Advertisement

European Archives of Oto-Rhino-Laryngology

, Volume 273, Issue 11, pp 3733–3739 | Cite as

Determining vestibular hypofunction: start with the video-head impulse test

  • B. F. van Esch
  • G. E. A. J. Nobel-Hoff
  • P. P. G. van Benthem
  • H. J. van der Zaag-Loonen
  • Tj. D. Bruintjes
Otology

Abstract

Caloric testing is considered the ‘reference standard’ in determining vestibular hypofunction. Recently, the video-head impulse test (vHIT) was introduced. In the current study we aimed to assess the diagnostic value of the vHIT as compared to caloric testing in determining vestibular function. In a cross-sectional study between May 2012 and May 2013, we prospectively analysed patients with dizziness who had completed caloric testing and the vHIT. For the left and right vestibular system we calculated the mean vHIT gain. We used a gain cut-off value of 0.8 for the vHIT and presence of correction saccades to define an abnormal vestibular-ocular reflex. An asymmetrical ocular response of 22 % or more (Jongkees formula) or an irrigation response with a velocity below 15°/s was considered abnormal. We calculated sensitivity, specificity, positive and negative predictive values with 95 % confidence intervals for the dichotomous vHIT. Among 324 patients [195 females (60 %), aged 53 ± 17 years], 39 (12 %) had an abnormal vHIT gain and 113 (35 %) had an abnormal caloric test. Sensitivity was 31 % (23–40 %), specificity 98 % (95–99 %), positive predictive value was 88 % (74–95 %), and negative predictive value 73 % (67–77 %). In case of vHIT normality, additional caloric testing remains indicated and the vHIT does not replace the caloric test. However, the high positive predictive value of the vHIT indicates that an abnormal vHIT is strongly related to an abnormal caloric test result; therefore, additional caloric testing is not necessary. We conclude that the vHIT is clinically useful as the first test in determining vestibular hypofunction in dizzy patients.

Keywords

Video head impulse test Caloric testing Vestibular hypofunction Dizziness Nystagmus 

Notes

Acknowledgments

The authors thank P. Oostenbrink and S. Masius-Olthof for technical assistance.

Funding

This work was supported solely from institutional and/or departmental sources from the Apeldoorn Dizziness Centre, Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict 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 and its later amendments or comparable ethical standards.

Informed consent

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

References

  1. 1.
    Aw ST, Haslwanter T, Fetter M (1998) Contribution of the vertical semicircular canals to the caloric nystagmus. Act Otolaryngol 118:618–627CrossRefGoogle Scholar
  2. 2.
    Schmid-Provisceanu A, Böhmer A, Obzina HH (2001) Caloric and search-coil head-impulse testing in patients after vestibular neuritis. J Assoc Res Otolaryngol 2:72–78CrossRefGoogle Scholar
  3. 3.
    Halmagyi GM, Curthoys IS (1998) A clinical sign of canal paresis. Arch Neurol 45:737–739CrossRefGoogle Scholar
  4. 4.
    Beynon GJ, Jani P, Baguley DM (1998) A clinical evaluation of head impulse testing. Clin Otolaryngol 23:22–177CrossRefGoogle Scholar
  5. 5.
    Harvey SA, Wood DJ, Feroah TR (1997) Relationship of the head impulse test and head-shake nystagmus in reference to caloric testing. Am J Otol 18:207–213PubMedGoogle Scholar
  6. 6.
    Magnusson M, Karlberg K, Halmagyi M, Hafström A (2002) The video-impulse test enhances the possibility of detecting vestibular lesions. J Vestib Res 11:231Google Scholar
  7. 7.
    Weber KP, MacDougall HG, Curthoys IS (2009) Impulsive testing of semicircular-canal function using video-oculography. An NY Acad Sci 1664:486–491CrossRefGoogle Scholar
  8. 8.
    Jorns-Haderli M, Straumann D, Palla A (2007) Accuracy of the bedside head impulse test in detecting vestibular hypofunction. J Neurol Neurosurg Psych 78:1113–1118CrossRefGoogle Scholar
  9. 9.
    Perez N, Rama-Lopez J (2003) Head-impulse and caloric tests in patients with dizziness. Otol Neurotol 24:913–917CrossRefPubMedGoogle Scholar
  10. 10.
    Bartolomeo M, Biboulet R, Pierre G, Mondain M, Uziel A, Venail F (2013) Value of the video head impulse test in assessing vestibular deficits following vestibular neuritis. Eur Arch Otorhinolaryngol 271:681–688CrossRefPubMedGoogle Scholar
  11. 11.
    Mahringer A, Rambold HA (2013) Caloric test and video-head-impulse: a study of vertigo/dizziness patients in a community hospital. Eur Arch Otorhinolaryngol 271:463–472CrossRefPubMedGoogle Scholar
  12. 12.
    McCaslin DL, Gary JP, Marc BL (2014) Predictive properties of the video head impulse test: measures of the caloric symmetry and self-report dizziness handicap. Ear Hear 34:185–191CrossRefGoogle Scholar
  13. 13.
    Committee on Hearing and Equilibrium (1995) Guidelines for the diagnosis and evaluation of therapy in Meniere’s disease. Otolaryngol Head Neck Surg 113:181–185CrossRefGoogle Scholar
  14. 14.
    Lempert T, Olesen J, Furman J (2012) Vestibular migraine: diagnostic criteria. J Vestib Res 22:167–172PubMedGoogle Scholar
  15. 15.
    Zingler VC, Cnyrim C, Jahn K (2007) Causative factors and epidemiology of bilateral vestibulopathy in 255 patients. Ann Neurol 61:524–532CrossRefPubMedGoogle Scholar
  16. 16.
    Jongkees LBW, Maas JPM, Philipszoon AJ (1962) Clinical nystagmography. Pract Otolaryngol 24:65–93Google Scholar
  17. 17.
    Bossuyt PM, Reitsma JB, Bruns DE et al (2003) Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. BMJ 326:41–44CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Goncalves DU, Felipe L, Lima TMA (2008) Interpretation and use of caloric testing. Rev Bras Otorhinolaryngol 73:440–446Google Scholar
  19. 19.
    MacDougall HG, Weber KP, McGarvie LA (2009) The video head impulse test: diagnostic accuracy in peripheral vestibulopathy. Neurology 73:1134–1141CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Rambold HA (2015) Economic management of vertigo/dizziness disease in a county hospital: video-head-impulse test vs. caloric irrigation. Eur Arch Otorhinolaryngol 272:2621–2628CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • B. F. van Esch
    • 1
  • G. E. A. J. Nobel-Hoff
    • 2
  • P. P. G. van Benthem
    • 3
  • H. J. van der Zaag-Loonen
    • 1
  • Tj. D. Bruintjes
    • 1
  1. 1.Apeldoorn Dizziness CentreGelre HospitalApeldoornThe Netherlands
  2. 2.Department of OtorhinolaryngologyMaastricht University Medical CentreMaastrichtThe Netherlands
  3. 3.Otorhinolaryngology and Head and Neck Surgery DepartmentLeiden University Medical CentreLeidenThe Netherlands

Personalised recommendations