Head Impulse Research Articles

Refractive Error Impact on Video Head Impulse Test Outcomes.

The objective of this study is to investigate the potential influence of refractive error on Video Head Impulse Test outcomes. Eighty-two patients were included in the study, and all patients underwent video head impulse testing. Patients were divided into four groups according to their refractive error: myopia, myopia-astigmatism, astigmatism, and emmetropia as control. Patients with myopia are younger than patients with astigmatism and controls; similarly, patients with myopia-astigmatism are younger than patients with astigmatism. The right and left lateral, anterior, and posterior gain values were statistically significantly lower in the control group compared with myopia and myopia-astigmatism patients (p < 0.05). There was a statistically significant relationship between the right and left lateral, anterior, and posterior gain values and the degree of myopia in the patients (p < 0.05). The results of the Video Head Impulse Test gain in myopia patients are higher than that in patients without refractive error. In addition, age may have an effect on gain values. It is important to consider this factor when evaluating the results of the Video Head Impulse Test in patients, and corrections should be made if necessary. Level 3 Laryngoscope, 2024.

Methods for Detecting the Patient’s Pupils’ Coordinates and Head Rotation Angle for the Video Head Impulse Test (vHIT), Applicable for the Diagnosis of Vestibular Neuritis and Pre-Stroke Conditions

In the contemporary era, dizziness is a prevalent ailment among patients. It can be caused by either vestibular neuritis or a stroke. Given the lack of diagnostic utility of instrumental methods in acute isolated vertigo, the differentiation of vestibular neuritis and stroke is primarily clinical. As a part of the initial differential diagnosis, the physician focuses on the characteristics of nystagmus and the results of the video head impulse test (vHIT). Instruments for accurate vHIT are costly and are often utilized exclusively in healthcare settings. The objective of this paper is to review contemporary methodologies for accurately detecting the position of pupil centers in both eyes of a patient and for precisely extracting their coordinates. Additionally, the paper describes methods for accurately determining the head rotation angle under diverse imaging and lighting conditions. Furthermore, the suitability of these methods for vHIT is being evaluated. We assume the maximum allowable error is 0.005 radians per frame to detect pupils’ coordinates or 0.3 degrees per frame while detecting the head position. We found that for such conditions, the most suitable approaches for head posture detection are deep learning (including LSTM networks), search by template matching, linear regression of EMG sensor data, and optical fiber sensor usage. The most relevant approaches for pupil localization for our medical tasks are deep learning, geometric transformations, decision trees, and RASNAC. This study might assist in the identification of a number of approaches that can be employed in the future to construct a high-accuracy system for vHIT based on a smartphone or a home computer, with subsequent signal processing and initial diagnosis.

The dissociation between pathological caloric testing and a normal video head impulse test helps differentiate between Menière's disease, vestibular migraine, and other vestibular disorders: a confirmatory study in a large cohort of 2,101 patients.

Vestibular migraine (VM) and Menière's disease (MD) are characterized by episodes of vertigo of similar duration. It is well known that differentiation between both diseases is not always possible based only on the patient history, physical examination, and audiological testing. In addition, the quantification of the vestibular function can also be helpful since, among patients with MD, there is often a dissociation between a normal/pseudo-normal video head impulse test (vHIT) and reduced caloric testing. The goal of this confirmatory study was to determine the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of this dissociation to differentiate between MD and VM as well as between MD and other vestibular diseases. We performed a retrospective analysis of 2,101 patients. The examination group consisted of 1,100 patients; of these, 627 (57%) had MD according to the diagnostic criteria of the Bárány Society and 473 (43%) had VM. The comparison group consisted of 1,001 patients with other peripheral, central, or functional vestibular disorders. Statistical analysis revealed the following findings for the dissociation: MD vs. VM: specificity: 83.5%, sensitivity: 58.9%, PPV: 82.6%, and NPV: 60.5%, and MD vs. all other vestibular disorders (VM plus others): specificity: 83.5%, sensitivity: 58.9%, PPV: 60.3%, and NPV: 82.7%. The dissociation between a normal vHIT and a reduced caloric response is due to the high specificity and PPV suited for the differentiation between MD and VM. This part of the study confirms previous findings in a large cohort of patients. When it comes to differentiating between MD and all observed vestibular disorders, if there is no dissociation, the diagnosis of MD is unlikely.

