Agreement Between Caloric and Horizontal Video Head Impulse Testing in School-Aged Children Presenting With Dizziness

Area of Science:

• Pediatric Vestibular Assessment
• Neurotology
• Otolaryngology

Background:

• Vestibular testing in children is crucial for diagnosing dizziness and imbalance.
• The horizontal semicircular canal video head impulse test (hvHIT) and caloric testing assess horizontal semicircular canal function.
• Understanding the relationship between hvHIT and caloric testing in pediatric populations is important due to differing causes of vestibular loss compared to adults.

Purpose of the Study:

• To determine the relationship between hvHIT and caloric testing in school-aged children with dizziness or imbalance.
• To compare the utility of these two vestibular tests in a pediatric cohort.

Main Methods:

• Retrospective analysis of electronic records from pediatric patients (<18 years) who underwent both hvHIT and caloric testing.
• Evaluation of test agreement using sensitivity, specificity, and Cohen's kappa coefficient.

Main Results:

• Analysis included 117 pediatric patients (mean age 13.7 years).
• Most patients (84.3%) had normal results on both hvHIT and caloric tests.
• hvHIT demonstrated excellent specificity (98.0%) but low sensitivity (38.9%) compared to caloric testing, with moderate agreement (Cohen's kappa = 0.49).

Conclusions:

• A moderate agreement exists between hvHIT and caloric testing in pediatric patients undergoing vestibular evaluation.
• The excellent specificity of hvHIT is noted, but its low sensitivity may be influenced by the low prevalence of peripheral vestibular disease in this cohort.
• Findings may not be generalizable to populations with higher vestibular disorder prevalence, such as children with sensorineural hearing loss.