The Video Head Impulse Test and Predictability of Vestibular Disorders
Authors
Term
5. Term (Master thesis)
Education
Publication year
2025
Submitted on
2025-12-19
Pages
28
Abstract
Introduction Vestibular disorder (VD) is a prominent socioeconomic burden due to its high prevalence and diagnostic difficulty. A rather new tool, the video head impulse test (vHIT), might act as a screening tool for VD by separate evaluation of the vestibulo-ocular reflex (VOR) involving all six semicircular canals (SCCs) and thereby also both the superior and inferior vestibular nerves bilaterally. Methods All subjects included presented with vertigo and/or dizziness and underwent a vHIT examina-tion of the horizontal semicircular canals. This study had rather strict inclusion and exclusion criteria, standardized vHIT quality requirements, and clear definitions of pathological gain and saccades. A potential diagnosis related to VD was placed either on the day of the vHIT exam-ination or following more extensive vestibular testing. All vHIT reports were assessed thor-oughly. Poor-quality markers and artifacts were recorded for each subject excluded due to the low quality of the vHIT results. Results A total of 1119 subjects met the inclusion criteria. The subjects had a mean age of 59.2 years, and 42.4% were males. The subjects were divided into two subgroups: VD (52.0%) and non-VD (48.0%). For the main analyses, the following three criteria were used: 1) low mean VOR gain and pathological saccades, 2) low mean VOR gain only, and 3) pathological saccades only with the following results: sensitivity (43.5%, 47.2%, and 54.3%), specificity (96.1%, 94.0% and 84.0%), positive predictive value (92.3%, 89.6% and 78.6%), negative predictive value (61.1%, 62.2% and 62.9%), overall agreement ranged from 68.5% to 69.7%, and Cohen’s kappa indicated fair agreement. Sub-analyses showed substantial variation between individual VDs. Conclusion Results of the main analyses implied a combination of parameters gain and saccades as the rational choice for vHIT when predicting VD. Gain proved a viable standalone parameter when encountering a pathological mean VOR gain value and doubtful saccades. Based upon the re-sults of this study, vHIT should not act as a screening tool for VD but rather as a first-line vestibular test among others. vHIT was a poor screening tool for benign paroxysmal positional vertigo, Ménière’s disease, and vestibular schwannoma. However, vHIT showed great potential as a screening tool for vestibular neuritis. Notably, this study found 40.5% of all vHIT examinations to be of poor quality, emphasizing the need for implementation of some kind of universal quality markers with this test.
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