Hyperventilation-induced nystagmus test (HINT) is capable of generating a response in 77.2% of cases of acute unilateral vestibulopathy (AUVP); both nystagmus toward the affected side (excitatory pattern) and toward the healthy side (inhibitory pattern) have been described. The aim of the study is to investigate the clinical and prognostic role of the test by evaluating its correlation with vestibulo-ocular reflex (VOR) gain. We evaluated 33 AUVP patients by performing the HINT and video head impulse test (V-HIT) during the acute phase and then at 15 and 90 days after the onset of the symptoms. The correlation between the VOR gain of the affected side and test responses was evaluated first, phase by phase, and then considering the pattern shown during the first assessments. Patients with a negative HINT had a higher mean VOR gain than patients with a positive test at both 15 and 90 days. Patients who showed an inhibitory pattern at the first assessment had a continuous improvement in V-HIT performance, while patients with an initial excitatory response had a transient decrease in gain at the subsequent evaluation (P=.001). No difference between these 2 groups emerged at 90 days (P=.09). The finding of a negative HINT during the follow-up correlates with good V-HIT performance and could be an indicator of good recovery. The inhibitory pattern is associated with a subsequent improvement; and it would be indicative of compensation. but, despite this, the prognostic value of the test is limited.

BACKGROUND:  There may be confusion about which canal is involved in patients with benign paroxysmal positional vertigo (BPPV), especially with those that have subtle findings. The study aimed to determine if video head impulse testing may be used in such patients as a diagnostic tool. Symptom scoring and treatment efficiency in BPPV are essential parts of the process. Therefore, inventories like \"Dizziness Handicap Inventory\" may be useful in this regard.
METHODS:  Patients with posterior and lateral canal BPPV were included. Video head impulse testing was performed prior to treatment and 1 week after treatment. Vestibuloocular reflex (VOR) gains were noted and compared to the opposite side. The presence of correction saccades was noted as well. Also, pretreatment and posttreatment Dizziness Handicap Inventory scores were compared.
RESULTS:  Fifty-seven patients were diagnosed with posterior canal BPPV, and sixteen were with horizontal canal BPPV. In patients with posterior canal BPPV, there was no difference between the involved canal VOR gains and the other canals on the same side (P=.639). The involved horizontal canal did not differ from the opposite horizontal canal. Patients with lateral canal BPPV show more significant improvement after treatment compared to patients with posterior canal BPPV.
CONCLUSIONS:  Video head impulse testing may not be used to estimate the involved canal in BPPV; however, it may be used to evaluate the efficiency of the treatment, especially in the lateral canal.

BACKGROUND: the vestibular system has neural connections from the vestibular nucleus to limbic and cortical areas, involved in both cognition and spatial orientation. The superior vestibular cortex consists of a network that interacts with other sensory systems, such as visual, sensorimotor, motor and cognition. Studies have found structural changes in the brain of patients with persistent perceptual postural dizziness (PPPD) when compared to controls, particularly in visual, vestibular and limbic areas, including a decrease in gray matter volume and turnover, a decrease in blood flow to the cortex region.
METHODS: cross-sectional, observational and analytical study. The sample consisted of 50 elderly people, of both sexes, aged between 60 and 86 years. Elderly individuals with vestibular dysfunction confirmed by Vestibular Evoked Myogenic Potential (VEMP) and Video Head Impulse Test (v-HIT) tests were included. Balance and the impact of dizziness on quality of life were evaluated through tests and vestibular scales. Cognition, functioning and depression were assessed in a quiet room using tests and scales. Univariate analysis was performed using the Spearman test. Variables that presented correlation ≤ 0.2 were selected for multivariate analysis by linear regression. A significance level of 5% was adopted (p< 0.05).
RESULTS: there was a correlation between vestibular dysfunction and imbalance with the results of neuropsychological assessment (p = 0.000), depressive symptoms (p = 0.001) and functionality (p = 0.002).
CONCLUSIONS: in this present study, a correlation was found between vestibular dysfunction and imbalance with the worst clinical and functional indices, worse functionality, depressive symptoms and in visuospatial function skills, executive functions and praxis.

