Refining the Video Head Impulse Test Diagnostic Accuracy: A Case-Control Study

Nabil Faranesh, Khaldon Abo-Saleh, Margalith Kaminer, Avi Shupak

Research output: Contribution to journalArticlepeer-review


INTRODUCTION: Current clinical practice considers the vestibulo-ocular reflex (VOR) gain as registered by the video head impulse test (vHIT) as the primary measure for semicircular canal function, while the role of the re-fixation saccades (RSs) is still under evaluation. The goal of the study was to appraise the added benefit of RS towards the improvement of vHIT diagnostic accuracy in cases of suspected left horizontal semicircular canal dysfunction.

METHODS: The vHIT recordings of 40 patients with left-sided horizontal VOR gains <0.8 were retrospectively evaluated for the presence of RS. The study groups included 20 patients with a final diagnosis of left horizontal semicircular canal dysfunction and 20 patients for whom vestibular dysfunction was ruled out.

RESULTS: Gain values >0.72 were found in all patients with no vestibular disease and in 4 (20%) patients having vestibulopathy. Significantly higher average left-sided RS velocity and frequency were found among the vestibular patients. VOR gain <0.72 was found to be highly specific for the diagnosis of vestibular dysfunction. However, for gain values in the range of 0.72-0.79, the presence of RS with frequency >80% largely improved vHIT diagnostic accuracy.

CONCLUSIONS: Although VOR gain <0.8 is considered to reflect dysfunction, a significant false-positive rate for left-sided horizontal vHIT was found for gains in the range of 0.72-0.79. The presence of RS with frequency >80% could improve vHIT diagnostic ability in these patients.

Original languageEnglish
Pages (from-to)202-210
Number of pages9
JournalAudiology and Neurotology
Issue number3
StatePublished - 1 Jun 2023

Bibliographical note

Publisher Copyright:
© 2023 The Author(s). Published by S. Karger AG, Basel. This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission.


  • Case-Control Studies
  • Head Impulse Test
  • Humans
  • Reflex, Vestibulo-Ocular
  • Retrospective Studies
  • Semicircular Canals
  • Vestibular Diseases/diagnosis


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