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<b>Introduction:</b> The vestibular organ (VO) is essential for maintaining balance and stabilizing visual images during head movements. To evaluate its function, the strength of the vestibulo-ocular reflex (VOR) is assessed using kinetic tests like the Sinusoidal Harmonic Acceleration Test (SHAT), video Head Impulse Test (vHIT), and slow-phase peak velocity (SPV) measurement in the caloric test (CT). Despite their limited sensitivity and specificity, they are used to determine eligibility for positions requiring strong balance control.<b>Aim:</b> To determine the range of VOR gain in young healthy individuals in SHAT, vHIT and CT. To search for correlations between vestibular test results and age and gender of the subjects.<b>Materials and methods:</b> Sixty two healthy individuals, with 32 males and 30 females, aged 7 to 33 who met the inclusion criteria were included in the study. Each participant underwent SHAT, vHIT and CT. Standard statistical methods and Spearman's rank correlation were used.<b>Results:</b> The age of the subjects correlated negatively with the VOR gain in SHAT. There was no correlation between results for SHAT, vHIT or CT.<b>Discussion:</b> Various factors, such as vestibular stimulation and anatomical variations, affect vestibular test results. While these tests complement each other in diagnosing vertigo, they are not recommended for healthy individuals qualifying for high-vestibular-performance occupations.<b>Conclusions:</b> With age, the sensitivity of the VO to kinetic stimuli decreases. The inability to calibrate stimuli can result in varied responses among individuals. A comprehensive evaluation of the VO requires testing across different frequency ranges.

Background: Because the inner ear requires high-energy metabolism and because of the iron content of some cochlear enzymes, iron deficiency-related hypoxia can affect hearing and the balance system. Objectives: To evaluate the hearing and balance functions in adults with iron deficiency (ID) and iron deficiency anemia (IDA). Material and Methods: 22 ID patients, 22 IDA patients and 22 healthy controls underwent pure tone audiometry (0.125-16 kHz), VNG, VEMP, and vHIT. Results: Significant differences were observed in the hearing thresholds of the IDA group at frequencies ranging from 0.125 kHz to 14 kHz, as well as in the ID group at frequencies of 2.0 kHz, 4.0 kHz, and 6.0 kHz. The pursuit test was pathological at the rate of 40.9% in the IDA group. The oVEMP test showed prolonged latency values in both ID and IDA groups. IDA group had lower p1-n1 amplitude than the control group in the oVEMP and cVEMP tests. A significant difference was determined between the groups concerning anterior SCC VOR gains. Conclusions and significance: The hypoxia caused by anemia might negatively impact hearing and vestibular functions. The current study is the first study to comprehensively evaluate anemia patients with VNG, VEMP, and vHIT tests. [ABSTRACT FROM AUTHOR]

Introduction: The vestibular organ (VO) is essential for maintaining balance and stabilizing visual images during head movements. To evaluate its function, the strength of the vestibulo-ocular reflex (VOR) is assessed using kinetic tests like the Sinusoidal Harmonic Acceleration Test (SHAT), video Head Impulse Test (vHIT), and slow-phase peak velocity (SPV) measurement in the caloric test (CT). Despite their limited sensitivity and specificity, they are used to determine eligibility for positions requiring strong balance control. Aim: To determine the range of VOR gain in young healthy individuals in SHAT, vHIT and CT. To search for correlations between vestibular test results and age and gender of the subjects. Materials and methods: Sixty two healthy individuals, with 32 males and 30 females, aged 7 to 33 who met the inclusion criteria were included in the study. Each participant underwent SHAT, vHIT and CT. Standard statistical methods and Spearman's rank correlation were used. Results: The age of the subjects correlated negatively with the VOR gain in SHAT. There was no correlation between results for SHAT, vHIT or CT. Discussion: Various factors, such as vestibular stimulation and anatomical variations, affect vestibular test results. While these tests complement each other in diagnosing vertigo, they are not recommended for healthy individuals qualifying for high-vestibular-performance occupations. Conclusions: With age, the sensitivity of the VO to kinetic stimuli decreases. The inability to calibrate stimuli can result in varied responses among individuals. A comprehensive evaluation of the VO requires testing across different frequency ranges. [ABSTRACT FROM AUTHOR]

Background: Systemic lupus erythematosus (SLE) is a chronic, inflammatory, autoimmune disease, characterized by multiple organ involvement, which is seen more often in young females. Objectives: To evaluate the hearing and balance functions in SLE patients. Materials and methods: Twenty-four SLE patients, 24 healthy controls underwent pure tone audiometry (0.125–16 kHz), VNG, vestibular evoked myogenic potential (VEMP), and video head impulse test (vHIT). Results: A statistically significant difference was determined between the control group and the SLE group at 0.125, 0.25, 0.5, 1.0, 6.0, 8.0, 10, 12, 14, and 16 kHz frequencies. Sensorineural hearing loss was observed in 37.5% of the SLE group. The pursuit test was pathological at the rate of 25% in the SLE group. No response was obtained in six SLE patients in the oVEMP test and four SLE patients in the cVEMP test. The mean posterior SCC VOR gain values were 0.64 ± 0.2 in the SLE group. A significant difference was determined between the groups with respect to posterior SCC VOR gains. Conclusions and significance: Our findings show that SLE disease may negatively affect the hearing system and the vestibular system as well. The current study is the first study to comprehensively evaluate SLE patients with VNG, VEMP, and vHIT tests. [ABSTRACT FROM AUTHOR]

