehead skin. Two calibrations were completed in each system, prior to beginning the test. Results: Test parameters were recorded through both systems for healthy subjects with no history or complaint of any vestibular disorder (N = 12; M/F = 5/7; age 35.1 ± 13.5 y) and for pathological subjects with a diagnosis of unilateral or bilateral vestibular disorder (N = 15; M/F = 7/8; age 53.4 ± 16.7 y). Conclusions: The vHIT is an important tool for otoneurological complementary evaluation. Both systems are reliable for vestibular disorders. The EyeSeeCam seems to reject fewer data and provides more information to include in diagnostics. Because of the small sample, there is a need for further in-depth comparison of both systems.

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Vestibular function assessment of Susac syndrome patients by the video head impulse test and cervical vestibular-evoked myogenic potentials

Journal of Vestibular Research ◽

10.3233/ves-200720 ◽

2020 ◽

pp. 1-7

Author(s):

Yahav Oron ◽

Ophir Handzel ◽

Zohar Habot-Wilner ◽

Keren Regev ◽

Arnon Karni ◽

...

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Vestibular Function ◽

Pure Tone Audiometry ◽

Sensorineural Hearing ◽

Vestibular Evoked Myogenic Potentials ◽

Head Impulse Test ◽

Video Head Impulse Test ◽

Head Impulse ◽

Susac Syndrome

BACKGROUND: Susac syndrome (retino-cochleo-cerebral vasculopathy, SuS) is an autoimmune endotheliopathy characterized by the clinical triad of encephalopathy, branch retinal artery occlusions and sensorineural hearing loss. In contrast to data regarding auditory function, data measuring vestibular function is sparse. OBJECTIVE: To determine whether the video head impulse test (vHIT) can serve as a confirmatory assessment of vestibulocochlear dysfunction in cases of suspected SuS. METHODS: Seven patients diagnosed with SuS underwent pure tone audiometry, a word recognition test, cervical vestibular-evoked myogenic potentials (cVEMPs), and the v-HIT. RESULTS: Five patients were diagnosed with definite SuS, and two with probable SuS. Two patients were asymptomatic for hearing loss or tinnitus, and no sensorineural hearing loss was detected by audiograms. Four patients complained of tinnitus, and three patients reported experiencing vertigo. Three patients had abnormal cVEMPs results. All seven patients’ vHIT results were normal, except for patient #2, who was one of the three who complained of vertigo. The calculated gain of her left anterior semicircular canal was 0.5, without saccades. CONCLUSIONS: This is the first study to describe the results of the vHIT and cVEMPs among a group of patients with SuS. The results suggest that the vHIT should not be the only exam used to assess the function of the vestibular system of SuS patients.

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