Korean J Otorhinolaryngol-Head Neck Surg.  2017 Mar;60(3):107-111. 10.3342/kjorl-hns.2016.16943.

Causes of False Negative Bedside Head Impulse Test

Affiliations
  • 1Department of Otorhinolaryngology-Head and Neck Surgery, Inha University College of Medicine, Incheon, Korea. Stedman@inha.ac.kr
  • 2Soree Ear Clinic, Seoul, Korea.

Abstract

BACKGROUND AND OBJECTIVES
The bedside head impulse test (bHIT) in bare eyes often overlooks possible vestibular losses by missing the corrective saccade. This is why it is necessary to compare bHIT against video head impulse test (vHIT), which is more accurate in identifying vestibular losses than the bedside test.
SUBJECTS AND METHOD
A total of 51 vHIT positive ears underwent the study, and out of those, 47 were diagnosed with dizziness. bHIT and vHIT were performed for patients, and the occurrence rate of overt saccade (OS) was calculated.
RESULTS
Among the 51 vHIT positive ears, 33 (64.7%) were bHIT positive ears and 18 ears (35.3%) were bHIT negative. Patterns of positive vHIT were classified as A: no corrective saccade, B: covert saccade (CS) only, C: OS only, and D: CS with OS (CS+OS), which were 45 out of 51 ears (88%). The occurrence rate of OS was higher in the bHIT positive group than in the bHIT negative group (p=0.05), and higher in the CS negative group (CS-) than in the CS positive group (CS+) (p<0.001).
CONCLUSION
Possible causes of false negative results of bHIT are seen as following: the absence of corrective (covert and overt) saccade, the occurrence of CS only, and missing the OS during the bHIT (probably due to low occurrence rate of OS). The occurrence of CS should be considered as an important factor in false negative bHIT when lowering the occurrence rate of OS.

Keyword

Dizziness; Head impulse test; Saccade

MeSH Terms

Dizziness
Ear
Head Impulse Test*
Head*
Humans
Methods
Saccades
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