European Archives of Oto-Rhino-Laryngology

, Volume 271, Issue 9, pp 2375–2383 | Cite as

Relation of video-head-impulse test and caloric irrigation: a study on the recovery in unilateral vestibular neuritis

  • Stephanie Zellhuber
  • Andrea Mahringer
  • Holger A. Rambold


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. Alternatively, one can test for vestibular hypofunction with the caloric irrigation test. Various studies have shown that both tests may not always identify vestibular hypofunction; instead, the results of the tests might be contradictory. To further explore the question, of whether vHIT and caloric irrigation test the same part of the angular horizontal vestibulo-ocular reflex (VOR), we examined patients with unilateral vestibular neuritis at different points in time. The tonic vestibular imbalance (e.g., subjective-visual-vertical, ocular torsion and spontaneous nystagmus) and dynamic dysfunction of VOR (vHIT and bithermal caloric irrigation) were measured and quantified. While parameters of the tonic vestibular imbalance were well described by single exponential decay functions, dynamic parameters were less well defined. Therefore, to better compare the time course of pairs of two different parameters, we used a linear regression analysis. No linear correlation was found in the group and individually for the gain asymmetry and the ipsilesional gain of the vHIT with the unilateral weakness of the bithermal caloric irrigation tests. Linear correlation was found for most parameters of tonic vestibular imbalance. These findings are further evidence that vHIT and caloric irrigation test different parts of the angular VOR.


Vertigo Dizziness Caloric irrigation Head-impulse-test Vestibular recovery 



The authors thank I. Ribarczyk and U. Goetz for technical assistance and W. Benning and G. Kuska for copyediting the manuscript.

Conflict of interest

H. A. Rambold is beta-tester of the Otosuite® vHIT system but has no financial interest in the product.

Supplementary material

405_2013_2723_MOESM1_ESM.xlsx (35 kb)
Supplementary material 1 Table 1 Linear regression analysis: In (A) only significant linear correlations are shown for the group analysis. The p values indicate the result of the statistical t test for the slope being different from zero (p > 0.05) and rho and p S the test results of the Spearman rank correlation tests. In (B) the successful linear regressions analysis of the individuals is summarized as mean ± standard deviation (std) ‘%’ again indicates the number of successful correlations in relation to the number of all analyzed patients in percentage (XLSX 35 kb)
405_2013_2723_MOESM2_ESM.jpg (194 kb)
Supplementary material 2 Fig. 1 Group data (gray dots) for different measured parameters (a1–b3) can be described by an exponential decay function (black lines) and are shown over time (log scale) in days. Open squares indicate the average values for defined time bins, vertical lines indicate the standard error and the black thick solid line indicates the exponential function fitted to the average data points. SVV subjective visual vertical, SPN slow phase velocity of the spontaneous nystagmus, DHI score of the dizziness handicap inventory, GA gain asymmetry of the vHIT, SaPVal mean peak velocity of all correcting saccades ipsilesional, UW unilateral weakness of the caloric irrigation (JPEG 142 kb)
405_2013_2723_MOESM3_ESM.jpg (350 kb)
Supplementary material 3 Fig. 2 Data (open squares) are displayed as in Fig. 1, but exponential decay functions, fitted to each patient, are overlayed (red lines). Abbreviations as in Fig. 1 (JPEG 102 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Stephanie Zellhuber
    • 1
  • Andrea Mahringer
    • 1
  • Holger A. Rambold
    • 1
    • 2
  1. 1.Department of NeurologyCounty Hospitals of Altötting and BurghausenAltoettingGermany
  2. 2.Department of NeurologyUniversity of RegensburgRegensburgGermany

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