Background: Acute and complete unilateral vestibular deafferentation induces a significant change in ipsilateral vestibuloocular reflex gain, making the patient unable to stabilize gaze during active or passive head movements. This inability creates the illusion that the visual environment is moving, resulting in persistent visual discomfort during rapid angular or linear acceleration of the head. This is known as oscillopsia. Our objective was to understand if the spontaneous sensation of oscillopsias after complete unilateral vestibular deafferentation by vestibular neurotomy at 5 days (D5) and at 3 months (M3) is correlated with the loss of vestibuloocular reflex gain and dynamic visual acuity. Methods: Retrospective cohort study was conducted in an otolaryngology tertiary care center (2019-2022) on patients with complete unilateral vestibular loss by vestibular neurotomy. They were divided into 2 groups according to the presence (group G1) or absence (group G2) of a spontaneous complaint of oscillopsia assessed at M3. Severity of oscillopsias evaluated by Oscillopsia Severity Questionnaire. Vestibuloocular reflex gain based on video head impulse test (vHIT) and the dynamic visual acuity were measured for each group at D5 and M3. Categorical variables were compared using χ2 test and quantitative variables using the nonparametric Wilcoxon-Mann-Whitney test. Results: All patients have a complete vestibular deafferentation at D5 and M3. At D5 (G1 = 8 patients, G2 = 5 patients), there is no significant difference for ipsilateral and contralateral vestibuloocular reflex gains and dynamic visual acuity losses. The Oscillopsia Severity Questionnaire was 2.68 ± 1.03 in G1 and 1.23 ± 1.03 in G2 (P <.05). At M3 (G1 = 9 patients, G2 = 6 patients), there is no significant difference between groups for epidemiologic and clinical data and for vestibuloocular reflex and dynamic visual acuity losses. The Oscillopsia Severity Questionnaire was 2.10 ± 0.63 in G1 and 1.24 ± 0.28 in G2 (P <.05). Conclusions: The spontaneous disabling sensation of oscillopsia after complete unilateral vestibular loss is well assessed by the Oscillopsia Severity Questionnaire but cannot be explained by objective vestibular tests assessing vestibuloocular reflex gain (vHIT) or dynamic visual acuity loss at D5 or M3. Further studies are needed to measure the sensation of oscillopsia under real-life conditions and to identify the factors responsible for its persistence. Trial registration: Retrospectively registered. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Otosclerosis is one of the most common causes of hearing loss in adults with clinical onset between 20 and 40 years of age. Vestibular symptoms may be the most agonizing and primary symptom in cases with otosclerosis, so the assessment of patients is important. The vestibular-evoked myogenic potentials test (VEMP) is used to assess the saccular and the utricular functions using cervical and ocular vestibular-evoked myogenic potentials (cVEMP and oVEMP), respectively. The video head impulse test (vHIT) which measure vestibulo-ocular reflex (VOR) to rapid impulsive head acceleration in the plane of each semicircular canal (SCC) has allowed quantitative monitoring of each canal function. Methods: Twenty subjects with bilateral otosclerosis were studied, ranging in age from 30 to 55 years, divided into two groups. One group consisted of 10 adult patients with bilateral conductive otosclerosis. The second group consisted of 10 adult patients with bilateral mixed otosclerosis. All the patients underwent cVEMP and oVEMP, using a BC 500Hz tone burst stimulus and vHIT in three planes, left anterior right posterior (LARP), right anterior left posterior (RALP), and lateral SCCs. Results: The findings indicate statistically significant differences in the peak-to-peak amplitudes of cVEMP and oVEMP in the two studied groups, and the mixed cases had lower amplitudes than conductive cases and a significant increase in p13 latencies. Also, there is a statistically significant difference in the lateral SCC gain between the two groups, as mixed cases had lower gain than conductive cases, but not for anterior or posterior SCCs, with no gain less than 0.8 in all three canals. Conclusion: The findings suggested that the saccule is more liable to be affected by cochlear otosclerosis followed by the utricle. The three SCCs are mostly spared. [ABSTRACT FROM AUTHOR]

AIM: To comprehensively evaluate the dynamic change of vestibular function during long-term follow-up of vestibular neuritis, as well as the co-relationship with the outcomes of vestibular neuritis (VN), which provides the recommendations for vestibular function tests during the course of VN. METHODS: A prospective cohort study was conducted on 16 patients with acute VN. Caloric test, vHIT, rotatory chair tests, VEMP, dizziness handicap inventory (DHI) score, and dynamic dizzy scales (VAS-DD) was first performed within 7 days of neuritis onset, which were further re-evaluated during the 6–12 months of follow-up. The dynamic changes on multiple objective vestibular examinations were analyzed during the acute and recovery stage of VN. We further evaluated the co-relationship between the vestibular dysfunction scales and the prognosis of VN. RESULTS: In more than 6 months of follow-up, 44% of the ultralow frequency, 94% of the low-to-mid frequency, and 44% of the high-frequency function of the horizontal semicircular canal returned to normal (p < 0.05). The change degree in symmetry of the rotatory chair test was correlated with the gain of the horizontal semicircular canal on the vHIT and the unilateral weakness (UW) value on the caloric test (p < 0.05). The change in DHI score was correlated with the phase; change in VAS-DD level correlated with the symmetry and TC of the rotatory chair test at VN recovery stage (p < 0.05). There was no significant correlation between the change in DHI score or change in VAS-DD and the degree of vestibular function recovery (p > 0.05). CONCLUSION: In general, vestibular function improved during the course of VN. The rotatory chair test can be used to evaluate the overall function of the vestibular system and the compensatory state in patients with VN. [ABSTRACT FROM AUTHOR]

Background: Vestibular migraine (VM) is the most frequent etiology of recurrent spontaneous episodic vertigo. Vestibular and oculomotor abnormalities have been described in VM; however, the diagnosis is currently based on symptoms. The objective of this study was to determine the most frequent abnormalities in videonystagmography (VNG), caloric testing (Cal) and video head impulse test (vHIT) in patients with VM. Methods: A retrospective cohort study was conducted, including all VM and probable VM patients seen from January 2021 to July 2022. Demographics, auditory symptoms and results via VNG, Cal and vHIT were evaluated. VNG results were compared with a control group. Results: Sixty patients, 81.7% with VM and 18.3% with probable vestibular migraine, were included. VNG revealed the following abnormalities: 21.7% spontaneous nystagmus; 33.3% positional nystagmus, mostly central; 26.7% optokinetic nystagmus; 56.7% smooth pursuit abnormalities and 70% saccade test abnormalities, mostly velocity and latency. An abnormal unilateral caloric response was seen in 22.9%, while vHIT revealed a low gain in at least one canal in 21.7%, and saccades were seen in at least one canal with normal gains in 18.3%. Concordant results between Cal and lateral vHIT were seen in 77.1% of cases. Conclusions: Although VM is a clinical diagnosis, vestibular and oculomotor abnormalities are commonly seen. The most frequent oculomotor findings were an abnormal saccade test, abnormal smooth pursuit and central positional nystagmus. [ABSTRACT FROM AUTHOR]

