Skip to main content

Advertisement

SpringerLink
Log in

Economic management of vertigo/dizziness disease in a county hospital: video-head-impulse test vs. caloric irrigation

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

The video-head-impulse test (vHIT) is an important test for examining unilateral vestibular hypofunction. Alternatively, one can test for vestibular hypofunction with the caloric irrigation test. Various studies have shown that both tests may not always identify vestibular hypofunction; instead, the results of the tests might be contradictory. This retrospective study reproduces those finding in a much larger group of patients at a county hospital. 1063 patients were examined with the vHIT and bithermal caloric irrigation on the same day and analyzed with respect to side differences. Of those patients 13.3 % had pathological vHIT and a caloric irrigation test, 4.6 % a pathological vHIT only and 24.1 % a pathologic caloric test only. As both tests might be necessary, we calculated the optimal sequence of the two examinations based on savings in time for the different disease groups. Especially in vestibular failure using the vHIT first and only applying the caloric irrigation in case of an unremarkable vHIT saves time and optimizes the diagnostic work up. In contrast, in Menière’s disease and vestibular migraine testing caloric irrigation first might be more efficient.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Neuhauser HK, Radtke A, von Brevern M, Lezius F, Feldmann M, Lempert T (2008) Burden of dizziness and vertigo in the community. Arch Intern Med 168(19):2118–2124. doi:10.1001/archinte.168.19.2118

    Article  PubMed  Google Scholar 

  2. Bhansali SA, Honrubia V (1999) Current status of electronystagmography testing. Otolaryngol Head Neck Surg 120(3):419–426

    Article  CAS  PubMed  Google Scholar 

  3. Halmagyi GM, Curthoys IS (1988) A clinical sign of canal paresis. Arch Neurol 45(7):737–739

    Article  CAS  PubMed  Google Scholar 

  4. Perez N, Rama-Lopez J (2003) Head-impulse and caloric tests in patients with dizziness. Otol Neurotol 24(6):913–917

    Article  PubMed  Google Scholar 

  5. Beynon GJ, Jani P, Baguley DM (1998) A clinical evaluation of head impulse testing. Clin Otolaryngol Allied Sci 23(2):117–122

    Article  CAS  PubMed  Google Scholar 

  6. Weber KP, MacDougall HG, Halmagyi GM, Curthoys IS (2009) Impulsive testing of semicircular-canal function using video-oculography. Ann N Y Acad Sci 1164:486–491. doi:10.1111/j.1749-6632.2008.03730.x

    Article  PubMed  Google Scholar 

  7. MacDougall HG, Weber KP, McGarvie LA, Halmagyi GM, Curthoys IS (2009) The video head impulse test: diagnostic accuracy in peripheral vestibulopathy. Neurology 73(14):1134–1141. doi:10.1212/WNL.0b013e3181bacf85

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Mahringer A, Rambold HA (2013) Caloric test and video-head-impulse: a study of vertigo/dizziness patients in a community hospital. Eur Arch Otorhinolaryngol. doi:10.1007/s00405-013-2376-5

    Google Scholar 

  9. Kirchner H, Kremmyda O, Hufner K, Stephan T, Zingler V, Brandt T, Jahn K, Strupp M (2011) Clinical, electrophysiological, and MRI findings in patients with cerebellar ataxia and a bilaterally pathological head-impulse test. Ann N Y Acad Sci 1233:127–138. doi:10.1111/j.1749-6632.2011.06175.x

    Article  PubMed  Google Scholar 

  10. Machner B, Gottschalk S, Sander T, Helmchen C, Rambold H (2007) Intralabyrinthine schwannoma affecting the low but not high frequency function of the vestibulo-ocular reflex: implications for the clinical diagnosis of chronic peripheral vestibular deficits. J Neurol Neurosurg Psychiatry 78(7):772–774. doi:10.1136/jnnp.2006.106179

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Blodow A, Helbig R, Wichmann N, Wenzel A, Walther LE, Bloching MB (2013) Video head impulse test or caloric irrigation? Contemporary diagnostic tests for vestibular schwannoma. HNO 61(9):781–785. doi:10.1007/s00106-013-2752-x

    Article  CAS  PubMed  Google Scholar 

  12. Allison RS, Eizenman M, Tomlinson RD, Nedzelski J, Sharpe JA (1997) Vestibulo-ocular reflex deficits to rapid head turns following intratympanic gentamicin instillation. J Vestib Res 7(5):369–380

    Article  CAS  PubMed  Google Scholar 

  13. Zellhuber S, Mahringer A, Rambold HA (2013) Relation of video-head-impulse test and caloric irrigation: a study on the recovery in unilateral vestibular neuritis. Eur Arch Otorhinolaryngol. doi:10.1007/s00405-013-2723-6

    PubMed  Google Scholar 

  14. Jorns-Haderli M, Straumann D, Palla A (2007) Accuracy of the bedside head impulse test in detecting vestibular hypofunction. J Neurol Neurosurg Psychiatry 78(10):1113–1118. doi:10.1136/jnnp.2006.109512

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Halmagyi GM, Curthoys IS, Cremer PD, Henderson CJ, Todd MJ, Staples MJ, D’Cruz DM (1990) The human horizontal vestibulo-ocular reflex in response to high-acceleration stimulation before and after unilateral vestibular neurectomy. Exp Brain Res 81(3):479–490

    Article  CAS  PubMed  Google Scholar 

  16. Scherer H, Clarke AH (1985) The caloric vestibular reaction in space. Physiological considerations. Acta Otolaryngol 100(5–6):328–336

