Video Head Impulse Test: the guiding light in peripheral and central vestibular disorders
09-09, 14:30–15:00 (Europe/Istanbul), Equilibrium 2

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<p>Rationale: The progress made in recent decades in the vestibular field has been surprising. Previously, only the lateral semicircular canal was accessible and analyzable, and at absolutely non-physiological stimulation frequencies by means of thermal tests, with a significant commitment of time for the operator and a high level of discomfort for the patient. Then we witnessed the appearance of cervical and ocular vestibular myogenic evoked potentials which, in association with impulse tests, suddenly opened up new diagnostic horizons concerning the totality of vestibular receptors in their three-dimensional complexity. Through Video Head Impulse Test (VHIT), the selective investigation of the five vestibular receptors has become an achievable and concrete goal, thanks to the development of specific devices that have made the instrumental diagnostic process increasingly easier, increasingly more precise and increasingly accessible to everyone.</p> <p>Materials and methods: The examiner performs rapid and short head impulses in different planes corresponding to the semicircular canals (horizontal, anterior and posterior canals). The oculomotor response is recorded using a high-frequency camera, which allows the analysis of the gaze direction in response to head movement. The main objective of VHIT is to evaluate the ability of the vestibulo-ocular reflex (VOR) to stabilize the eyes during rapid head movements. VHIT specifically evaluates very high frequencies of vestibular stimulation, between 5 and 7 Hz, which correspond to high angular velocities that are not investigated by other vestibular tests such as the caloric test and kinetic tests performed in videonystagmographic recording. This allows to identify unilateral or bilateral vestibular deficits and to measure the compensatory capacity through corrective saccades.</p> <p>Results: The VHIT provides numerous numerical parameters relating to the constituent elements of the oculomotor response, mainly the slow phase of the vestibulo-oculomotor reflex and, when present, the refixation saccades, both covert (during the impulsive movement of the head) and overt (after the end of the head movement). There are normal ranges for the gain (ratio between the velocities of the eye and that of the head) and for the latency and amplitude of the corrective saccades. However, a notable strength of the VHIT is the information provided by the morphology of the oculomotor response, on which it is possible to identify the slow phase of the vestibulo-oculomotor reflex, the covert and overt saccades but also the presence of spontaneous nystagmus, fast anticompensatory movements, square waves, etc. It is essential to know the artefacts that can affect the test and that must always be promptly identified. Numerous patterns of deficit or hyperfunction of the vestibulo-oculomotor reflex are known, which can affect one or more semicircular canals on one or both sides. These patterns can be associated with one or more pathological processes, knowledge of which is essential. It is widely used in monitoring the vestibular response in the case of use of ototoxic drugs, even with curative purposes (gentamicin), and in the progress of vestibular rehabilitation therapies.</p> <p>Conclusions: The VHIT is an indispensable tool for assessing vestibular function, but requires in-depth knowledge of velocity curves, vestibulo-ocular gain and corrective saccades.</p>
<p>It is necessary to expand knowledge on the many potentials of a vestibular test that is reaching its maturity and that provides valid help in daily clinical practice.</p>
Session Chair Session Chair
Bülent Satar
Speaker Speaker
Armato Enrico
Armato Enrico
<p>https://orcid.org/my-orcid?orcid=0000-0002-8230-3122</p> <p>1984 Degree in Medicine & Surgery from the University of Padua, Italy. 1987 ENT specialization the University of Padua, Italy. 1990 Audiology specialization the University of Padua, Italy. 1986-2023 ENT consultant at the ENT department of AULSS 3 Serenissima, Regione Veneto, Dolo-Mirano (Venice), Italy. 2008-2023 Professional assignment of high specialization in "Clinical and Instrumental Neurotology" at the ENT department of AULSS 3 Serenissima, Regione Veneto, Dolo-Mirano (Venice), Italy. 2019 Book publication, Italian language: "Il video Head Impulse Test - Aspetti teorici e pratici". 2021 Book publication, English language: "The video Head Impulse Test - Theoretical and practical aspects". https://www.flipsnack.com/97D7DFBBDC9/the-video-head-impulse-test/full-view.html 2023 Book publication, French language: "Le Video Head Impulse Test: Aspects théoriques & pratiques". https://www.flipsnack.com/97D7DFBBDC9/vhit-fr/full-view.html 2023 Book publication, Italian language: "Il video Head Impulse Test - Aspetti teorici e pratici", second edition. https://www.flipsnack.com/97D7DFBBDC9/vhit-italiano/full-view.html Contract Professor at the Department of Neurosciences, University of Padua, Italy, for the teaching of “Clinical and instrumental Neurotology”, master on Audiological Techniques in the academic years 2022-2023/2023-2024/2024-2025. https://testweb.neuroscienze.unipd.it/en/category/ruoli/personale-docente?key=309A312C72656BBCB302E6CEFA4D9C63 Membership to Bárány Society since December 28th, 2023. Review Editor on the Editorial Board of Vestibular disorders (specialty section of Frontiers in Audiology and Otology) since January 28th, 2024. Affiliation with the Department of Neurosciences, University of Padua, Italy, concering student internships at my office, since May 2024.</p> <p>Doctor of Philosophy (PhD) Université de Lorraine, Nancy, France "Sciences de la Vie et de la Santé - BioSE", April 29th, 2025.</p>
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Bülent Satar
<p>Prof. Dr. Bülent Satar was born in İskenderun, Türkiye, in 1967. He completed his primary, secondary, and high school education in the same city. He graduated from Gülhane Military Medical School in 1990 and subsequently completed his residency training in Otolaryngology – Head and Neck Surgery at Gülhane Military Medical Academy.</p> <p>He pursued postdoctoral fellowship training at the University of Michigan and University of California, San Francisco (UCSF), where he focused on otology, neurotology, ear disorders, and vestibular system diseases besides other ORL subspecialties. In addition, he visited the Department of Otolaryngology – Head and Neck Surgery at the Royal National Throat, Nose and Ear Hospital (London), Stanford University (Palo Alto) and Gruppo Otologico in Piacenza for further clinical and academic development.</p> <p>Prof. Satar became an Assistant Professor in 1998, Associate Professor in 2004, and Full Professor in 2010.</p> <p>Although his clinical practice covers the full spectrum of otolaryngology–head and neck surgery, he primarily specializes in a variety of otologic and vestibular disorders.</p> <p>Correspondence</p> <p>Prof. Dr. Bülent Satar SBÜ Gülhane Tıp Fakültesi KBB Anabilim Dalı 06018 Etlik, Ankara – Türkiye</p> <p>Mobile: +90 533 811 21 30 E-mail: [email protected]</p>
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