Objective: To assess semicircular canal function in benign paroxysmal positional vertigo (BPPV) using the video head impulse test (vHIT) and caloric test. Methods: We retrospectively reviewed 39 patients with idiopathic BPPV who underwent both vHIT and the caloric test. Twenty‐one patients had posterior BPPV (p‐BPPV) and eighteen had horizontal BPPV (h‐BPPV). Vestibulo‐ocular reflex (VOR) gain and corrective saccades (CS) were analyzed in vHIT and canal paresis (CP) was calculated in the caloric test. Results: The mean VOR gain of the posterior canal in p‐BPPV was 0.75 ± 0.28 on the affected side, which was significantly smaller than that on the contralateral side (0.93 ± 0.24, p =.00738). On the other hand, there were no significant differences in the VOR gain of the horizontal canal in h‐BPPV between the affected and the contralateral sides (p =.769). The rates of the presence of CS were not significantly different between the affected canal and the contralateral canal either in p‐BPPV (p =.111) or h‐BPPV (p =.0599). The mean CP value in h‐BPPV patients (43.5 ± 31.3%) was significantly higher than that in p‐BPPV patients (22.2 ± 22.9%; p =.0184). Conclusion: The VOR gain of vHIT in the affected canal was significantly smaller than that in the contralateral canal in p‐BPPV, but not in h‐BPPV. The caloric responses of the affected canal are reduced to a significantly larger extent in h‐BPPV compared to p‐BPPV. These results suggest that BPPV affects the semicircular canal function differently depending on which semicircular canal is involved. [ABSTRACT FROM AUTHOR]

Aim: Otosclerosis is one of the common otologic diseases. The mechanism and the probable site of vestibular involvement are not yet fully understood. The present study aimed to perform a comprehensive vestibular evaluation in patients with otosclerosis, compared to the cases without otosclerosis. Materials and methods: patients underwent a comprehensive cochleovestibular evaluation, including audiometry, ocular and cervical vestibular evoked myogenic potential (o-VEMP and c-VEMP), video head impulse (vHIT) and caloric tests. The results were compared with those obtained from the non-otosclerosis control group. Results: A total of 61 individuals were included in the study who were divided into two groups of the case (50.82%) and control (49.18%). The results showed that there was a significant difference in the mean vHIT gain between the case and control groups (P < 0.05). However, the mean gain was still within the normal range. Besides, the patients with otosclerosis had significant bilateral or unilateral weaknesses according to caloric test results. Moreover, their o-VEMP and c-VEMP results were significantly abnormal as well (P < 0.05). Conclusion: Based on the results of the present study, the vestibular system even in asymptomatic cases, is affected by otosclerosis. Furthermore, it seems that the otolithic system has a higher chance of involvement, compared to the semicircular canals. [ABSTRACT FROM AUTHOR]

Background: This study aims to explore the clinical relevance of the Suppression Head Impulse Paradigm (SHIMP) to better understand if it represents an additional clinical value compared to the Head Impulse Paradigm (HIMP) in patients with vestibular neuritis (VN) in different stages of the disease. Methods: From January 2020 to June 2022, patients with unilateral VN were found in a database of an ENT vestibular clinic. Clinical presentation, vestibular test outcomes, therapy, and recovery were examined in medical records. Results: A total of 42 patients (16 Females, mean age 51.06 ± 12.96; 26 Male, mean age 62.50 ± 9.82) met the inclusion criteria and were enrolled in the study. The means of the VOR gain for both paradigms were respectively 0.38 ± 0.12 (SHIMP) and 0.46 ± 0.13 (HIMP) at T0 and 0.55 ± 0.20 (SHIMP) and 0.64 ± 0.19 (HIMP) at T1 for the lesional side. For the HIMP, the gain value <0.76 identified the affected side of VN with 100% sensitivity (92–100) and 100% specificity (91–100). For the SHIMP, the gain value <0.66 identified the affected side of VN with 100% sensitivity (92–100) and 100% specificity (91–100) and an AUC of 1.0 (0.96–1.0, p < 0.0001). Conclusion: The SHIMP paradigm has a diagnostic accuracy equal to the classic HIMP paradigm in patients with VN. The assessment of VOR slow phase velocity and vestibulo-saccadic interaction in patients with VN could be easier with the use of the SHIMPs paradigm. SHIMPs paradigm provides helpful information about the evaluation of VOR slow phase velocity and vestibulo-saccadic interaction as new recovery strategies in patients with VN. [ABSTRACT FROM AUTHOR]

Background: This review aims to explore the potential clinical application of the suppression head impulse paradigm (SHIMP) in patients with unilateral and bilateral vestibulopathy. Methods: An electronic search was conducted by two independent reviewers in the following databases: Embase, MEDLINE (PubMed), and Scopus. The screening of titles, abstracts, and full texts and data extraction were undertaken independently by pairs of reviewers. The included studies were quality appraised using a modified version of the Newcastle–Ottawa Scale. Results: The results were reported following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Our search yielded 935 unique records, of which 16 remained after screening titles and abstracts. A total of 11 studies were included, covering a total of 418 participants (230 patients and 188 healthy participants). Conclusion: SHIMP could be a useful tool to diagnose a VOR alteration in patients with vestibulopathy in both the acute and chronic phases of vestibulopathy. [ABSTRACT FROM AUTHOR]

Objective: Some studies have suggested that the human immunodeficiency virus causes dizziness and other balance problems; however, the exact effects on the vestibular system in acute and chronic phases of the disease are not clear. In this study, we aimed to evaluate the effect of the human immunodeficiency virus on semicircular canals using a video head impulse test. Materials and Methods: Seventy-two cases were included in the study. Twenty-six of the cases had positive human immunodeficiency virus RNA (group A) and 22 had negative human immunodeficiency virus RNA with positive anti-human immunodeficiency virus (group B) laboratory results. Twenty-four of the cases were healthy individuals (group C). The vestibular system was evaluated with a video head impulse test in all cases. Results: In the evaluation of overt/covert saccades, a statistically significant difference was detected for the left posterior semicircular canal between group B and the other 2 groups. However, this was considered an incidental finding and not a clinically significant result. There was no other significant difference in the catchup saccades for other canals. In addition, there was no statistically significant difference between the groups for the vestibulo-ocular reflex gain. Conclusion: Although the human immunodeficiency virus has been reported to be vestibulotoxic in previous studies, we found that the video head impulse test findings were not affected in our patient groups. Because the video head impulse test is considered a high-frequency test of vestibulo-ocular reflex, it is possible that vestibular effects of the human immunodeficiency virus can be confined to low frequencies. It is also possible that HIV affects the central structures while sparing the peripheral vestibular pathways. [ABSTRACT FROM AUTHOR]

