rss

This article has a correction

Please see: J Neurol Neurosurg Psychiatry 2008;79:967

J Neurol Neurosurg Psychiatry 78:1113-1118 doi:10.1136/jnnp.2006.109512
  • Paper

Accuracy of the bedside head impulse test in detecting vestibular hypofunction

  1. M Jorns-Häderli,
  2. D Straumann,
  3. A Palla
  1. Neurology Department, Zurich University Hospital, Zurich, Switzerland
  1. Dr A Palla, Neurology Department, Zurich University Hospital, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland; antpalla{at}access.unizh.ch
  • Received 23 October 2006
  • Revised 23 December 2006
  • Accepted 4 January 2007
  • Published Online First 12 January 2007

Abstract

Objective: To determine the accuracy of the bedside head impulse test (bHIT) by direct comparison with results from the quantitative head impulse test (qHIT) in the same subjects, and to investigate whether bHIT sensitivity and specificity changes with neuro-otological training.

Methods: Video clips of horizontal bHIT to both sides were produced in patients with unilateral and bilateral peripheral vestibular deficits (n = 15) and in healthy subjects (n = 9). For qHIT, eye and head movements were recorded with scleral search coils on the right eye and the forehead. Clinicians (neurologists or otolaryngologists) with at least 6 months of neuro-otological training (“experts”: n = 12) or without this training (“non-experts”: n = 45) assessed video clips for ocular motor signs of vestibular deficits on either side or of normal vestibular function.

Results: On average, bHIT sensitivity was significantly (t test: p<0.05) lower for experts than for non-experts (63% vs 72%), while bHIT specificity was significantly higher for experts than non-experts (78% vs 64%). This outcome was a consequence of the experts’ tendency to accept bHIT with corresponding borderline qHIT values as still being normal. Fitted curves revealed that at the lower normal limit of qHIT, 20% of bHIT were rated as deficient by the experts and 37% by the non-experts.

Conclusions: When qHIT is used as a reference, bHIT sensitivity is adequate and therefore clinically useful in the hands of both neuro-otological experts and non-experts. We advise performing quantitative head impulse testing with search coils or high speed video methods when bHIT is not conclusive.

Footnotes

  • Grant/financial support: Swiss National Science Foundation (#3200B0-105434); Betty and David Koetser Foundation for Brain Research, Zurich, Switzerland

  • Competing interests: None.

  • Abbreviations:
    bHIT
    bedside head impulse test
    CI
    caloric irrigation
    qHIT
    quantitative head impulse test
    SCC
    semicircular canals
    VOR
    vestibulo-ocular reflex

Podcasts
Visit the full archive of podcasts for JNNP here >>

Free sample
This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of JNNP.
View free sample issue >>

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.

Navigate This Article