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Published on: April 18, 2019
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Comparison Between the Video Head Impulse Test and Caloric Irrigation During Acute Vertigo
Elin Olivecrona1, Katarina Zborayova2, Marie-Louise Barrenäs2
1Clinical Science, Neurosciences, Umeå University, 90187 Umeå, Sweden.
Summary
Caloric irrigation (CI) and video head impulse test (vHIT) both assess vestibular function in acute vertigo. While vHIT shows promise, especially for identifying normal function, CI remains the gold standard for diagnosing vestibular dysfunction.
Area of Science:
- Neurology
- Otolaryngology
- Vestibular System Diagnostics
Background:
- Caloric irrigation (CI) is the established gold standard for evaluating peripheral vestibular dysfunction.
- The video head impulse test (vHIT) offers a faster, more accessible alternative, potentially aiding in acute vertigo and stroke risk assessment.
- Comparative studies are essential to understand the relationship between CI and vHIT findings.
Purpose of the Study:
- To compare vestibular function data obtained from caloric irrigation (CI) with that from the video head impulse test (vHIT).
- To evaluate the correlation between specific metrics derived from both CI and vHIT in patients experiencing acute vertigo.
Main Methods:
- Eighty patients with acute onset vertigo underwent both CI and vHIT.
- Correlation analyses were performed comparing CI-derived sum of slow phase velocities (SPVs) and unilateral weakness (UW) with vHIT vestibulo-ocular reflex (VOR) gain and gain asymmetry (GA).
- Optimal cut-off values for vHIT VOR gain and GA were determined using Youden indexes to predict normal CI results.
Main Results:
- A strong positive correlation was observed between UW (CI) and GA (vHIT), while the correlation between SPVs (CI) and VOR gain (vHIT) was weaker.
- Optimal cut-offs for diagnosing unilateral vestibular weakness were VOR gain of 0.80 and GA of 28%, with specificities of 55% and 93% for predicting normal CI, respectively.
- Results from CI and vHIT diverged in approximately one-third of cases, indicating neither test can fully replace the other.
Conclusions:
- While vHIT results correlate with CI findings, CI remains the gold standard for diagnosing vestibular dysfunction.
- vHIT, particularly the gain asymmetry (GA) measure, shows high specificity (93%) for identifying patients with likely normal vestibular function, warranting further investigation for central causes of vertigo.
- Neither CI nor vHIT alone is sufficient to replace the other in comprehensive vestibular assessment.
