European Archives of Oto-Rhino-Laryngology

, Volume 273, Issue 11, pp 3595–3602 | Cite as

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

  • Young Joon Seo
  • Yoon Ah Park
  • Tae Hoon Kong
  • Mi Ran Bae
  • Sung Huhn KimEmail author


This study investigated the effects of head position on gain values during video head impulse tests (vHITs). Different head positions were used for vHIT of the horizontal semicircular canals of 20 healthy controls and 18 patients with unilateral vestibular loss (UVL), with head velocities ranging from 150°/s to 200°/s. Differences in vestibulo-ocular reflex gain in the control and patient groups according to head position (0° and 30° downward pitch) were analyzed. In the unaffected control group, the 30° pitched-down position resulted in a mean gain increase of up to 1.0 in both ears (right ear: 0.85 ± 0.26 for head-up and 1.05 ± 0.12 for head-down, p = 0.004; left ear: 0.75 ± 0.18 for head-up and 0.98 ± 0.16 for head-down, p < 0.001). In patients with UVL, the mean gains on the diseased side were 0.92 ± 0.16 in the head-up position and 0.82 ± 0.2 in the head-down position, at similar head velocities (p = 0.046). The pitched-down position also increased the asymmetry between ears in patients with UVL, at the same head velocity. A 30° head-down position can increase vHIT sensitivity, which resulted in increased mean gain in unaffected people and decreased mean gain in most of the patients with UVL in this study. This method may more effectively stimulate the horizontal semicircular canal. This vHIT modification may be helpful for more precisely evaluating vestibular function, thus reducing false-negative findings.


Video head impulse test Unilateral vestibular loss Head position Downward pitch 



This work was supported by “Industrial Core Technology Development Program of Biomedical Devices” funded by the Ministry of Trade, industry and Energy (MI, Korea). (10051518).

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Financial disclosures

The authors have sources of financial support or funding to disclose.

Supplementary material

405_2016_3979_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 19 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Young Joon Seo
    • 1
  • Yoon Ah Park
    • 1
  • Tae Hoon Kong
    • 1
  • Mi Ran Bae
    • 2
  • Sung Huhn Kim
    • 2
    Email author
  1. 1.Department of OtorhinolaryngologyYonsei University WonJu College of MedicineWonjuKorea
  2. 2.Department of OtorhinolaryngologyYonsei University College of MedicineSeoulSouth Korea

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