BACKGROUND: Parkinson's disease (PD) is a common multi-system neurodegenerative disorder with possible vestibular system dysfunction, but prior vestibular function test findings are equivocal. OBJECTIVE: To report and compare vestibulo-ocular reflex (VOR) gain as measured by the video head impulse test (vHIT) in participants with PD, including tremor dominant and postural instability/gait dysfunction phenotypes, with healthy controls (HC). METHODS: Forty participants with PD and 40 age- and gender-matched HC had their vestibular function assessed. Lateral and vertical semicircular canal VOR gains were measured with vHIT. VOR canal gains between PD participants and HC were compared with independent samples t-tests. Two distinct PD phenotypes were compared to HC using Tukey's ANOVA. The relationship of VOR gain with PD duration, phenotype, severity and age were investigated using logistic regression. RESULTS: There were no significant differences between groups in vHIT VOR gain for lateral or vertical canals. There was no evidence of an effect of PD severity, phenotype or age on VOR gains in the PD group. CONCLUSION: The impulsive angular VOR pathways are not significantly affected by the pathophysiological changes associated with mild to moderate PD. [ABSTRACT FROM AUTHOR]

BACKGROUND: Unapparent saccades in video head impulse test (vHIT) are usually present in Meniere's disease (MD) patients but tend to be ignored by the clinician. The result of vHIT is constantly questioned in MD patients due to a lack of uniform metrics. A more effective indicator is needed for indicating MD's pathological progress. OBJECTIVES: To get a comprehensive understanding of the nature and usability of saccades in different MD stages. METHODS: 118 patients diagnosed with unilateral MD were recruited in this study. Patient history, audiological examination, caloric test, vHIT were performed. We proposed 'raw saccades' to represent all showed wave peaks behind the head peak and named saccades by their appearance sequence: 1st saccade, 2nd saccade and 3rd saccade. An exploratory saccade analysis was executed to investigate the effectiveness of saccade attributes in identifying MD stages. RESULTS: MD patients have greater detectable 1st saccade than PR score as well as 2nd saccade. The time and velocity of the 1st saccade show high interaural variability (p = 0.028, p = 0.000 respectively). No statistical difference concerning the vHIT gain, PR score and 2nd saccade among stages could be recognized on both affected and contralateral sides. Multiple comparisons show the affected 1st saccade velocity and affected 1st saccade absolute velocity have stage-difference. At late stages (3&4), the affected 1st saccade is manifested as a speed increase, and this measure shows a relatively high correlation with MD stages compared to other vestibular indicators. CONCLUSION: The 1st saccade velocity on the affected side could indicate the MD disease process and severity. [ABSTRACT FROM AUTHOR]

Background  To achieve balance, persons with blindness (PWB) use proprioceptive and vestibular cues rather than the visual system; however, PWB are equally susceptible to acquire vestibular disorders. Reliable assessments of the vestibular system in PWB are essential to determine the presence or absence of vestibular disorders. Purpose  The saccular and the utricular functioning can be assessed using cervical vestibular-evoked myogenic potential and ocular vestibular-evoked myogenic potential, respectively. Evaluation of the functional integrity of the semicircular canals requires an assessment of the vestibular ocular reflex; however, this can be challenging in PWB. Video head impulse test (vHIT) assesses the vestibular ocular reflex (VOR) elicited against the natural high-frequency head movement in the planes of all six semicircular canals. This study aimed to explore the feasibility and outcomes of administering vHIT in PWB. Research Design  Standard (static) groups comparison. Study Sample  Nineteen young PWB and 23 age-matched adults with "normal" vision (control group) were included in the study. Data Collection and Analyses  PWB underwent vHIT once, while the control group was tested in three conditions; condition 1 was used to simulate blindness for the control group, where vHIT was done in a pitch-dark room without prior instructions; condition 2 included vHIT testing in daylight, without a fixed visual target and any instructions; and condition 3 involved vHIT in daylight in the presence of a set visual target and with standard instructions to maintain visual focus on the visual target. Results  The VOR gain was abnormal in the PWB group for all the canals. Among the PWB, the lateral canals (mean = 0.63) had the best VOR gain, followed by the anterior canals (mean = 0.53) and the posterior canals (mean = 0.31). In the control group, the VOR gain was significantly reduced in condition 1. There was no significant difference between the VOR gain in the PWB group and the control group in condition 1 for the lateral and the anterior canals. A higher proportion of participants in the PWB group had the presence of refixation saccades. Conclusion  VOR is significantly reduced in PWB but not completely absent. There may be a need to develop normative data for blind individuals to decide whether or not a person with blindness has a vestibular dysfunction, specifically a VOR deficit. [ABSTRACT FROM AUTHOR]

Objectives: Obstructive sleep apnea (OSA) is a common sleep disorder, which is associated with recurrent oxygen desaturation during sleep. It has already been shown that nocturnal hypoxia may lead to cochlear dysfunction in patients with OSA. Less is known whether hypoxia during sleep also impacts vestibular function in those patients. Thus, the aim of the presented study was to assess a potential vestibulotoxic effect of nightly desaturations with hypoxia in patients with OSA by investigating a possible correlation between respiratory parameters and vestibular function tests. Methods: A total of 56 patients were included in the study and underwent a fully attended cardiorespiratory polysomnography (PSG). Vestibular function was assessed using video head impulse test to evaluate horizontal semicircular canal function and cervical vestibular evoked myogenic potentials (cVEMPs) and ocular vestibular evoked myogenic potentials (oVEMPs) to measure otolith function. Descriptive data analysis was conducted and correlation analysis between selected PSG parameters and the results of vestibular testing was performed using Kendall τ coefficient. Results: A significant correlation between vestibular function and respiratory polysomnographic parameters could not be demonstrated in the study (P >.05) but cVEMP and oVEMP results showed a trend toward a correlation with oxygen desaturation indices and apnea–hypopnea index. Additionally, otolith hypofunction was more prevalent in patients with hypertension as well as OSA. Conclusion: The results of our study show that there is no significant correlation between vestibular function and sleep apnea parameters, although otolith dysfunction might be more prevalent in patients with OSA and hypertension. [ABSTRACT FROM AUTHOR]