Is galvanic VEMP a prediction of the nerve origin and damage in patients of vestibular schwannoma

Background Recent studies proved that certain proportions of vestibular schwannoma (VS) originated other than vestibular nerve of the eighth cranial nerve. Aims/objectives Unlike air-conducted sounds (ACS) and bone-conducted vibration (BCV), galvanic vestibular stimulation (GVS) evokes vestibular evoked myogenic potentials (VEMPs) from the vestibular nerve. Materials and methods Case-control study was conducted in unilateral VS patients pre-operatively. Healthy ears were controls. Patients examined ACS, BCV and GVS ocular VEMP (oVEMP) and cervical VEMP (cVEMP), caloric test, video head impulse test (vHIT), suppression head impulse paradigm (SHIMP) and pure tone audiometry (PTA). Results Seven (26.9%) tumors affected left ear and 19 (73.1%) on the right(p < .05). Response rates in VS group were statistically lower than control except for ACS-cVEMP (p < .05). Response rates of VEMPs in VS patients decreased with the tumor size grows. But not all BCV and GVS VEMPs disappeared in the largest tumor group. Abnormal rates of caloric test, vHIT gains and SHIMP were found. Conclusions and significance Response rates of GVS VEMPs decreased with the residual functional nerve fibers. GVS VEMPs help to differentiating labyrinthine and retro-labyrinthine lesions. GVS combined with BCV VEMPs probably reflex the tumor origin from the eighth cranial nerve and/or the remaining vestibular function.

Evaluation of the Effects of Optokinetic Stimuli and Dual-Task Performance on Vestibulo-Ocular Reflex Function in Children With Attention Deficit and Hyperactivity Disorder.

This study investigated the effects of optokinetic stimuli and dual-task performance on vestibulo-ocular reflex (VOR) function. The study primarily focused on understanding the effects of attention deficit and hyperactivity disorder (ADHD) and its subtypes. A case-control study. Tertiary medical centre. Thirty-eight children diagnosed with ADHD and 40 typically developing (TD) children aged 8-18 were included in the study. According to their diagnostic reports, children diagnosed with ADHD were also examined in three subtypes: predominantly inattentive (ADHD-PI), predominantly hyperactive-impulsive (ADHD-HI) and the combined type. Functional head impulse test (fHIT) was applied to all participants in three conditions-with no additional stimulus, optokinetic stimulation and dual-task. Correct responses (CR) were determined for each group, and the conditions were compared. For the dual-task test performance, children were given a counting task. The findings of the study are significant. The CR values obtained from the fHIT tests applied under three different conditions were lower in the ADHD group compared to the control group. CR values for all fHIT conditions and all semicircular canals were lower in the ADHD-PI subtype and higher in the ADHD-HI subtype compared to other subgroups. This study has significant practical implications underscoring its relevance. fHIT, when applied with different protocols, can provide valuable information about the vestibular and cognitive states of children with ADHD. These results are particularly significant as the diagnosis of ADHD often relies on subjective interpretations, and fHIT offers a more objective and reliable method of evaluation.

MRI-confirmed cochlear artery infarct clinically diagnosed in a patient with sickle cell disease: a case report.

