Clinical experience with video Head Impulse Test in children.

Area of Science:

• Pediatric Neurology
• Vestibular System Assessment
• Ophthalmology

Background:

• A standardized diagnostic protocol for pediatric vestibular assessment is lacking in clinical practice.
• Traditional tests like rotatory chair and caloric tests are poorly tolerated by children.
• The video head impulse test (vHIT) offers a potential alternative for evaluating pediatric balance issues.

Purpose of the Study:

• To evaluate the importance and practicality of the video head impulse test (vHIT) in children with and without balance problems.
• To establish a diagnostic algorithm for children experiencing balance difficulties.
• To assess the feasibility and tolerance of vHIT in a pediatric population.

Main Methods:

• Prospective study of 55 children (aged 3-16 years) divided into two groups: normal balance and potential vestibular disorder.
• Balance assessed via health screening and a specific dizziness questionnaire.
• Horizontal vestibulo-ocular reflex (HVOR) measured using video-oculography (EyeSeeCam©), analyzing gain and gain variance.
• Tolerance and feasibility of system calibration and testing evaluated.

Main Results:

• Reproducible results obtained in 75% of children.
• Children with balance problems showed significantly reduced HVOR gain (0.47±0.3) compared to controls (1.02±0.28).
• vHIT testing took approximately 20 minutes in children, longer than in adults; calibration was easier with icons for younger children (3-5 years) and laser dots for older children (6+ years).

Conclusions:

• The video head impulse test (vHIT) is a sensitive and efficient vestibular assessment tool for children aged 3-16 years.
• vHIT is well-tolerated and can be readily implemented as a screening tool for pediatric vestibular dysfunction.
• The findings support the use of vHIT in diagnosing balance problems in children.