In patients with congenital nystagmus (CN), the study of vestibular function is complicated by many factors related to the measurement of the vestibulo-ocular reflex (VOR) by means of caloric testing and the video head impulse test (vHIT), and to date no such studies have successfully employed the vHIT to evaluate vestibular function in these patients. We present a case with CN and vertigo in which peripheral vestibular function was evaluated using the vHIT system, including head impulse testing and the suppression head impulse protocol. We show that it is possible (a) to identify lateral VOR changes such as abnormalities resembling those produced by bilateral vestibular lesions, though not necessarily related to the same mechanism; (b) to identify peripheral VOR lesions of the vertical semicircular canals (SCC); and (c) to document compensation and recovery subsequent to these peripheral lesions during follow-up of patients with CN. vHIT is a useful tool that should be used to study vestibular function in patients with CN and vertigo, which could constitute a new clinical application of this technique. [ABSTRACT FROM AUTHOR]

Superior Canal Dehiscence is classically diagnosed with typical abnormalities on Vestibular Evoked Myogenic Potentials (VEMPs) and Computed Tomography (CT) scans. This paper discusses the utility of the video Head Impulse Test (vHIT) in SCD. Data from 11 ears (8 patients) with SCD were retrospectively reviewed. Results from vHIT, VEMPs and CT and when possible, MRI scans were correlated. An audit of 300 vHIT from patients undergoing routine testing for any neurotological complaint was also conducted to look at the incidence of isolated abnormal superior canal function. 82% of patients (9 ears) with SCD showed abnormal vHIT (reduced gain and catch-up saccades) isolated to the affected superior semicircular canal. Correlation of the CT and VEMPs are important in forming a diagnosis of SCD. However, if isolated superior canal vHIT abnormalities are demonstrated, it is suggestive of SCD and such patients should be referred for further investigations [ABSTRACT FROM AUTHOR]

The vHIT device, which has a mechanism based on measuring the VOR gain, helps us to quickly evaluate six semicircular canals. The aim of this study was to establish normative values for semicircular canal function with the video head impulse test (vHIT) battery in normal adolescents. 100 (50 females, 50 males) individuals aged 11–18 years, with a mean age of 14.99 years, were included in the study. As a result of the vHIT evaluations performed with vHIT Otometrics ICS Impulse A/S Taastrup, Denmark, the mean lateral canal vestibulo-ocular reflex (VOR) gain value was 0.96, the mean anterior canal VOR gain value was 0.89, and the mean posterior canal VOR gain value was 0.87, all of which were within the normal value range. While the VOR gain values and asymmetry values are within the normal value range and are similar to the literature, no statistically significant correlation was observed between these values and age. As a result, the vHIT battery is an easy, fast, and practical test method that can be used in adolescents. [ABSTRACT FROM AUTHOR]

The caloric test and the video head impulse test (vHIT) are diagnostic tools to examine vestibular neuritis (VN) patients through assessing the function of the semicircular canals. Both tests assess the vestibular ocular reflex (VOR) with major differences between them as regards stimulus characteristics, frequency, methodology and function examined. The caloric test is the gold standard test in VOR assessment. The vHIT assesses the same reflex (VOR) by using a video-assisted examination of the impulsive manoeuvre. The aim of this study was to assess the presence or absence of agreement between both vHIT and the caloric test in VN patients. A case-control study was conducted in Audiovestibular unit, Department of ENT, Zagazig University Hospitals. About 24 patients with VN were included. Both vHIT and the caloric test were done on two consecutive days. We assessed the agreement between these two tests. Horizontal gain asymmetry (GA) with the canal paresis. There was a slight agreement between both tests. The VHIT and the caloric test stimulate different frequencies of VOR. They are complementary rather than being alternatives in the diagnosis of peripheral VN. [ABSTRACT FROM AUTHOR]

Clinical application of vHIT is limited due to a lack of interpretation of vHIT gain and saccades. This research focuses on comparing common vertigo diseases on vHIT gain and saccade divergence(PR score). We retrospectively reviewed 165 patients who have one definite diagnosis, good data quality, and can be read by MATLAB software. All patients were grouped into unilateral vestibular dysfunction (UVD), Meniere's disease (MD), vestibular migraine (VM), Ramsay Hunt Syndrome (RHS), bilateral vestibular hypofunction (BVH), benign paroxysmal positional vertigo (BPPV), and acoustic neuroma (AN). PR score was calculated by an open-source software HitCal. The saccade detection rate is higher than the abnormal vHIT gain on UVD, MD, VM, RHS, BVH and BPPV. PR score combined with vHIT gain could separate the affected side in UVD and RHS. In the MD group, both vHIT gain and PR score have inconspicuous performance. We also found that different compensation levels and hearing loss status affect results. vHIT gain combined with PR score enables a proper distinction among common vertigo diseases. PR score is more sensitive than the gain value on evaluating the physiological situation, vestibular compensation and disease progression. [ABSTRACT FROM AUTHOR]

BACKGROUND: Susac syndrome (retino-cochleo-cerebral vasculopathy, SuS) is an autoimmune endotheliopathy characterized by the clinical triad of encephalopathy, branch retinal artery occlusions and sensorineural hearing loss. In contrast to data regarding auditory function, data measuring vestibular function is sparse and the cervical vestibular-evoked myogenic potentials (cVEMPs). OBJECTIVE: To determine whether the video head impulse test (vHIT) can serve as a confirmatory assessment of vestibulocochlear dysfunction in cases of suspected SuS. METHODS: Seven patients diagnosed with SuS underwent pure tone audiometry, a word recognition test, cVEMPs and the vHIT. RESULTS: Five patients were diagnosed with definite SuS, and two with probable SuS. Two patients were asymptomatic for hearing loss or tinnitus, and no sensorineural hearing loss was detected by audiograms. Four patients complained of tinnitus, and three patients reported experiencing vertigo. Three patients had abnormal cVEMPs results. All seven patients' vHIT results were normal, except for patient #2, who was one of the three who complained of vertigo. The calculated gain of her left anterior semicircular canal was 0.5, without saccades. CONCLUSIONS: This is the first study to describe the results of the vHIT and cVEMPs among a group of patients with SuS. The results suggest that the vHIT should not be the only exam used to assess the function of the vestibular system of SuS patients. [ABSTRACT FROM AUTHOR]

