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- Clinical Application of the Head Impulse Test in Vestibular Disorders
- Seung Han Lee
- Res Vestib Sci. 2015;14(1):1-8.
- 2,376 View
- 129 Download
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Abstract
PDF - The head impulse test (HIT) is an established way to test the angular vestibulo-ocular reflex (aVOR) at the bedside. When the aVOR is normal, the eyes rotate opposite to the head movement through the angle required to keep images stable on the fovea. If the aVOR is impaired, the eyes move less than required and, at the end of the head rotation, the eyes are not directed at the intended target and the visual image is displaced from the fovea. A promptly-generated corrective saccade brings the image of the target back on the fovea. The identification of this corrective saccade is the signature feature of vestibular hypofunction and has greatly increased the utility of the bedside examination for identifying an aVOR deficit. However, sometimes it is not easy to detect corrective saccades without quantitative HIT devices. Exact execution and interpretation of the HIT are warranted to reduce the diagnostic errors, because the HIT has become an important part of the differential diagnosis of both acute and chronic vestibular disturbances.
Original Article
- Residual Vestibulo-Ocular Reflex Result in Better Functional Outcomes in Bilateral Vestibulopathy
- Ji Eun Choi, Gwanghui Ryu, Young Sang Cho, Won Ho Chung
- Res Vestib Sci. 2014;13(4):89-95.
- 2,177 View
- 36 Download
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Abstract
PDF
- Background
and Objectives: The patients with bilateral vestibulopathy (BV) suffer from unsteadiness and oscillopsia, and despite of appropriate rehabilitation, permanent disability is inevitable. However, the level of functional outcomes could be influenced by whether there is residual vestibulo-ocular reflex (VOR) or not. Under the hypothesis that residual VOR function could result in better performances, we tried to compare in functional outcomes between complete and incomplete BV. Materials and Methods: Fifty patients who have been diagnosed with BV in our institution were retrospectively reviewed retrospectively between 2008 and 2012. We classified them into complete BV group (n=19) and incomplete BV (n=31) group according to the presence of residual VOR. Among them, 31 patients responded to telephone survey (6 in complete group and 25 in incomplete group). The survey includes 5 categories such as the subjective dizziness restriction on daily life, oscillopsia, unsteadiness and depression. Each score ranged from 0 to 4 and patients were asked twice in different time period.
Results
There was no difference in etiology between complete and incomplete group. Incomplete group showed significant improvement in dizziness, restriction on daily life, oscillopsia and unsteadiness compared to complete group. Among 5 catergories, dizziness score was significantly improved in incomplete group (each mean improved sore±standard deviation; dizziness 1.84±0.83, oscillopsia 0.44±0.64, unsteadiness 1±1.09, depression 0.24±0.86 restriction on daily life 1.16±0.97). Conclusion: The presence of residual VOR function had better functional outcomes in bilateral vestibulopathy.
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