To corroborate the vascular etiology of sudden sensorineural hearing loss (SNHL) utilizing magnetic resonance imaging (MRI). A 24-year-old male with a history of sickle cell disease experienced sudden SNHL and right horizontal nystagmus, without accompanying vertigo. Audiometric evaluation revealed left-sided SNHL, predominantly affecting high frequencies. Video head impulse testing demonstrated isolated dysfunction of the left posterior semicircular canal. An urgent brain MRI identified a recent punctiform ischemic stroke in the frontal region. A subsequent MRI, conducted with a 4-hour delay and post-contrast enhancement, highlighted a hyperintense signal within the left cochlear region and the left posterior semicircular canal. The investigative results substantiate an infarction in the territory of the cochlear artery, precipitated by a vaso-occlusive event, thereby reinforcing the vascular hypothesis of cochleovestibular artery syndrome. This case underscores the congruence between clinical observations and delayed post-contrast MRI findings.

Customized Vestibular Rehabilitation for Vestibular Schwannoma Excision via Translabyrinthine Approach: A Single-Center Experience.

Objectives: To evaluate the effectiveness of intensive customized vestibular rehabilitation after vestibular schwannoma (VS) excision. Methods: 52 patients who underwent VS removal via a translabyrinthine approach from 2020 to 2022 were involved in this study. Bedside examination, video head impulse test (vHIT), functional head impulse test (fHIT), and the dizziness handicap inventory (DHI) were performed before and after the rehabilitation, which consisted of 10 sessions of specifically designed vestibular, visual, and physical integrated training. Results: After rehabilitation, the vHIT showed overall unchanged values on the affected and healthy side. In contrast, the scores of fHIT, which explores the higher connection of the vestibular system with visual and cerebellar pathways, improved on both the pathological and healthy sides after training (p-value 0.004 and 0.000, respectively). The effectiveness of the rehabilitation was reinforced by the DHI scores, which were considerably lower after training. Conclusions: To our knowledge, this is the first study to explore fHIT outcomes after removal of VS, estimating the impact of rehabilitation on the overall compensation process. The outcomes support the role of extensive postsurgical rehabilitation in the compensatory process, even just a few days after surgery.

Impact of audiovestibular factors on prognosis in patients with sudden sensorineural hearing loss without vertigo.

This study aimed to investigate the hearing outcomes in patients with sudden sensorineural hearing loss without vertigo (SSNHLwoV). Patients with SSNHLwoV managed from December 2016 to March 2020 were prospectively enrolled in an academic tertiary referral center. Fifty-one patients with SSNHLwoV who completed high-dose steroid treatment. The hearing prognosis was analyzed using a multivariate Cox regression model. The rates of complete, partial, and no hearing recovery were 52.9%, 17.6%, and 29.4% in patients with SSNHLwoV, respectively. The video head impulse test (vHIT) of the posterior semicircular canal (PSC), high-tone hearing loss (4-8kHz) ≥ 30 dB, and average hearing threshold (0.5-1-2-4kHz) were significantly associated with incomplete recovery of hearing after treatment. In multivariate analysis, the vHIT of the PSC (hazard ratio [HR], 14.502; 95% confidence interval [CI], 1.371-153.355) and high-tone hearing loss ≥ 30 dB (HR, 9.170; 95% CI, 2.283-36.830) remained robust. Abnormal vestibular function tests were performed in 80.4% of the patients with SSNHLwoV. Abnormal vHIT of the PSC and high-tone hearing loss ≥ 30 dB were independent factors resulting in incomplete recovery of hearing in patients with SSNHLwoV. In the SSNHLwoV cohort, the caloric test was not significantly associated with hearing prognosis, and vHIT was a feasible predictor of treatment outcome.

Goggle Versus Remote-Camera Video Head Impulse Test Device Comparison.

This study compared remote versus goggle video head impulse testing (vHIT) outcomes to validate remote-camera vHIT, which is gaining popularity in difficult to test populations. Seventeen controls and 10 individuals with vestibular dysfunction participated. Each participant completed remote-camera and goggle vHIT. The main outcome parameters were canal gain, frequency of corrective saccades, and a normal versus abnormal rating. Horizontal and vertical canal vHIT gain was significantly lower in the vestibular compared with the control group; remote-camera gains were significantly lower compared with goggle gain for the vestibular group only. The devices categorized control versus vestibular canals identically except for one vertical canal. In the vestibular group, there was not a significant difference in the percentage of compensatory saccades between devices. These data provide validation that results obtained with a remote-camera device are similar to those obtained using a standard goggle device.