Third window disorders are structural abnormalities in the bony otic capsule that establish a connection between the middle/inner ear or the inner ear/cranial cavity. Investigated extensively in adults, they have hardly been studied in children. This study is a retrospective study of children (aged 5–17 years) diagnosed with rare third window disorders (third window disorders reported rarely or not reported in children) in a tertiary pediatric vestibular unit in the United Kingdom. It aimed to investigate audiovestibular function in these children. Final diagnosis was achieved by high resolution CT scan of the temporal bones. Of 920 children attending for audiovestibular assessment over a 42 month period, rare third windows were observed in 8 (<1%). These included posterior semicircular canal dehiscence (n = 3, 0.3%), posterior semicircular canal thinning (n = 2, 0.2%), X linked gusher (n = 2, 0.2%), and a combination of dilated internal auditory meatus/irregular cochlear partition/deficient facial nerve canal (n = 1, 0.1%). The majority of them (87.5%) demonstrated a mixed/conductive hearing loss with an air-bone gap in the presence of normal tympanometry (100%). Transient otoacoustic emissions were absent with a simultaneous cochlear pathology in 50% of the cohort. Features of disequilibrium were observed in 75% and about a third showed deranged vestibular function tests. Video head impulse test abnormalities were detected in 50% localizing to the side of the lesion. Cervical vestibular evoked myogenic potential test abnormalities were observed in all children in the cohort undergoing the test where low thresholds and high amplitudes classically found in third window disorders localized to the side of the defects in 28.5%. In the series, 71.4% also demonstrated absent responses/amplitude asymmetry, some of which did not localize to the ipsilesional side. Two children presented with typical third window symptoms. This study observes 2 new rare pediatric third window phenotypes and the presence of a cochlear hearing loss in these disorders. It emphasizes that these disorders should be considered as an etiology of hearing loss/disequilibrium in children. It also suggests that pediatric third window disorders may not present with classical third window features and are variable in their presentations/audiovestibular functions. [ABSTRACT FROM AUTHOR]

Introduction: We currently interpret the video Head Impulse Test (vHIT) results mainly based on the gain value. Aim: The purpose of this study is to evaluate vHIT results for both gain and re-fixation saccades on unilateral definite Meniere's disease (MD) subjects in comparison with normal healthy subjects. Materials and Methods: Forty unilateral definite MD subjects and age-matched healthy subjects were recruited. Pure tone audiometry, the caloric test, and the vHIT test were performed on MD subjects. The vHIT test was performed on healthy subjects. Results: The velocity regression gain (VRG) of the affected ear in patients with MD is significantly lower than of those in healthy subjects. The total percentage of refixation saccades is significantly higher in patients with MD when compared to healthy subjects. VRG values were not well-correlated with the percentage of refixation saccades. VRG asymmetry values are also not well-correlated with the percentage of unilateral canal weakness. A moderately stronger correlation between the percentage of refixation saccades and percentage of unilateral canal weakness, with an r2 of 0.474. Conclusions: The present study suggests that while VRGs are still a diagnostic parameter of detecting MD, the presence of refixation saccades can also have diagnostic value, especially with normal VRGs, in detecting MD. [ABSTRACT FROM AUTHOR]

Background Ototoxicity induced by organic solvents has been identified in several groups of workers. Little is known, however, about the effects of organic solvents on the vestibular system. Purpose The aim of the study was to comprehensively assess the vestibular system and auditory functions in a worker exposed to organic solvents. Research Design Both behavioral and physiological auditory and vestibular evaluations were performed. Results No auditory-related findings associated with solvent exposure were found. The vestibulo-ocular reflex gain was abnormal for all semicircular canals with significant catch-up saccades, as measured by the video head impulse test. The cervical vestibular evoked myogenic potentials was absent in the right ear and small but replicable in the left ear. Ocular vestibular evoked myogenic potential were bilaterally absent. Conclusions The results suggest a case of vestibulotoxicity induced by a long history of organic solvent exposure. We suggest that solvent-exposed individuals should be evaluated with a comprehensive battery of auditory and vestibular tests. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to assess the effects of cochlear implantation on the functional integrity of the horizontal semicircular canal using multiple methodologies, and to discuss and highlight the limitations of using isolated vestibular tests to assess vestibular function in surgical ears. Methods: Ten cochlear implant patients were consented to undergo a preoperative and 3‐month postoperative vestibular assessment. The horizontal semicircular canal (SCC) was assessed using three different vestibular test measures that assess function using different stimuli and at different frequencies ranges: caloric testing, sinusoidal harmonic acceleration testing in the rotary chair, and video head impulse testing in the plane of the horizontal SCC. Data was analyzed using different methods: descriptive, statistical, and by an examination of individual case studies. Results: Each analysis method yielded a different interpretation. Statistical analysis showed no significant group mean differences between baseline pre‐op vestibular test results and 3‐month post‐op vestibular test results. Descriptive analysis showed 30% of individuals presented with postoperative abnormal vestibular testing findings. A case study examination showed that only one patient presented with a post‐op decrease in vestibular function in the implanted ear. Conclusions: There are several limitations of conventional vestibular testing in postsurgical cochlear implant patients. A test‐battery approach, including case history, and test interpretation made on a case‐by‐case basis is needed to determine whether the patient has undergone vestibular damage, is at risk for falling, or in need of further management. Level of Evidence: 2b individual cohort study. [ABSTRACT FROM AUTHOR]

Purpose: Adolescents presenting with vertigo can be a diagnostic challenge. Video head impulse testing (vHIT) offers examination of the semicircular canals in adolescents with few drawbacks. It quantifies the vestibular ocular reflex as a gain-value. However, there is no standardized method to calculate the gain-value. The aim of this article is to define which gain measure is the most optimal and whether the test is clinically tolerable and feasible in diagnostics of adolescents. Methods: Thrity-three Danish healthy adolescents aged 13–16 years, had their lateral semicircular canals examined with vHIT. Gain calculations were obtained at 40, 60, 80, 0–100 ms and as a regression gain. Results: Mean gain values for the right side were: 40 ms: 1.04, 60 ms: 0.98, 80 ms: 0.93, 0–100 ms: 1.08 and regression: 1.04. For the left-side gain values were 40 ms: 0.96, 60 ms: 0.96, 80 ms: 0.98, 0–100 ms: 1.00 and regression: 1.01. T-tests on 60 ms, 0–100 ms and regressions gain showed that 60 ms differed significantly from 0 to100 ms and regression gain. No complaints of discomfort were reported by any of the test subjects. Conclusions: vHIT proved to be a highly applicable procedure with many advantages, but also some potential pitfalls. In healthy adolescents, 0–100 ms and regression gain produce the most reliable results. [ABSTRACT FROM AUTHOR]