    Article  CAS  PubMed  Google Scholar 

  17. Haque A, Angelaki DE, Dickman JD (2004) Spatial tuning and dynamics of vestibular semicircular canal afferents in rhesus monkeys. Exp Brain Res 155(1):81–90. doi:10.1007/s00221-003-1693-0

    Article  PubMed  Google Scholar 

  18. Goldberg JM (2000) Afferent diversity and the organization of central vestibular pathways. Exp Brain Res 130(3):277–297

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Curthoys IS, Halmagyi GM (1999) Vestibular compensation. Adv Otorhinolaryngol 55:82–110

    CAS  PubMed  Google Scholar 

  20. Dieringer N (1995) ‘Vestibular compensation’: neural plasticity and its relations to functional recovery after labyrinthine lesions in frogs and other vertebrates. Prog Neurobiol 46(2–3):97–129

    CAS  PubMed  Google Scholar 

  21. Li H, Dokas LA, Godfrey DA, Rubin AM (2002) Remodeling of synaptic connections in the deafferented vestibular nuclear complex. J Vestib Res 12(4):167–183

    PubMed  Google Scholar 

  22. Sander T, Machner B, Rambold H, Neumann G, Fritztmannova M, Trillenberg P, Helmchen C (2009) Vertigo: case history and findings on clinical examination. Klin Neurophysiol 40(9)

  23. Brandt T (2003) Vertigo: its multisensory syndromes, 2nd edn. Springer, London

    Book  Google Scholar 

  24. (1995) Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere’s disease. American Academy of Otolaryngology-Head and Neck Foundation, Inc. Otolaryngol Head Neck Surg 113(3):181–185

  25. Lempert T, Olesen J, Furman J, Waterston J, Seemungal B, Carey J, Bisdorff A, Versino M, Evers S, Newman-Toker D (2012) Vestibular migraine: diagnostic criteria. J Vestib Res 22(4):167–172. doi:10.3233/VES-2012-0453

    PubMed  Google Scholar 

  26. Zwergal A, Rettinger N, Frenzel C, Dieterich M, Brandt T, Strupp M (2009) A bucket of static vestibular function. Neurology 72(19):1689–1692. doi:10.1212/WNL.0b013e3181a55ecf

    Article  CAS  PubMed  Google Scholar 

  27. Kurre A, van Gool CJ, Bastiaenen CH, Gloor-Juzi T, Straumann D, de Bruin ED (2009) Translation, cross-cultural adaptation and reliability of the german version of the dizziness handicap inventory. Otol Neurotol 30(3):359–367. doi:10.1097/MAO.0b013e3181977e09

    Article  PubMed  Google Scholar 

  28. Lehnen N, Aw ST, Todd MJ, Halmagyi GM (2004) Head impulse test reveals residual semicircular canal function after vestibular neurectomy. Neurology 62(12):2294–2296

    Article  PubMed  Google Scholar 

  29. Newman-Toker DE, Saber Tehrani AS, Mantokoudis G, Pula JH, Guede CI, Kerber KA, Blitz A, Ying SH, Hsieh YH, Rothman RE, Hanley DF, Zee DS, Kattah JC (2013) Quantitative video-oculography to help diagnose stroke in acute vertigo and dizziness: toward an ECG for the eyes. Stroke 44(4):1158–1161. doi:10.1161/STROKEAHA.111.000033

    Article  PubMed  Google Scholar 

  30. Rohrmeier C, Richter O, Schneider M, Wirsching K, Fiedler I, Haubner F, Strutz J, Kuhnel TS (2013) Triple test as predictive screen for unilateral weakness on caloric testing in routine practice. Otol Neurotol 34(2):297–303

    Article  PubMed  Google Scholar 

  31. Jacobson GP, Calder JA, Shepherd VA, Rupp KA, Newman CW (1995) Reappraisal of the monothermal warm caloric screening test. Ann Otol Rhinol Laryngol 104(12):942–945

    Article  CAS  PubMed  Google Scholar 

  32. Kamran B (2008) Balance function assessment and management. Plural Publishing,

  33. Enticott JC, Dowell RC, O’Leary SJ (2003) A comparison of the monothermal and bithermal caloric tests. J Vestib Res 13(2–3):113–119

    CAS  PubMed  Google Scholar 

  34. Murnane OD, Akin FW, Lynn SG, Cyr DG (2009) Monothermal caloric screening test performance: a relative operating characteristic curve analysis. Ear Hear 30(3):313–319. doi:10.1097/AUD.0b013e31819c3ec7

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank I. Ribarczyk and U. Goetz for technical assistance and W. Benning for copyediting the manuscript.

Conflict of interest

H. Rambold is beta-tester of the Otosuite® vHIT system but has no financial interest in the product. He received honorary from GN-Otometrics, Denmark and Hennig-Arzneitmittel, Germany.

Author information

Authors and Affiliations

  1. Department of Neurology, County Hospitals of Altötting and Burghausen, Vinzenz-von-Paul Str. 10, 84531, Altoetting, Germany

    Holger A. Rambold

  2. Department of Neurology, University of Regensburg, Regensburg, Germany

    Holger A. Rambold

Authors
  1. Holger A. Rambold
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Holger A. Rambold.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rambold, H.A. Economic management of vertigo/dizziness disease in a county hospital: video-head-impulse test vs. caloric irrigation. Eur Arch Otorhinolaryngol 272, 2621–2628 (2015). https://doi.org/10.1007/s00405-014-3205-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-014-3205-1

Keywords

Search

Navigation