Accuracy of the Bedside Examination in Patients With Suspected Acute Unilateral Peripheral Vestibulopathy.

Acute unilateral peripheral vestibulopathy (AUPVP) is a frequent form of peripheral vestibular vertigo characterized by unilateral vestibular organ dysfunction. Diagnostic challenges in anamnesis and bedside examination can lead to potential misdiagnoses. This study investigated the sensitivity of bedside examinations in diagnosing AUPVP. This retrospective analysis examined 136 AUPVP inpatients at a level 3 university hospital between 2017 and 2019. Demographic data and bedside test results were collected. Instrumental otoneurological tests included caloric testing and video head impulse test (HIT). The sensitivity of each bedside parameter was computed based on the instrumental diagnostics, and statistical analyses were performed. The study included 76 men and 60 women, with a mean age of 59.2 years. Spontaneous nystagmus exhibited a sensitivity of 92%, whereas the absence of skew deviation was identified with a sensitivity of 98%. Abnormal bedside HIT showed a sensitivity of 87%. The combined HINTS (HIT, nystagmus, and test of skew) had a sensitivity of 83%. The Romberg test and Fukuda test demonstrated sensitivities of 26% and 48%, respectively. The sensitivity of bedside tests varied from 26% to 98%. This aligns with previous literature, highlighting the challenge of differentiating AUPVP from vestibular pseudoneuritis solely through bedside examination. Although the tests excel in excluding central causes, they are insufficient for diagnosing AUPVP with certainty. In addition, the bedside examination sensitivities vary widely, and early radiological imaging can be misleading. Therefore, this study underlines the necessity of prompt otoneurological testing for accurate exclusion of vestibular pseudoneuritis and thus improve patient outcomes.

Correlation between parameters of suppression head impulse paradigm and changesin DHI score in acute vestibular neuritis

Objective:To explore the correlation between the parameters of suppression head impulse paradigm（SHIMP） and changes in dizziness handicap inventory（DHI） scores. Additionally, to evaluate the degree of vertigo and prognosis of patients with acute vestibular neuritis through SHIMP parameters. Methods:Thirty-three patients with acute vestibular neuritis were enrolled for DHI evaluation, vHIT and SHIMP. A secondary DHI score were evaluated after after two weeks, once patients no longer exhibited spontaneous nystagmus. The decrease in the second DHI score was used as the efficacy index（EI）. All patients were divided into significantly effective group, effective group and ineffective group based on EI. Differences of the VOR gain values of SHIMP and the anti-compensatory saccade were compared among the three groups. Results:There were 13 cases in the significant effective group, 11 cases in the effective group, and 9 cases in the ineffective group. ①The mean gain of the horizontal semicircular canal in the significant effective group, the effective group, and the ineffective group was（0.50±0.11）, （0.44±0.12）, and（0.34±0.08）, respectively. The difference between the significant effective group and the ineffective group was statistically significant（P<0.01）. The gain of horizontal semicircular canal was positively correlated with EI（r=0.538 5, P<0.01） 。②The occurrence rate of the anti-compensatory saccade in the significant effective group, the effective group, and the ineffective group was（51.23±19.59）, （33.64±17.68）, and（13.78±11.81）, respectively. Pairwise comparisons between each group showed statistical significance（P<0.05）. The occurrence rate of anti-compensatory saccade was positively correlated with EI（r=0.658 2, P<0.01）. Conclusion:The horizontal semicircular canal gain and the occurrence rate of the anti-compensatory saccade in SHIMP for patients with acute vestibular neuritis were closely correlated with decrease in DHI score.

