Caloric test and video-head-impulse: a study of vertigo/dizziness patients in a community hospital
- 1.7k Downloads
The head-impulse test (HIT) is an important test for examining unilateral vestibular hypofunction. The new video-head-impulse test (vHIT) is more sensitive and specific than the clinical bedside-head-impulse test (bHIT). Alternatively, one can test for vestibular hypofunction with the caloric irrigation test. Various studies showed that both tests may not always identify vestibular hypofunction; instead, the results of the tests might be contradictory. To evaluate the diagnostic value of these tests, we routinely measured patients exhibiting vertigo or dizziness at our community hospital with bithermal caloric irrigation, the bHIT and the vHIT. Only those patients (n = 172) with a pathological caloric irrigation test of more than 25 % unilateral weakness in the Jongkee’s formula were included. Out of these patients, 41 % had a pathologic vHIT. Among the subgroup with acute symptoms (symptom onset within 5 days), 63 % had a pathological video-head-impulse, whereas only 33 % of the non-acute group (symptom onset more than 5 days) tested pathological. A pathological HIT depended on the disease stage, the amount of unilateral weakness in caloric examination and on the test itself.
KeywordsVertigo Dizziness Caloric irrigation Head-impulse-test
The authors thank Mrs. Ribarczyk and Mrs. Goetz for technical assistance and Dr. Blaine Nelson for copyediting the manuscript.
Conflict of interest
H. Rambold is beta-tester of the Otosuite® vHIT system but has no financial interest in the product.
- 4.Beynon GJ, Jani P, Baguley DM (1998) A clinical evaluation of head impulse testing. Clin Otolaryngol Allied Sci 23(2):117–122Google Scholar
- 8.Sander T, Machner B, Rambold H, Neumann G, Fritzmannova M, Trillenberg P, Helmchen C (2009) Vertigo: case history and findings on clinical examination. Klin Neurophysiol 40:9Google Scholar
- 9.Brandt T (2003) Vertigo: its multisensory syndroms. 2 edn. Springer, London, Berlin, HeidellbergGoogle Scholar
- 10.Committee on hearing and equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere's disease. American Academy of Otolaryngology-Head and Neck Foundation, Inc (1995) Otolaryngology—head and neck surgery. J American Academy Otolaryngol-Head Neck Surg 113(3):181–185Google Scholar
- 16.Maire R, van Melle G (2006) Diagnostic value of vestibulo-ocular reflex parameters in the detection and characterization of labyrinthine lesions. Otol Neurotol 27(4):535–541. doi: 10.1097/01.mao.0000201432.42498.08 official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and NeurotologyPubMedCrossRefGoogle Scholar
- 17.Becker GD (1978) Sources of error in interpretation of caloric tests. Otolaryngology 86 (5):ORL-830–833Google Scholar
- 18.Baloh RW, Solingen L, Sills AW, Honrubia V (1977) Caloric testing. 1. Effect of different conditions of ocular fixation. Ann otol Rhinol Laryngol Supp 86(5 Pt 3 Suppl 43):1–6Google Scholar
- 25.Scherer H, Clarke AH (1985) The caloric vestibular reaction in space physiological considerations. Acta Otolaryngol 100(5–6):328–336Google Scholar
- 27.Kirchner H, Kremmyda O, Hufner K, Stephan T, Zingler V, Brandt T, Jahn K, Strupp M (2011) Clinical, electrophysiological, and MRI findings in patients with cerebellar ataxia and a bilaterally pathological head-impulse test. Ann N Y Acad Sci 1233:127–138. doi: 10.1111/j.1749-6632.2011.06175.x PubMedCrossRefGoogle Scholar
- 28.Machner B, Gottschalk S, Sander T, Helmchen C, Rambold H (2007) Intralabyrinthine schwannoma affecting the low but not high frequency function of the vestibulo-ocular reflex: implications for the clinical diagnosis of chronic peripheral vestibular deficits. J Neurol Neurosurg Psychiatry 78(7):772–774. doi: 10.1136/jnnp.2006.106179 PubMedCrossRefGoogle Scholar
- 30.Manzari L, Macdougall HG, Burgess AM, Curthoys IS (2012) New, fast, clinical vestibular tests identify whether a vertigo attack is due to early Meniere’s disease or vestibular neuritis. Laryngoscope. doi: 10.1002/lary.23479
- 31.Maire R, van Melle G (2008) Vestibulo-ocular reflex characteristics in patients with unilateral Meniere’s disease. Otol Neurotol 29(5):693–698. doi: 10.1097/MAO.0b013e3181776703 official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and NeurotologyPubMedCrossRefGoogle Scholar