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Updated: Aug 5, 2026
Testing of all Six Semicircular Canals with Video Head Impulse Test Systems
Published on: April 18, 2019
Functional head impulse test and video head impulse test in interictal Ménière's disease and inferior vestibular
Fumiyuki Goto1,2, Yukiko Tsuda2, Kenji Okami1
1Department of Otolaryngology-Head and Neck Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
Background And Objective:
In interictal Ménière's disease (MD), a caloric-vHIT dissociation is well established: caloric testing reveals vestibular hypofunction, yet video head impulse test (vHIT) gains in the lateral canal are preserved. Whether this preservation corresponds to preserved functional gaze stabilization remains unknown. This preliminary, exploratory study compared affected and unaffected ear responses of dynamic visual acuity (DVA), functional head impulse test (FHIT), and vHIT in interictal MD, and evaluated the clinical value of each measure.
Methods:
Eleven interictal MD patients (10 female, 1 male; mean age 61.6 ± 16.7 years) and 12 inferior vestibular neuritis (IVN) patients (6 female, 6 male; mean age 61.5 ± 9.9 years) were enrolled. IVN was defined by reduced posterior canal vHIT gain (<0.7) or absent cVEMP on the affected side. All tests were performed during the interictal phase (≥48 h after the last episode). Six-canal FHIT (correct answer rate, CA%), six-canal vHIT, and DVA were measured. Lesion-side versus intact-side comparisons used the Wilcoxon signed-rank test.
Results:
In MD, lesion-side FHIT-H CA% was significantly lower than intact-side (53.9 ± 33.5% vs. 77.3 ± 26.5%; p = 0.022), whereas vHIT-H gain (p = 0.146) and DVA (p = 0.820) showed no significant laterality. The FHIT laterality index (25.4 ± 31.4%) significantly exceeded the vHIT-H laterality index (4.2 ± 9.1%; p = 0.019; r = 0.71); the FHIT-H abnormality rate was 8/11 (73%) versus vHIT-H 2/11 (18%). In IVN, lesion-side posterior canal vHIT gain was significantly reduced (p = 0.027), while FHIT-H showed no laterality (p = 0.413).
Conclusion:
MD and IVN showed contrasting patterns: MD exhibited selective lesion-side FHIT-H reduction with preserved vHIT, whereas IVN showed selective posterior canal vHIT reduction with normal FHIT-H laterality. These findings suggest that FHIT may reflect endolymphatic hydrops-related functional vestibular changes distinct from the structural nerve lesions characteristic of IVN. FHIT may be a useful adjunct for detecting functional vestibular asymmetry in interictal MD; these findings are hypothesis-generating and require replication in larger prospective cohorts.
Insights
Functional head impulse test (FHIT) reveals vestibular dysfunction in Ménière's disease (MD) patients, unlike video head impulse test (vHIT). FHIT may help detect functional vestibular asymmetry in interictal MD.
Area of Science:
- Neurology
- Otolaryngology
- Vestibular System Function
Background:
- Ménière's disease (MD) shows a dissociation between caloric testing (hypofunction) and video head impulse test (vHIT) (preserved lateral canal gains).
- The functional significance of preserved vHIT gains for gaze stabilization in interictal MD remains unclear.
Purpose of the Study:
- To compare dynamic visual acuity (DVA), functional head impulse test (FHIT), and vHIT responses between affected and unaffected ears in interictal MD patients.
- To evaluate the clinical utility of these measures in detecting vestibular asymmetry.
Main Methods:
- Eleven interictal MD patients and 12 inferior vestibular neuritis (IVN) patients were assessed during their interictal phase.
- Six-canal FHIT (correct answer rate, CA%), six-canal vHIT, and DVA were measured.
- Comparisons between lesion-side and intact-side responses were performed using the Wilcoxon signed-rank test.
Main Results:
- In MD, FHIT-H CA% was significantly lower on the lesion side compared to the intact side (p=0.022), while vHIT-H gain and DVA showed no significant laterality.
- The FHIT laterality index was significantly higher than the vHIT-H laterality index in MD (p=0.019), with a higher abnormality rate for FHIT (73%) versus vHIT (18%).
- IVN patients showed reduced lesion-side posterior canal vHIT gain (p=0.027) but normal FHIT-H laterality (p=0.413).
Conclusions:
- MD exhibits selective FHIT-H reduction with preserved vHIT, contrasting with IVN's selective vHIT reduction.
- FHIT may detect functional vestibular changes related to endolymphatic hydrops in MD, distinct from structural nerve lesions in IVN.
- FHIT shows potential as an adjunct for detecting functional vestibular asymmetry in interictal MD, warranting further research.