Association Between Noise-Induced Hearing Loss and Vestibular Dysfunction in Workers Chronically Exposed to Occupational Noise

Background: Despite the understanding of the association between noise exposure and noise-induced hearing loss (NIHL), the effects of noise on vestibular function are less well understood and neglected. Aim: The aim of this study was to investigate the function of the vestibular system in workers with NIHL. Materials and Methods: Thirty male textile workers with symmetrical NIHL (49.3 ± 4.5 dB at 4 kHz) and thirty healthy male textile office staff with normal hearing were included in this study. Pure tone audiometry using air conduction and bone conduction was used to determine hearing thresholds. The videonystagmography battery test, including the oculomotor test, caloric test, and video head impulse test (vHIT), was used for the evaluation of vestibular system function. Results: There was no difference in saccadic tracking, smooth pursuit tracking, and optokinetic nystagmus between the two groups. It was found that the abnormal vHIT was significantly higher in workers with NIHL (40%) than in the control group (3.3%). In addition, the abnormal caloric test was significantly higher in workers with NIHL (33.3%) than in the control group (0%). The association between the hearing thresholds of 3, 4, 6, and 8 kHz and vestibular dysfunction was significant. Conclusion: This study provides evidence of the simultaneous occurrence of NIHL and vestibular dysfunction. In other words, the results support the role of noise as a risk factor for the development of vestibular dysfunction in textile workers.

Distinguishing Peripheral from Central Causes of Dizziness and Vertigo without using HINTS or STANDING

Three validated diagnostic algorithms for diagnosing patients with acute onset dizziness or vertigo (HINTS, HINTS-plus and STANDING) exist. All are extremely accurate in distinguishing peripheral from central causes of dizziness when done by experienced clinicians. However, uptake of these diagnostic tools in routine emergency medicine practice has been sub-optimal, in part, due to clinicians’ unease with the head impulse test, the most useful component contained of these algorithms. Use of these validated algorithms is the best way to accurately diagnose patients with acute dizziness. For clinicians who are unfamiliar with or uncomfortable performing or interpreting HINTS and STANDING, this article will suggest alternative approaches to help with accurate diagnosis of patients with acute dizziness or vertigo.

Vestibular evaluation with video head impulse test in pediatric cochlear implant patients

Vestibular evaluation with video head impulse test in pediatric cochlear implant patients

Vestibular Migraine and Recurrent Vertigo in Children: A Diagnostic Focus From a Tertiary Hospital Study

BackgroundTo improve diagnostic precision in pediatric vertigo, particularly in Vestibular Migraine of Childhood (VMC), probable VMC (pVMC), Recurrent Vertigo of Childhood (RVC), and unspecified categories, by delineating clinical characteristics and prevalence to refine diagnostics and treatments. MethodsRetrospective analysis of 102 pediatric patients (five to 18 years; 46 females, 56 males) at the Dizziness Center of the Otolaryngology Department in a tertiary-level hospital from January 2019 to December 2023. Patients were classified into VMC, pVMC, RVC, and indeterminate groups. Evaluations included audiometry and vestibular tests (video head impulse test [vHIT] or caloric testing), conducted in the audiology unit and vestibular testing laboratory. Data were analyzed using IBM SPSS 20.0. ResultsDiagnoses were 8.8% VMC, 31.4% pVMC, 51.0% RVC, and 8.8% indeterminate. Nausea and vomiting were common in VMC and pVMC; cochlear symptoms like tinnitus and hearing loss predominated in VMC. Although vestibular testing showed no significant group differences, VMC had more vHIT abnormalities and RVC had more caloric test anomalies. ConclusionsThis study highlights the need for comprehensive diagnostics in pediatric vestibular disorders, revealing unique and overlapping traits across VMC, pVMC, and RVC. Insights call for further research to refine diagnostic criteria and improve treatment methods.

The Role of Asymmetry Values, Gain, and Pathological Saccades of the Video Head Impulse Test (vHIT) in Sudden Sensorineural Hearing Loss.

