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Updated: May 17, 2026
Testing of all Six Semicircular Canals with Video Head Impulse Test Systems
Published on: April 18, 2019
How to uncover the covert saccade during the head impulse test
Fredrik Tjernström1, Anastasia Nyström, Måns Magnusson
1Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Sciences Skåne University Hospital, Lund, Sweden. Fredrik.Tjernstrom@med.lu.se
Objective:
The appearance of "covert" saccades in the head impulse test in patients with vestibular loss may lead to diagnostic misinterpretations. Here, we demonstrate a procedure that can convert covert eye saccades to overt when performing the head impulse test.
Patients:
Patients with known vestibular deficits that have covert saccades during head impulse test.
Intervention:
Diagnostic: random and sudden changes of the amplitude (degree of head turn) when performing the head impulse test.
Main Outcome Measure:
Evaluation of bedside test with video recording and registration from video head impulse test (v-HIT).
Results:
A video recording and registration from v-HIT that demonstrate the covert saccades of a subject and how the overt saccade is uncovered by changing the amplitude of the head impulse. Five cases are briefly presented.
Conclusion:
By performing the head impulse test with random amplitudes, overt saccades may become detectable and advance accuracy in bedside diagnosis of vestibular deficits.
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