How Good Are We in Evaluating a Bedside Head Impulse Test?

Korda, Athanasia; Carey, John Patrick; Zamaro, Ewa; Caversaccio, Marco Domenico; Mantokoudis, Georgios (2020). How Good Are We in Evaluating a Bedside Head Impulse Test? Ear and hearing, 41(6), pp. 1747-1751. Wolters Kluwer Health 10.1097/AUD.0000000000000894

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OBJECTIVES

Clinicians performing a horizontal head impulse test (HIT) are looking for a corrective saccade. The detection of such saccades is a challenge. The aim of this study is to assess an expert's likelihood of detecting corrective saccades in subjects with vestibular hypofunction.

DESIGN

In a prospective cohort observational study at a tertiary referral hospital, we assessed 365 horizontal HITs performed clinically by an expert neurootologist from a convenience sample of seven patients with unilateral or bilateral deficient vestibulo-ocular reflex (VOR). All HITs were recorded simultaneously by video-oculography, as a gold standard. We evaluated saccades latency and amplitude, head velocity, and gain.

RESULTS

Saccade amplitude was statistically the most significant parameter for saccade detection (p < 0.001).The probability of saccade detection was eight times higher for HIT toward the pathological side (p = 0.029). In addition, an increase in saccade amplitude resulted in an increased probability of detection (odds ratio [OR] 1.77 [1.31 to 2.40] per degree, p < 0.001). The sensitivity to detect a saccade amplitude of 1 degree was 92.9% and specificity 79%. Saccade latency and VOR gain did not significantly influence the probability of the physician identifying a saccade (OR 1.02 [0.94 to 1.11] per 10-msec latency and OR 0.84 [0.60 to 1.17] per 0.1 VOR gain increase).

CONCLUSIONS

The saccade amplitude is the most important factor for accurate saccade detection in clinically performed head impulse tests. Contrary to current knowledge, saccade latency and VOR gain play a minor role in saccade detection.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Ear, Nose and Throat Disorders (ENT)

UniBE Contributor:

Korda, Athanasia; Zamaro, Ewa; Caversaccio, Marco and Mantokoudis, Georgios

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0196-0202

Publisher:

Wolters Kluwer Health

Language:

English

Submitter:

Stefan Weder

Date Deposited:

13 Jan 2021 15:48

Last Modified:

12 Jun 2021 02:30

Publisher DOI:

10.1097/AUD.0000000000000894

PubMed ID:

33136647

BORIS DOI:

10.48350/150354

URI:

https://boris.unibe.ch/id/eprint/150354

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