Background: Video head impulse test (vHIT) is widely accepted as a test for the assessment of functional integrity of semicircular canals (SCCs). It allows for the evaluation of the functioning of all six SCCs independent of each other. It works on the principle of the vestibulo-ocular reflex (VOR). In individuals with vestibular pathologies, the VOR is impaired, and hence, the use of vHIT may provide vital information about the functional status of SCCs and the VOR pathway originating from them. Purpose: In the recent past, studies reported excellent test--retest reliability of vHIT in healthy individuals. However, these studies used analysis of variance or the nonparametric counterpart Wilcoxon signed-rank test, which are insufficient statistical methods for conclusions about test--retest reliability. Further, because vHIT assesses VOR function in individuals with vestibular pathologies, it is important to assess test--retest reliability in the pathological group as well. Therefore, the present study aimed to evaluate test--retest reliability of vHIT in healthy individuals and individuals with vestibular pathology. Research Design: Repeated measures. Study Sample: Twenty healthy individuals with no history of vestibular pathology and 20 individuals with known vestibular pathology were included. Data Collection and Analysis: Each participant underwent vHIT testing for all three SCCs of both sides on four different occasions. VOR gain and the presence of pathological saccades were noted and analyzed for each recording. Results: Intraclass correlation coefficient (ICC) revealed excellent test--retest reliability for VOR gain in both groups (ICC ≥ 0.76). Kappa coefficient analysis for the presence of refixation saccades demonstrated moderate to excellent agreement between test sessions (K ≥ 0.63) for the lateral canal. For the anterior and posterior SCC, there was large variability between sessions for refixation saccades. Conclusions: This study provides evidence about test--retest reliability of VOR gain and refixation saccades assessed using vHIT in healthy individuals and individuals with vestibulopathies. These findings suggest that both measures are highly reliable and replicable across test sessions, except refixation saccades in vertical canals which varied between sessions in some individuals. [ABSTRACT FROM AUTHOR]

Introduction: Neuropathies of the eighth nerve may be due to primary demyelination or axonal diseases or by mixed disorder of the two resulting in normal cochlear functioning and affected afferent neural conduction in the auditory pathway. Since vestibular nerve is a part of the eighth nerve, there is a possibility of vestibular nerve also getting affected in individuals with auditory neuropathy. Aims and objectives: The aim of the study was to understand the correlation between caloric and video head impulse test (vHIT) results in individuals with auditory neuropathy. Method: A total of three participants diagnosed as having auditory neuropathy, with no other otological or neurological problems were taken for the study. Bithermal caloric test and vHIT were administered for all the participants. Results: In two of the participants with auditory neuropathy spectrum disorder (ANSD), hypofunctional caloric responses were observed along with reduced vestibuloocular reflex (VOR) gain and refixation saccades. However, third participant had hypofunctional caloric response along with normal VOR gain and absent refixation saccade. Discussions: In the present study, the caloric responses were found to be hypofunctional in all three participants suggesting vestibular deficits. Presence of hypofunctional caloric responses reduced VOR gain and refixation saccades suggested greater involvement of vestibular deficit. Conclusions: Findings of the study suggest that in addition to the auditory system, the vestibular system may also be affected in ANSD. [ABSTRACT FROM AUTHOR]

Objective: Monitor the impact of Video Head Impulse Testing (vHIT) conducted during initial ENT consultations on diagnosis rates and requirement for onward referral for further laboratory-based vestibular testing. Design: Prospective service evaluation audit. Setting: ENT outpatients department of a tertiary balance service within a University Teaching Hospital. Main outcome measures: The capability of vHIT to identify vestibular pathology was recorded in 100 consecutive dizzy patients prospectively enrolled into the study. Diagnosis rates at first appointment, as well as the need to onward refer for further vestibular testing, were noted. Results: Of the 100 new patients seen with dizziness, 85% were diagnosed and managed by the end of the first appointment. VHIT was conducted in 83% of cases and provided clinically useful information that aided diagnosis in over 90% of these cases. Conclusions: vHIT is a safe, quick and noninvasive way of obtaining clinically useful information relating to the function of all three semicircular canal pairs within an ENT outpatient clinic. It does not replace advanced vestibular testing but acts as a useful adjunct that can be used to reach a diagnosis more quickly and thereby provide a more efficient patient centred model of care. [ABSTRACT FROM AUTHOR]

Quantitative tests of vestibular function include the caloric test, cervical and ocular vestibular evoked myogenic potential (VEMP), rotary chair, and head impulse test, either at the bedside or utilizing video head impulse test (vHIT). The purpose ofthis article is to provide an overview of how to perform these tests in children, including which tests are recommended based on the child's age and any modifications or considerations that can be made. A variety of clinical measures have been recommended as screening measures for vestibular loss, which will be reviewed. Symptom questionnaires designed to assess the functional impact of dizziness and vestibular loss in children will also be discussed. If a child complains of dizziness or if vestibular loss is suspected (either by case history or positive screening measure), vestibular function testing is warranted. For vestibular function testing, children aged 0 to 2 years typically receive rotary chair, cervical VEMP, and vHIT if a remote system is available. For children aged 3 to 7 years, vHIT, cervical VEMP, and ocular VEMP are completed, and for children aged 8+ years, vHIT, caloric testing if vHIT is normal, and cervical and ocular VEMP are completed. For all children, modifications to testing can be made, as needed. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the high-frequency function of bilateral lateral, posterior and anterior semicircular canals by video head impulse testing (vHIT) in adult patients with profound sensorineural hearing loss subjected to cochlear implant.Methods: A group of 19 adult bearers of monolateral cochlear implants for more than one year was assessed by vHIT on both sides with CI-ON modality and CI-OFF modality. The average of the VOR gains in each of the six semicircular canals was assessed. The Mann-Whitney U-test was used to compare VOR of implanted and non-implanted side semicircular canals (independent samples) and the Wilcoxon test was used to compare VOR with CI-ON modality and CI-OFF modality (related samples).Results: From a clinical point of view, no vestibular symptoms were observed although the median of VOR gain to vHIT was lower than normal values in most cases. Comparing the VOR in semicircular canals in the implanted side with that in the non-implanted side and each canal in the OFF modality compared to the ON modality, we observed no significant difference in VOR gain values, except in the lateral semicircular canal of the opposite side, in which the median of VOR gain was 0.80 (0.68-0.95) in OFF modality and 0.84 in ON modality (0.76-1.06) (p = .04).Conclusion: Even though cochlear implant has no negative impact on clinical vestibular function VOR gain in vHIT recordings is frequently reduced. [ABSTRACT FROM AUTHOR]