The purpose of this study was to evaluate the value of asymmetry values, gain, and pathological saccades of the video head impulse test (vHIT) in sudden sensorineural hearing loss (SSNHL). Retrospective study. Tertiary referral center. A total of 226 individuals diagnosed with unilateral definite SSNHL were hospitalized. The assessment included a comprehensive evaluation of medical history, pure-tone test, acoustic impedance, positional test, video nystagmography (VNG), vHIT, vestibular evoked myogenic potentials (VEMPs) and magnetic resonance. vHIT, VNG, cVEMP, oVEMP. Statistical analysis was performed with SPSS version 22.0 for Windows. The asymmetry values, gain, and pathological saccades of the vHIT. The abnormal gain of vHIT in anterior, horizontal, and posterior canal in SSNHL patients with vertigo were revealed in 20 of 112 (17.9%), 24 of 112 (21.4%), and 60 of 112 (53.6%), respectively. The vHIT pathological saccades (overt + covert) of anterior, horizontal, and posterior canal in SSNHL patients with vertigo were observed in 5 of 112 (4.6%), 52 of 112 (46.4%), and 58 of 112 (51.8%), respectively. Multivariate analysis indicated that the prognosis of patients with vertigo was correlated with vHIT gain of posterior canal, pathological saccade in horizontal canal, asymmetric ratio of horizontal canal gain, asymmetric ratio of posterior canal gain, Canal paresis (%) on caloric test and spontaneous nystagmus. In the vHIT of patients with SSNHL with vertigo, the posterior canal is most easily affected. Reduced gain of posterior canal, pathological saccade of horizontal canal, and larger asymmetric gain of posterior canal and horizontal canal may be negative prognostic factors.

Computerized Rotational Head Impulse Test: Age-Dependent Normative Data.

The objective of this study was to determine the normative vestibulo-ocular reflex gain output values of the computerized rotational head impulse test (crHIT) with stationary visual targets (earth bound) in healthy participants in each decade age band of life: 10-19, 20-29, 30-39, 40-49, 50-59, 60-69, and 70+ years. Seventy-seven community-dwelling participants (10-85 years of age) with normal lateral semicircular canal (SCC) functioning and no symptoms or history of vestibular dysfunction were recruited through convenience sampling and assessed with the crHIT using stationary targets. These participants were assessed using two standard protocols in a randomized order. Results from 77 participants (M age = 46 years; 43 women, 34 men) were analyzed. Pearson's correlation coefficient and simple linear regression indicated a statistically significant relationship between crHIT gain output and age (p > .05) for right gain, 1030°/s2, and left gain, 1005°/s2. Although a statistically significant relationship was found, the slope was minor, demonstrating that the clinical effect of age on crHIT gain output was insignificant. Furthermore, no statistically significant relationship exists between crHIT gain output and gender (p > .05). Age-dependent normative data were calculated using the 2.5th and 97.5th confidence interval (CI) percentile method. The responses of angular vestibulo-ocular reflex (aVOR) gain values for crHIT are expected to occur within the range for lower limit reference interval (RI) of 0.85-0.9 and upper limit RI of 1.11-1.18 for 1030°/s2 and lower limit RI of 0.86-0.92 and upper limit RI of 1.13-1.16 for 1005°/s2. It can be expected that 90% CI of the population with normal lateral SCC functioning will have aVOR gain values that fall within this range. Despite a statistically significant relationship that exists with aVOR gain output and age, the changes are minor, declining by 0.0088 units per 10 years, justifying the same normative data for all decade age bands.

Nationwide Prevalence of Video Head Impulse Test Abnormality and its Risk Factors in South Korea.

