European Archives of Oto-Rhino-Laryngology

, Volume 274, Issue 3, pp 1215–1222 | Cite as

Video head impulse test: a review of the literature

  • Salman F Alhabib
  • Issam Saliba
Review Article


Video head impulse test (vHIT) is a new testing which able to identify the overt and covert saccades and study the gain of vestibulo-ocular reflex (VOR) of each semicircular canal. The aim of this study is to review the clinical use of vHIT in patients with vestibular disorders in different diseases. PubMed and Cochrane databases were searched for all articles that defined vHIT, compared vHIT with another clinical test, and studied the efficacy of vHIT as diagnostic tools with vestibular disease. 37 articles about vHIT were reviewed. All articles studied the vHIT in English and French languages up to May 2015 were included in the review. Editorial articles or short comments, conference abstracts, animal studies, and language restriction were excluded from the review. Four systems were used in the literature to do the vHIT. vHIT is physiological quick test, which studied the VOR at high frequency of each semicircular canal by calculating the duration ratio between the head impulse and gaze deviation. vHIT is more sensitive than clinical head impulse test (cHIT), especially in patient with isolated covert saccades. vHIT test is diagnostic of vestibular weakness by gain reduction and the appearance of overt and covert saccades. If the vHIT is normal, then caloric test is mandatory to rule out a peripheral origin of vertigo. It is recommended to test each semicircular canal, as isolated vertical canal weakness was identified in the literature. More investigation would be required to determine the evolution of the VOR gain with the progression of the vestibular disease.


Video head impulse test Vestibulo-ocular reflex Semicircular canals Vestibular disease vHIT 


Compliance with ethical standards

Conflict of interest

Nothing to disclose.


