Validation of a portable video head impulse test using an iPod touch and an oral stabilization three-dimensional (3D)...

Although video head impulse testing (vHIT) is widely used to assess semicircular canal function, access to quantitative vestibular testing remains limited. Smartphone-based vHIT systems with goggle-based fixation have been described, but larger validation studies and improved fixation stability are needed. We evaluated a portable vHIT application using an iPod touch with an oral stabilization three-dimensional (3D)-printed mount to determine whether it detects laterality in unilateral vestibular hypofunction and is noninferior to a medical-grade device for a patient-level laterality endpoint.

Thirteen patients with unilateral vestibular hypofunction and 14 healthy volunteers underwent testing with the portable and medical-grade vHIT systems on the same day. The primary endpoint was the patient-level laterality difference, defined as the difference between unaffected and affected vestibulo-ocular reflex (VOR) gain. Noninferiority was assessed using the two-sided 95% confidence interval (CI) for the mean between-device difference with a prespecified margin of 0.15. Agreement was evaluated using Bland-Altman analysis. Secondarily, absolute VOR gain agreement between devices was evaluated. False-positive classifications in healthy volunteers were assessed at the ear and subject levels using a gain threshold of <0.78.

Both systems showed higher VOR gains on the unaffected side (paired t-test: medical device, p = 2.44 × 10^-7; portable vHIT, p = 1.02 × 10^-8). Mean laterality difference was 0.518 ± 0.180 for the medical-grade device and 0.453 ± 0.118 for the portable system. The between-device difference was -0.065 (95% CI: -0.149 to 0.018), supporting noninferiority. Bland-Altman analysis demonstrated a bias of -0.065, with 95% limits of agreement from -0.337 to 0.207. For absolute VOR gain, average between-device bias was small, but individual-ear agreement remained variable. In healthy volunteers, abnormal classifications occurred in 0 of 28 ears and 0 of 14 subjects with the medical-grade device, and in 2 of 28 ears (7.1%) and 2 of 14 participants (14.3%) with the portable system.

The portable vHIT system detected laterality in unilateral vestibular hypofunction and met noninferiority criteria relative to a medical-grade device. Larger studies are warranted to refine quality control and define individual-ear absolute VOR gain agreement.