Usefulness and practical insights of the pediatric video head impulse test

Abstract

ObjectiveThe video head impulse test (vHIT) is a diagnostic tool to examine patients experiencing dizziness by assessing the function of the semicircular canals. vHIT has been widely studied in adults but relatively less so in children. The aim of this study was to evaluate the causes of dizziness and the results of vHIT in children. We also identified factors that affect the vHIT results such as artifacts and technical errors. Study designRetrospective review; SettingTertiary care center. PatientsA total of 39 patients who visited our clinic for dizziness from 2014 to 2017. Main outcome measuresThe gain of vestibulo-ocular reflex, refixation saccades, and artifacts were analyzed using vHIT. We analyzed 691 individual vHIT traces and categorized the artifacts into 8 categories. ResultsTwenty-three males and 16 females were included. The mean age was 13.84 ± 2.60 years (range, 7–18). Common causes of dizziness were benign paroxysmal vertigo of childhood (25.6%), vestibular neuritis (20.5%), and vestibular migraine (17.9%). The sensitivity and specificity of vHIT based on the bithermal caloric test results were 40% and 94%, respectively. The analysis of vHIT traces revealed that the children had higher artifact ratios of vHIT than the adults. The main artifacts were high gain and blinking eyes. ConclusionThe vHIT results showed a higher percentage of artifacts in children than in the adults. More careful efforts are required to obtain more accurate results during the test, and it is necessary to check for technical errors while interpreting the results.