To identify the prevalence of and relevant information for video head impulse test (vHIT) abnormality in a large population. A cross-sectional design. Korean National Health and Nutrition Examination Survey, 2021. The sample was representative of the Korean population, with 2237 participants aged ≥40 years. A vHIT was performed to evaluate vestibular function. The vestibulo-ocular reflex (VOR) gain and the presence of reproducible catch-up saccades was assessed in a vHIT. Participants also completed questionnaires for demographics, socioeconomic status, and basic information regarding systemic diseases and dizziness and underwent hearing tests with automated pure-tone audiometry. The prevalence of vHIT abnormality was 22.5%, with unilateral (14.3%) being more common than bilateral (8.2%). The prevalence of vHIT abnormality increased significantly with age, with the highest rate observed in individuals aged >70 years (42.5%). Both hearing and VOR gain deteriorated with age, but the patterns of age-related progression were different. While hearing loss (HL) deteriorated gradually and progressively throughout adulthood, VOR gain deterioration was markedly evident after 70 years of age. Considering the high prevalence of vHIT abnormality, appropriate social and medical policies are needed to prevent associated injuries and improve patients' quality of life. The distinct age-related changes in HL and objective findings of vestibular dysfunction indicate the need for different approaches to address these social problems in aging countries.

Application of a Video Head Impulse Test in the Diagnosis of Vestibular Neuritis.

In patients presenting in the emergency department with acute vertigo, a rapid and accurate differential diagnosis is crucial, as posterior circulation strokes can mimic acute vestibular losses, leading to inappropriate treatment. The diagnosis of vestibular neuritis is made based on the clinical manifestation and a bedside otoneurological assessment. In the clinical examination, an evaluation of the vestibulo-ocular reflex is the key element; however, the accuracy of the bedside head impulse test depends on the clinician's experience. Thus, new diagnostic methods are needed to objectify and facilitate such rapid vestibular evaluations. The aim of our paper is to provide a comprehensive review of the video head impulse test's application in the diagnosis of vestibular neuritis. Numerous studies have reported advantages that make this method helpful in detailed otoneurological evaluations; in contrast to the bedside head impulse test, it enables an analysis of all six semicircular canals function and records the covert corrective saccades, which are invisible to the naked eye. As a portable and easy diagnostic tool, it is known to improve the diagnostic accuracy in patients with acute vertigo presenting in the emergency department. Moreover, as it evaluates the vestibulo-ocular reflex across different frequencies, as compared to caloric tests, it can be used as an additional test that is complementary to videonystagmography. Recently, several papers have described the application of the video head impulse test in follow-up and recovery evaluations in patients with vestibular neuritis.

High-Frequency Vestibular Function Is Vulnerable to Presbyvestibulopathy.

In 2019, mild vestibular function deficiency in elder populations was defined as presbyvestibulopathy (PVP) by the Classification Committee of the Bárány Society. The diagnostic criteria include tests for low-, mid-, and high-frequency vestibular function, represented by caloric testing, rotary chair testing, and head impulse testing, respectively. However, there is still a lack of large-scale reports supporting the relationship between vestibular function tests (VFTs) and aging. In this study, we evaluated whether each test is correlated with aging in the elderly population aged over 50. This study retrospectively enrolled 1043 subjects from a single university hospital database after excluding those with unilateral and bilateral vestibulopathy, central dizziness, and acute dizziness. Enrolled subjects had caloric canal paresis <20%, vHIT lateral canal gain >0.6, vHIT interaural difference <0.3, and age >50 years old. Significant negative correlations with age were identified in the vHIT (p < 0.001) and rotary chair test (RCT) 1.0 Hz gain (p = 0.030). However, the caloric test (p = 0.739 and 0.745 on the left and right sides, respectively) and RCT 0.12 Hz gain (p = 0.298) did not show a significant correlation with age. A total of 4.83% of subjects aged 70 years or older showed sub-normal vHIT gain that met the criteria of PVP, whereas only 0.50% of subjects aged 60 to 69 did. The prevalence of sub-normal caloric test results, however, was not significantly different between the two age groups (21.55% in the 60-69 age group and 26.59% in the >70 age group). The high-frequency range vestibular function seems vulnerable to aging, and this is more discernible at age >70 years. The weak correlation between age and low-frequency vestibular function tests, such as the caloric test and low-frequency rotary chair testing, suggests the need to revisit the diagnostic criteria for PVP.