  1. 1.
    Hullar TE, Della Santina CC (2005) Responses of irregularly discharging chinchilla semicircular canal vestibular nerve afferents during high-frequency head rotations. J Neurophysiol 93(5):2777–2786CrossRefPubMedGoogle Scholar
  2. 2.
    Ulmer E, Chays A (2005) Head Impulse test: an analytical device. Ann Otolaryngol Chir Cervicofac 122(2):84–90CrossRefPubMedGoogle Scholar
  3. 3.
    Hoshowsky B, Tomlinson D (1994) The horizontal vestibule-ocular reflex gain during active and passive high-frequency head movements. Laryngoscope 104(2):140–145PubMedGoogle Scholar
  4. 4.
    Blodow A, Pannasch S (2013) Detection of isolated covert saccades with the video head impulse test in peripheral vestibular disorders. Auris Nasus Larynx 40(4):348–351CrossRefPubMedGoogle Scholar
  5. 5.
    Bell SL, Barker F (2015) A study of the relationship between the video head impulse test and air calorics. Eur Arch Otorhinolaryngol 272(5):1287–1294CrossRefPubMedGoogle Scholar
  6. 6.
    MacDougall HG, Weber K (2009) The video head impulse test: diagnostic accuracy in peripheral vestibulopathy. Neurology 73(14):1134–1141CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    MacDougall HG, McGarvie LA (2013) Application of the video head impulse test to detect vertical semicircular canal dysfunction. Otol Neurotol 34(6):974–979CrossRefPubMedGoogle Scholar
  8. 8.
    Imai T, Sekine K (2005) Comparing the accuracy of video-oculography and the scleral search coil system in human eye movement analysis. Auris Nasus Larynx 32:3–9CrossRefPubMedGoogle Scholar
  9. 9.
    Agrawal Y (2014) Schubert MC Evaluation of quantitative head impulse testing using search coils versus video-oculography in older individuals. Otol Neurotol 35(2):283–288CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    MacDougall HG, Weber KP (2009) The video head impulse test: diagnostic accuracy in peripheral vestibulopathy. Neurology 73(14):1134–1141CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
  12. 12.
  13. 13.
    Black RA, Halmagyi GM (2005) The active head-impulse test in unilateral peripheral vestibulopathy. Arch Neurol 62(2):290–293CrossRefPubMedGoogle Scholar
  14. 14.
    Ulmer E, Bernard-Demanze L (2011) Statistical study of normal canal deficit variation range. Measurement using the head impulse test video system. Eur Ann Otorhinolaryngol Head Neck Dis 128(5):278–282CrossRefPubMedGoogle Scholar
  15. 15.
    McGarvie LA, Martinez-Lopez M (2015) Horizontal eye position affects measured vertical VOR gain on the video head impulse test. Front Neurol 17(6):58Google Scholar
  16. 16.
    Weber KP, Aw ST, Todd MJ, McGarvie LA, Curthoys IS et al (2008) Head impulse test in unilateral vestibular loss: vestibulo-ocular reflex and catch-up saccades. Neurology 70:454–463CrossRefPubMedGoogle Scholar
  17. 17.
    Hullar TE, Della Santina CC (2005) Responses of irregularly discharging chinchilla semicircular canal vestibular nerve afferents during high-frequency head rotations. J Neurophysiol 93(5):2777–2786CrossRefPubMedGoogle Scholar
  18. 18.
    Weber KP, Aw ST (2008) Head impulse test in unilateral vestibular loss Vestibulo-ocular reflex and catch-up saccades. Neurology 70(6):454–463CrossRefPubMedGoogle Scholar
  19. 19.
    Manzari L, Burgess AM (2013) Vestibular function after vestibular neuritis. Int J Audiol 52(10):713–718CrossRefPubMedGoogle Scholar
  20. 20.
    Murnane O, Mabrey H (2014) Normative data and test–retest reliability of the SYNAPSYS video head impulse test. J Am Acad Audiol 25(3):244–252CrossRefPubMedGoogle Scholar
  21. 21.
    Kim JS, Kim HJ (2012) Inferior vestibular neuritis J Neurol 259(8):1553–1560. doi: 10.1007/s00415-011-6375-4 (Epub 2012 Jan 4. 259:1553–1560)
  22. 22.
    Blödow A, Blödow J, Bloching MB, Helbig R, Walther LE (2015) Horizontal VOR function shows frequency dynamics in vestibular schwannoma. Eur Arch Otorhinolaryngol 272(9):2143–2148CrossRefPubMedGoogle Scholar
  23. 23.
    Roth TN, Weber KP (2014) Ethanol consumption impairs vestibule-ocular reflex function measured by the video head impulse test and dynamic visual acuity. J Vestib Res 24(4):289–295PubMedGoogle Scholar
  24. 24.
    Matiño-Soler E, Esteller-More E (2015) Normative data on angular vestibule-ocular responses in the yaw axis measured using the video head impulse test. Otol Neurotol 36(3):466–471CrossRefPubMedGoogle Scholar
  25. 25.
    Paige GD (1992) Senescence of human visual-vestibular interactions. Vestibulo-ocular reflex and adaptive plasticity with aging. J Vestib Res 2(2):133–151Google Scholar
  26. 26.
    Kim JS, Kim HJ (2012) Inferior vestibular neuritis. J Neurol 259(8):1553–1560CrossRefPubMedGoogle Scholar
  27. 27.
    Walther LE, Blödow A (2013) Ocular vestibular evoked myogenic potential to air conducted sound stimulation and video head impulse test in acute vestibular neuritis. Otol Neurotol 34(6):1084–1089CrossRefPubMedGoogle Scholar
  28. 28.
    Nadol JB (1995) Vestibular neuritis. Otolaryngol Head Neck Surg 112(1):162–172CrossRefPubMedGoogle Scholar
  29. 29.
    Bartolomeo M, Biboulet R (2014) Value of the video head impulse test in assessing vestibular deficits following vestibular neuritis. Eur Arch Otorhinolaryngol 271(4):681–688CrossRefPubMedGoogle Scholar
  30. 30.
    Magliulo G, Iannella G (2015) Retinitis pigmentosa: evaluation of the vestibular system with cervical and ocular vestibular evoked myogenic potentials and the video head impulse test. Otol Neurotol 36(2):273–276CrossRefPubMedGoogle Scholar
  31. 31.
    Crawford J (1964) Living without a balancing mechanism. Br J Ophthalmol 48:357–360CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Ishiyama G, Ishiyama A (2006) Gentamicin ototoxicity: clinical features and the effect on the human estibule-ocular reflex. Acta Otolaryngol 126(10):1057–1061CrossRefPubMedGoogle Scholar
  33. 33.
    Halmagyi GM, MacDougall H (2012) Video head impulse test diagnoses vestibulotoxicity. Otolaryngol Head Neck Surg 147(2 suppl):P95CrossRefGoogle Scholar
  34. 34.
    McCaslin DL, Rivas A (2015) The dissociation of video head impulse (vHIT) and bithermal caloric test results provide topological localization of vestibular system impairment in patients with “definite” Ménière’s disease. Am J Audiol 24(1):1–10CrossRefPubMedGoogle Scholar
  35. 35.
    McGarvie LA, Curthoys IS, MacDougall HG, Halmagyi GM (2015) What does the dissociation between the results of video head impulse versus caloric testing reveal about the vestibular dysfunction in Ménière’s disease? Acta Otolaryngol 135(9):859–865CrossRefPubMedGoogle Scholar
  36. 36.
    Rambold HA (2015) Economic management of vertigo/dizziness disease in a county hospital: video-head-impulse test vs. caloric irrigation. Eur Arch Otorhinolaryngol 272(10):2621–2628CrossRefPubMedGoogle Scholar
  37. 37.
    Manzari L, Burgess M (2011) Rapid fluctuations in dynamic semicircular canal function in early Ménière’s disease. Eur Arch Otorhinolaryngol 268:637–639CrossRefPubMedGoogle Scholar
  38. 38.
    Blödow A, Helbig R (2013) Video head impulse test or caloric irrigation? Contemporary diagnostic tests for vestibular schwannoma. HNO 61(9):781–785CrossRefPubMedGoogle Scholar
  39. 39.
    Batuecas-Caletrio A, Santacruz-Ruiz S (2014) The estibule-ocular reflex and subjective balance after vestibular schwannoma surgery. Laryngoscope 124(6):1431–1435CrossRefPubMedGoogle Scholar
  40. 40.
    Lee H, Sohn SI (2006) Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns. Neurology 67(7):1178–1183CrossRefPubMedGoogle Scholar
  41. 41.
    Tarnutzer AA, Berkowitz AL et al (2011) Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ 183:E571Y92Google Scholar
  42. 42.
    Mantokoudis G1, Tehrani AS, Wozniak A, Eibenberger K, Kattah JC, Guede CI et al (2015) VOR gain by head impulse video-oculography differentiates acute vestibular neuritis from stroke. Otol Neurotol 36(3):457–465CrossRefPubMedGoogle Scholar
  43. 43.
    McCaslin DL, Jacobson GP (2014) Predictive properties of the video head impulse test: measures of caloric symmetry and self-report dizziness handicap. Ear Heart 35(5):e185–e191Google Scholar
  44. 44.
    Mahringer A, Holger A (2014) Caloric test and video-head-impulse: a study of vertigo/dizziness patients in a community hospital. Eur Arch Otorhinolaryngol 271:463–472CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Otology and Neurotology FellowUniversity of MontrealMontrealCanada
  2. 2.Division of Otolaryngology, Head and Neck Surgery - Otology and NeurotologyMontreal University Hospital Center (CHUM), University of MontrealMontrealCanada

Personalised recommendations