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The Vestibular System

The Vestibular System

The vestibular system is a set of inner ear structures that provide a sense of balance and spatial orientation. This system is comprised of structures within the labyrinth of the inner ear, including the cochlea and two otolith organs—the utricle and saccule. The labyrinth also contains three semicircular canals—superior, posterior, and horizontal—that are oriented on different planes.

Equilibrium and Balance

Equilibrium and Balance

The inner ear assumes dual functionalities of auditory perception and equilibrium maintenance. The vestibule is the organ responsible for balance. This organ contains mechanoreceptors, specifically hair cells, endowed with stereocilia, which aid in deciphering information regarding the position and motion of our heads. Two intrinsic components, the utricle and saccule, help perceive head position, while the semicircular canals track head movement. Neurological messages initiated in the...

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Related Experiment Video

Updated: Mar 22, 2026

Testing of all Six Semicircular Canals with Video Head Impulse Test Systems

Testing of all Six Semicircular Canals with Video Head Impulse Test Systems

Published on: April 18, 2019

Determining vestibular hypofunction: start with the video-head impulse test.

B F van Esch¹, G E A J Nobel-Hoff², P P G van Benthem³

¹Apeldoorn Dizziness Centre, Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, The Netherlands. b.van.esch@gelre.nl.

European Archives of Oto-Rhino-Laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery

|April 27, 2016

Summary

The video-head impulse test (vHIT) is a useful first step for diagnosing vestibular hypofunction in dizzy patients. While not a complete replacement for caloric testing, an abnormal vHIT strongly suggests a problem, often negating the need for further caloric tests.

Keywords:

Caloric testing Dizziness Nystagmus Vestibular hypofunction Video head impulse test

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Last Updated: Mar 22, 2026

Testing of all Six Semicircular Canals with Video Head Impulse Test Systems

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Published on: April 18, 2019

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Using Unidirectional Rotations to Improve Vestibular System Asymmetry in Patients with Vestibular Dysfunction

Using Unidirectional Rotations to Improve Vestibular System Asymmetry in Patients with Vestibular Dysfunction

Published on: August 30, 2019

Area of Science:

Neurology
Ophthalmology
Audiology

Background:

Caloric testing is the established standard for diagnosing vestibular hypofunction.
The video-head impulse test (vHIT) is a newer diagnostic tool for assessing vestibular function.

Purpose of the Study:

To evaluate the diagnostic accuracy of the vHIT compared to caloric testing in patients experiencing dizziness.
To determine if vHIT can serve as a primary diagnostic tool for vestibular hypofunction.

Main Methods:

A cross-sectional study analyzed 324 dizzy patients who underwent both vHIT and caloric testing.
Diagnostic values (sensitivity, specificity, predictive values) were calculated for vHIT using defined abnormal criteria.
Abnormalities were defined by vHIT gain < 0.8, presence of correction saccades, or abnormal caloric test results (asymmetrical ocular response ≥ 22% or irrigation response velocity < 15°/s).

Main Results:

12% of patients had abnormal vHIT gain, while 35% had abnormal caloric test results.
vHIT demonstrated high specificity (98%) and positive predictive value (88%) for detecting vestibular abnormalities.
Sensitivity (31%) and negative predictive value (73%) indicated that a normal vHIT does not rule out vestibular issues.

Conclusions:

The vHIT is clinically valuable as an initial test for vestibular hypofunction in dizzy individuals.
While vHIT does not replace caloric testing, a normal vHIT necessitates further caloric assessment.
An abnormal vHIT result is highly correlated with abnormal caloric testing, often making additional caloric tests unnecessary.