Journal of Neurology

, Volume 264, Issue 5, pp 1002–1004 | Cite as

Clinical and video head impulses: a simple bedside test in children

  • Nadine Lehnen
  • Cecilia RamaioliEmail author
  • Nicholas Sean Todd
  • Klaus Bartl
  • Stefan Kohlbecher
  • Klaus Jahn
  • Erich Schneider
Letter to the Editors

Dear Sirs,

Missed vestibular deficiency in children bares the risk of delayed postural, motor, and cognitive development [1, 2]. Conversely, of the 5–25% of children experiencing dizziness or vertigo per year [3], many will have migraine-equivalents [4] or somatoform disorders [5], where it is important to reassure children and parents about the normal peripheral-vestibular function. This requires a good history and an easy vestibular function test [6]. Whereas in adults, clinical [7] and now also video-based head impulses [8, 9] are widely used to assess vestibulo-ocular reflex (VOR) function, and there has long been no quantitative bedside test of vestibular function in children [10]. In addition, the stationary tests available (calorics and rotational chair testing) may induce unpleasant vertigo and nausea [10, 11] and are, therefore, not always tolerated by children [11].

Here, we determined feasibility and normative data for video head impulses in children. We first performed the...


Head Velocity Head Impulse Head Impulse Testing Rotational Chair Vestibular Function Test 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Solveig Schneider and Grit Paerschke for help with subject recruitment. This work was supported by the German Federal Ministry of Education and Research (Grant 01 EO 1401) and by the Faculty of Medicine of the University of Munich.

Compliance with ethical standards

Conflicts of interest

NL is a shareholder and consultant of EyeSeeTec GmbH. She received speaker honoraria and compensation for travel expenses from Interacoustics. NST is an employee of EyeSeeTec GmbH. KB and SK are shareholders and employees of EyeSeeTec GmbH. ES is the managing director and a shareholder of EyeSeeTec GmbH and an unpaid consultant to Interacoustics. He received speaker honoraria and compensation for travel expenses from Interacoustics and Actelion. CR and KJ have no competing interests to report.


  1. 1.
    Wiener-Vacher SR, Hamilton DA, Wiener SI (2013) Vestibular activity and cognitive development in children: perspectives. Front Integr Neurosci 7:92CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Inoue A, Iwasaki S, Ushio M, Chihara Y, Fujimoto C et al (2013) Effect of vestibular dysfunction on the development of gross motor function in children with profound hearing loss. Audiol Neurootol 18:143–151CrossRefPubMedGoogle Scholar
  3. 3.
    Humphriss RL, Hall AJ (2011) Dizziness in 10 year old children: an epidemiological study. Int J Pediatr Otorhinolaryngol 75:395–400CrossRefPubMedGoogle Scholar
  4. 4.
    Al-Twaijri WA, Shevell MI (2002) Pediatric migraine equivalents: occurrence and clinical features in practice. Pediatr Neurol 26:365–368CrossRefPubMedGoogle Scholar
  5. 5.
    Ketola S, Niemensivu R, Henttonen A, Appelberg B, Kentala E (2009) Somatoform disorders in vertiginous children and adolescents. Int J Pediatr Otorhinolaryngol 73:933–936CrossRefPubMedGoogle Scholar
  6. 6.
    Jahn K, Langhagen T, Heinen F (2015) Vertigo and dizziness in children. Curr Opin Neurol 28:78–82CrossRefPubMedGoogle Scholar
  7. 7.
    Halmagyi GM, Curthoys IS (1988) A clinical sign of canal paresis. Arch Neurol 45:737–739CrossRefPubMedGoogle Scholar
  8. 8.
    MacDougall HG, Weber KP, McGarvie LA, Halmagyi GM, Curthoys IS (2009) The video head impulse test: diagnostic accuracy in peripheral vestibulopathy. Neurology 73:1134–1141CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Bartl K, Lehnen N, Kohlbecher S, Schneider E (2009) Head impulse testing using video-oculography. Ann N Y Acad Sci 1164:331–333CrossRefPubMedGoogle Scholar
  10. 10.
    Fife TD, Tusa RJ, Furman JM, Zee DS, Frohman E et al (2000) Assessment: vestibular testing techniques in adults and children: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 55:1431–1441CrossRefPubMedGoogle Scholar
  11. 11.
    Christy JB, Payne J, Azuero A, Formby C (2014) Reliability and diagnostic accuracy of clinical tests of vestibular function for children. Pediatr Phys Ther 26:180–189CrossRefPubMedGoogle Scholar
  12. 12.
    Heuberger M, Saglam M, Todd NS, Jahn K, Schneider E et al (2014) Covert anti-compensatory quick eye movements during head impulses. PLoS One 9:e93086CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Hulse R, Hormann K, Servais JJ, Hulse M, Wenzel A (2015) Clinical experience with video head impulse test in children. Int J Pediatr Otorhinolaryngol 79:1288–1293CrossRefPubMedGoogle Scholar
  14. 14.
    Mossman B, Mossman S, Purdie G, Schneider E (2015) Age dependent normal horizontal VOR gain of head impulse test as measured with video-oculography. J Otolaryngol Head Neck Surg 44:29CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Hamilton SS, Zhou G, Brodsky JR (2015) Video head impulse testing (VHIT) in the pediatric population. Int J Pediatr Otorhinolaryngol 79:1283–1287CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Center for Sensorimotor Research, NeurologyMunich University HospitalMunichGermany
  2. 2.German Center for Vertigo and Balance DisordersMunich University HospitalMunichGermany
  3. 3.Department of Psychosomatic Medicine and PsychotherapyKlinikum rechts der Isar, Technical University of MunichMunichGermany
  4. 4.Schön Klinik Bad AiblingBad AiblingGermany
  5. 5.Brandenburg University of TechnologyCottbus-SenftenbergGermany

Personalised recommendations