European Archives of Oto-Rhino-Laryngology

, Volume 273, Issue 6, pp 1379–1385 | Cite as

Compensatory saccades benefit from prediction during head impulse testing in early recovery from vestibular deafferentation

  • Georgios Mantokoudis
  • Yuri Agrawal
  • David E. Newman-Toker
  • Li Xie
  • Ali S. Saber Tehrani
  • Aaron Wong
  • Michael C. SchubertEmail author


The head impulse test (HIT) can identify a deficient vestibulo-ocular reflex (VOR) by the compensatory saccade (CS) generated once the head stops moving. The inward HIT is considered safer than the outward HIT, yet might have an oculomotor advantage given that the subject would presumably know the direction of head rotation. Here, we compare CS latencies following inward (presumed predictable) and outward (more unpredictable) HITs after acute unilateral vestibular nerve deafferentation. Seven patients received inward and outward HITs delivered at six consecutive postoperative days (POD) and again at POD 30. All head impulses were recorded by portable video-oculography. CS included those occurring during (covert) or after (overt) head rotation. Inward HITs included mean CS latencies (183.48 ms ± 4.47 SE) that were consistently shorter than those generated during outward HITs in the first 6 POD (p = 0.0033). Inward HITs induced more covert saccades compared to outward HITs, acutely. However, by POD 30 there were no longer any differences in latencies or proportions of CS and direction of head rotation. Patients with acute unilateral vestibular loss likely use predictive cues of head direction to elicit early CS to keep the image centered on the fovea. In acute vestibular hypofunction, inwardly applied HITs may risk a preponderance of covert saccades, yet this difference largely disappears within 30 days. Advantages of inwardly applied HITs are discussed and must be balanced against the risk of a false-negative HIT interpretation.


Compensatory saccades Vestibular Deafferentation Latency Prediction 



This study was supported by the Swiss National Science Foundation (PBBEP2 136573). The authors would like to thank Dr. Hergen Friedrich, MD, for the illustrations.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Georgios Mantokoudis
    • 1
  • Yuri Agrawal
    • 2
  • David E. Newman-Toker
    • 3
  • Li Xie
    • 4
  • Ali S. Saber Tehrani
    • 3
  • Aaron Wong
    • 3
  • Michael C. Schubert
    • 5
    Email author
  1. 1.University Department of Otorhinolaryngology Head and Neck SurgeryInselspital BernBernSwitzerland
  2. 2.Department of Otolaryngology Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Department of NeurologyJohns Hopkins University School of MedicineBaltimoreUSA
  4. 4.Nemours Biomedical ResearchAlfred I. du Pont Hospital for ChildrenWilmingtonUSA
  5. 5.Department of Otolaryngology Head and Neck Surgery and Physical Medicine and RehabilitationThe Johns Hopkins University School of MedicineBaltimoreUSA

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