Video head impulse test (vHIT) is a new testing which able to identify the overt and covert saccades and study the gain of vestibulo-ocular reflex (VOR) of each semicircular canal. The aim of this study is to review the clinical use of vHIT in patients with vestibular disorders in different diseases. PubMed and Cochrane databases were searched for all articles that defined vHIT, compared vHIT with another clinical test, and studied the efficacy of vHIT as diagnostic tools with vestibular disease. 37 articles about vHIT were reviewed. All articles studied the vHIT in English and French languages up to May 2015 were included in the review. Editorial articles or short comments, conference abstracts, animal studies, and language restriction were excluded from the review. Four systems were used in the literature to do the vHIT. vHIT is physiological quick test, which studied the VOR at high frequency of each semicircular canal by calculating the duration ratio between the head impulse and gaze deviation. vHIT is more sensitive than clinical head impulse test (cHIT), especially in patient with isolated covert saccades. vHIT test is diagnostic of vestibular weakness by gain reduction and the appearance of overt and covert saccades. If the vHIT is normal, then caloric test is mandatory to rule out a peripheral origin of vertigo. It is recommended to test each semicircular canal, as isolated vertical canal weakness was identified in the literature. More investigation would be required to determine the evolution of the VOR gain with the progression of the vestibular disease. [ABSTRACT FROM AUTHOR]

Balance disorders are common issues for aging populations due to the effects of normal aging on peripheral vestibular structures. These changes affect the results of vestibular function evaluations and make the interpretation of these results more difficult. The objective of this article is to review the current state of knowledge of clinically relevant vestibular measures. We will first focus on otolith function assessment methods cVEMP and oVEMP, then the caloric and vHIT methods for semi-circular canals assessment. cVEMP and oVEMP are useful methods, though research on the effects of age for some parameters are still inconclusive. vHIT results are largely independent of age as compared to caloric stimulation and should therefore be preferred for the evaluation of the semi-circular canals function.

Conclusion:The low clinical efficacy of the treatment for patients included in this work correlates with no noticeable effect on the vestibular function.Objective:To assess follow-up in patients with idiopathic and secondary Ménière’s disease after treatment with intra-tympanic dexamethasone and correlate clinical findings with changes in the vestibular-ocular reflex elicited after stimulation of each of the six semicircular canals.Methods:This is a single center retrospective review of patients presenting the clinical symptomatology of Meniérè’s disease treated with intra-tympanic dexamethasone. An audiometric evaluation was performed in each patient before and after treatment. The study cohort was divided into two groups: those evaluated after a short period of time and after a long period of time.Results:The study included 30 patients, mean age = 61 years. Differences in mean pure-tone average before and after treatment were non-significant for both treated (0.61 dB,p= 0.723) and untreated (0.59 dB,p= 0.609) ears. Vestibular–ocular reflex gain averages in the treated ear after treatment were 0.73 (superior semicircular canal), 0.86 (horizontal semicircular canal), and 0.69 (posterior semicircular canal). The gain did not vary significantly in the Superior (p= 0.194), the Horizontal (p= 0.646), or the Posterior Semicircular Canal (p= 0.820). Similar were obtained for the untreated ear. [ABSTRACT FROM PUBLISHER]

Conclusion: It is suggested that the different results of rotational (video head impulse - vHIT) and caloric tests in patients with Ménière's disease (MD) may be a consequence of the physical enlargement of the membranous duct in the hydropic labyrinths in MD, causing a reduced response to caloric stimulation. Objectives: There have been reports that the results of two tests of semicircular canal function, the caloric response and the responses to vHIT do not agree. This retrospective study at a tertiary referral hospital examined this disagreement. Methods: This study reviewed the data of 22 patients who met the AAO-HNS criteria for MD and who had both caloric and vHIT testing. Results: There was a clear dissociation: patients with MD had a small or absent response to caloric stimulation of their affected ear, whilst their response to vHIT was in the normal range. Discussion: The accepted Gentine model of the mechanism of caloric stimulation could account for this dissociation: the increased diameter of the semicircular duct in hydropic labyrinths resulting in endolymph circulation within the duct itself and so a smaller thermally induced pressure across the cupula. The increased duct diameter will have little effect on responses to rotation. [ABSTRACT FROM AUTHOR]

Balance disorders are common issues for aging populations due to the effects of normal aging on peripheral vestibular structures. These changes affect the results of vestibular function evaluations and make the interpretation of these results more difficult. The objective of this article is to review the current state of knowledge of clinically relevant vestibular measures. We will first focus on otolith function assessment methods cervical-VEMP (cVEMP) and ocular-VEMP (oVEMP), then the caloric and video-head impulse test (vHIT) methods for semicircular canals assessment. cVEMP and oVEMP are useful methods, though research on the effects of age for some parameters are still inconclusive. vHIT results are largely independent of age as compared to caloric stimulation and should therefore be preferred for the evaluation of the semicircular canals function. [ABSTRACT FROM AUTHOR]

Conclusion: There were no changes in the function of the six semicircular canals in active fighter pilots, through the use of the video head impulse test (vHIT). These results suggest that the vestibuloocular reflex (VOR) works well at the high frequencies related to the natural head movements in this population. Objectives/hypothesis: The vestibular function in pilots has been reported as being different from that of other normal subjects. These differences are attributed to adaptation of the vestibuloocular reflex (VOR) or by habituation. These studies were conducted with caloric and/or rotatory tests and were limited to the lateral semicircular canals. The aim of the present study was to verify the occurrence of high frequency changes in the function of the six semicircular canals in active fighter pilots, through the use of the video head impulse test (vHIT). Study design: Cross-sectional design. Methods: The subjects participating in this study were divided in three groups, according to their flight experience. The control group (Group 1) consisted of 20 soldiers with no experience of in-flight training. For the test subjects 14 fighter pilots were selected and divided into two groups. Group 2 included the pilots with 1000-2000 hours of flight experience and Group 3 included pilots with 2001-3000 hours of flight experience. They were all submitted to a video head impulse test and the gains of the six semicircular canals were analysed. Results: There were significantly low gain values (p < 0,013) only in the left posterior semicircular canal in the control group as compared with the subject groups. However, there were no significant differences in gain values between the two groups of the active pilots. [ABSTRACT FROM AUTHOR]