Normative vestibulo-ocular reflex data in yaw and pitch axes using the video head-impulse test
AbstractBackground and Aim: The video head-impulse test (vHIT) measures the vestibulo-ocular reflex (VOR) driven by each semicircular canal, following high-acceleration head rotations. The main measurable response is the ratio of eye movement velocity to the angular head velocity, which reflects canal function. Although normative data is available for VOR gain, most studies only report horizontal VOR characteristics, ignoring variations in vertical plane VOR gains. The purpose of this study was to establish normative data for future comparisons of vestibulopathy patients.Methods: Vestibulo-ocular reflex gain and refixation saccades were assessed across 50 healthy individuals between the ages of 20 and 64, without any previous or current vestibular disorders, by applying and measuring horizontal and vertical head impulses.Results: The mean VOR velocity gain was 0.96 (SD=0.11) and 0.93 (SD=0.17) for the horizontal and vertical canals, respectively. The variation of the gain in right anterior/left posterior and left anterior/right posterior movements appeared to be wider than in the laterals, but the results were not influenced by direction (p>0.05). Refixation saccades occurred in 7.2 percent of all impulse trials, with a majority occurring covertly in lateral canals. Unlike saccades (more often observed in subjects older than 50), the VOR velocity gain varied independently of age.Conclusion: The findings suggest these gain values can be used to determine VOR deficits in patients. vHIT values are affected by different factors, especially in the vertical plane, so further study is needed to confirm normal ranges of vertical vHIT values.
2. MacDougall HG, Weber KP, McGarvie LA, Halmagyi GM, Curthoys IS. The video head impulse test: diagnostic accuracy in peripheral vestibulopathy. Neurology. 2009;73(14):1134-41.
3. Matiño-Soler E, Esteller-More E, Martin-Sanchez JC, Martinez-Sanchez JM, Perez-Fernandez N. Normative data on angular vestibulo-ocular responses in the yaw axis measured using the video head impulse test. Otol Neurotol. 2015;36(3):466-71.
4. Blödow A, Pannasch S, Walther LE. Detection of isolated covert saccades with the video head impulse test in peripheral vestibular disorders. Auris Nasus Larynx. 2013;40(4):348-51.
5. Mossman B, Mossman S, Purdie G, Schneider E. Age dependent normal horizontal VOR gain of head impulse test as measured with video-oculography. J Otolaryngol Head Neck Surg. 2015;44:29.
6. Patterson JN, Bassett AM, Mollak CM, Honaker JA. Effects of hand placement technique on the video head impulse test (vHIT) in younger and older adults. Otol Neurotol. 2015;36(6):1061-8.
7. Perez N, Rama-Lopez J. Head-impulse and caloric tests in patients with dizziness. Otol Neurotol. 2003;24(6):913-7.
8. Tjernström F, Nyström A, Magnusson M. How to uncover the covert saccade during the head impulse test. Otol Neurotol. 2012;33(9):1583-5.
9. Weber KP, Aw ST, Todd MJ, McGarvie LA, Curthoys IS, Halmagyi GM. Head impulse test in unilateral vestibular loss: vestibulo-ocular reflex and catch-up saccades. Neurology. 2008;70(6):454-63.
10. Bell SL, Barker F, Heselton H, MacKenzie E, Dewhurst D, Sanderson A. A study of the relationship between the video head impulse test and air calorics. Eur Arch Otorhinolaryngol. 2015;272(5):1287-94.
11. Colagiorgio P, Colnaghi S, Versino M, Ramat S. New tool for investigating the functional testing of the VOR. Front Neurol. 2013;4:165.
12. Perez-Fernandez N, Eza-Nuñez P. Normal gain of VOR with refixation saccades in patients with unilateral vestibulopathy. J Int Adv Otol. 2015;11(2):133-7.
13. Mangabeira Albernaz PL, Zuma e Maia FC. The video head impulse test. Acta Otolaryngol. 2014;134(12):1245-50.
14. Guerra Jiménez G, Pérez Fernández N. Reduction in posterior semicircular canal gain by age in video head impulse testing. Observational study. Acta Otorrinolaringol Esp. 2016;67(1):15-22.
15. McGarvie LA, MacDougall HG, Halmagyi GM, Burgess AM, Weber KP, Curthoys IS. The video head
impulse test (vHIT) of semicircular canal function - age-dependent normative values of VOR gain in healthy subjects. Front Neurol. 2015;6:154.
16. Rambold HA. Age-related refixating saccades in the three-dimensional video-head-impulse test: source and dissociation from unilateral vestibular failure. Otol Neurotol. 2016;37(2):171-8.
17. Hülse R, Hörmann K, Servais JJ, Hülse M, Wenzel A. Clinical experience with video head impulse test in children. Int J Pediatr Otorhinolaryngol. 2015;79(8):1288-93.
18. Nyström A, Tjernström F, Magnusson M. Outward versus inward head thrusts with video-head impulse testing in normal subjects: does it matter? Otol Neurotol. 2015;36(3):e87-94.
19. Petrak MR, Bahner C, Beck DL. Video head impulse testing (vHIT): VOR analysis of high frequency vestibular activity. Hearing Review. 2013.
20. Yang CJ, Lee JY, Kang BC, Lee HS, Yoo MH, Park HJ. Quantitative analysis of gains and catch-up saccades of video-head impulse testing by age in normal subjects. Clin Otolaryngol. 2015 Oct 9.
21. Khattar VS, Hathiram BT. Head impulse test. Otorhinolaryngol Clin Int J. 2012;4(2):106-11.
22. Ulmer E, Bernard-Demanze L, Lacour M. Statistical study of normal canal deficit variation range. Measurement using the head impulse test videosystem. Eur Ann Otorhinolaryngol Head Neck Dis. 2011;128(5):278-82.
23. MacDougall HG, McGarvie LA, Halmagyi GM, Curthoys IS, Weber KP. Application of the video head impulse test to detect vertical semicircular canal dysfunction. Otol Neurotol. 2013;34(6):974-9.
24. Bansal S, Sinha SK. Assessment of VOR gain function and its test-retest reliability in normal hearing individuals. Eur Arch Otorhinolaryngol. 2016 Mar 1.
25. Mossman B, Mossman S, Purdie G, Schneider E. Normal horizontal VOR gain with video-oculography (EyeSeeCam VOG). In Poster presented at: the 27th Barany Society Meeting, Uppsala, Sweden 2012 Jun 10 (pp. 10-13).
26. Cerchiai N, Navari E, Dallan I, Sellari-Franceschini S, Casani AP. Assessment of vestibulo-oculomotor reflex in Ménière's disease: defining an instrumental profile. Otol Neurotol. 2016;37(4):380-4.