Bevezetés: A Ménière-betegség gyógyíthatatlan, de menedzselhető betegség. Alapja az endolympha terének „kitágulása”, az endolympha hydrops. Lehet egy- vagy kétoldali. A tünetek megjelenése alapján metakrón vagy szinkrón megjelenésről beszélhetünk. Hasonló tünetekkel jelentkezhet az autoimmun belsőfül-betegség. Célkitűzés: Kétoldali Ménière-betegséggel diagnosztizált betegek (7 beteg: 2 férfi és 5 nő) belső fülének feltérképezése, immunológiai statusuk felderítése, továbbá az egyéb kórképektől, főleg az autoimmun belsőfül-betegségtől való differenciálás, tapasztalatok alapján egy kivizsgálási protokoll felállítása. Módszer: Kétoldali Ménière-betegeknél rohammentes állapotban a fül-orr-gégészeti, otoneurológiai és immunológiai status, valamint az anamnézis felvétele, továbbá az angularis vestibuloocularis reflex (aVOR) nagy és kis frekvenciájú működésének felmérése. Az előbbit videofejimpulzus-teszt (vHIT), míg az utóbbit kalorizációs teszt során vizsgáltuk. Tisztahang-küszöbaudiogramot végeztünk. Mágneses rezonanciás képalkotó segítségével koponyafelvétel készült. Az immunológiai laborvizsgálat vérszérumból történt. Eredmények: A betegeknél szisztémás autoimmun betegség nem igazolódott. Minden esetben kétoldali, a mély frekvenciákat is érintő pancochlearis sensorineuralis halláscsökkenés volt látható. vHIT során két esetben a magas frekvenciájú aVOR érintettsége is igazolható volt, melyet a betegség előrehaladottságának véleményeztünk. A többi esetben ép működésű, magas frekvenciájú aVOR-t találtunk. A kalorizációs teszt során minden esetben kétoldali ívjáratparesis volt látható. Megbeszélés: A szakirodalomban számos tanulmány foglalkozik az általunk megfigyelt, a vHIT és a kalorizációs teszt közötti diszkrepanciával. Ez az aVOR receptorának, a crista ampullarisnak az anatómiájából következhet: míg a magas frekvenciájú aVOR-t a centrálisan elhelyezkedő I-es típusú szőrsejtek érzékelik, addig az alacsony frekvenciájú aVOR-t a perifériásan elhelyezkedő II-es típusú szőrsejtek. Az utóbbiak szelektív károsodását figyelték meg Ménière-betegségben és autoimmun belsőfül-betegségben is. Ugyanakkor segített a differenciálásban a betegek rendezett immunológiai statusa, az intravénás kortikoszteroidra adott gyenge válaszuk, egy esetben pedig a saccotomiát követő állapotjavulás. Következtetés: A tapasztalatok alapján egy kivizsgálási protokollt kíséreltünk meg felállítani olyan betegek esetében, akik kétoldali fültünetekkel, rohamokban jelentkező, forgó jellegű szédüléssel jelentkeznek. Javasoljuk többek között a vHIT, a kalorizációs teszt és az immunológiai kivizsgálás elvégzését is. Megfontolandónak tartjuk egy multicentrikus vizsgálat elvégzését is mindkét kórképpel kapcsolatban. Orv Hetil. 2024; 165(30): 1176–1183.

BACKGROUND: Recently, end-point nystagmus, traditionally observed in an upright position, has been identified in the Dix-Hallpike position among healthy subjects, suggesting a physiological origin.However, its characteristics in individuals with vestibular hypofunction remain unexplored.
OBJECTIVE: To elucidate the impact of vestibular hypofunction on the characteristics of positional end-point nystagmus.
METHODS: Thirty-one patients diagnosed with acute unilateral vestibulopathy according to Bárány Society criteria were selected. A video head impulse test was conducted in all participants, followed by McClure and Dix-Hallpike maneuvers with and without gaze fixation, and with the initial position of the eye in the straight-ahead position or in the horizontal end-point position. Nystagmus direction, sense, latency, slow-phase velocity, and duration were recorded. The relationship between these characteristics and video head impulse test values was analyzed.
RESULTS: Positional end-point nystagmus was observed in 92.6% of subjects with vestibular hypofunction, significantly more than in healthy individuals. Nystagmus direction varied depending on the performed positional test and on the vestibulo-ocular reflex gains. Gaze occlusion and the initial horizontal end-point position increased its frequency.
CONCLUSIONS: Vestibular hypofunction influences the manifestation of positional end-point nystagmus. Recognizing this nystagmus can aid in resolving diagnostic uncertainties and preventing the misdiagnosis of benign paroxysmal positional vertigo in subjects with acute unilateral vestibulopathy.

BACKGROUND: To improve diagnostic precision in pediatric vertigo, particularly in Vestibular Migraine of Childhood (VMC), probable VMC (pVMC), Recurrent Vertigo of Childhood (RVC), and unspecified categories, by delineating clinical characteristics and prevalence to refine diagnostics and treatments.
METHODS: Retrospective analysis of 102 pediatric patients (five to 18 years; 46 females, 56 males) at the Dizziness Center of the Otolaryngology Department in a tertiary-level hospital from January 2019 to December 2023. Patients were classified into VMC, pVMC, RVC, and indeterminate groups. Evaluations included audiometry and vestibular tests (video head impulse test [vHIT] or caloric testing), conducted in the audiology unit and vestibular testing laboratory. Data were analyzed using IBM SPSS 20.0.
RESULTS: Diagnoses were 8.8% VMC, 31.4% pVMC, 51.0% RVC, and 8.8% indeterminate. Nausea and vomiting were common in VMC and pVMC; cochlear symptoms like tinnitus and hearing loss predominated in VMC. Although vestibular testing showed no significant group differences, VMC had more vHIT abnormalities and RVC had more caloric test anomalies.
CONCLUSIONS: This study highlights the need for comprehensive diagnostics in pediatric vestibular disorders, revealing unique and overlapping traits across VMC, pVMC, and RVC. Insights call for further research to refine diagnostic criteria and improve treatment methods.

Objective:To explore the correlation between the parameters of suppression head impulse paradigm（SHIMP） and changes in dizziness handicap inventory（DHI） scores. Additionally, to evaluate the degree of vertigo and prognosis of patients with acute vestibular neuritis through SHIMP parameters. Methods:Thirty-three patients with acute vestibular neuritis were enrolled for DHI evaluation, vHIT and SHIMP. A secondary DHI score were evaluated after after two weeks, once patients no longer exhibited spontaneous nystagmus. The decrease in the second DHI score was used as the efficacy index（EI）. All patients were divided into significantly effective group, effective group and ineffective group based on EI. Differences of the VOR gain values of SHIMP and the anti-compensatory saccade were compared among the three groups. Results:There were 13 cases in the significant effective group, 11 cases in the effective group, and 9 cases in the ineffective group. ①The mean gain of the horizontal semicircular canal in the significant effective group, the effective group, and the ineffective group was（0.50±0.11）, （0.44±0.12）, and（0.34±0.08）, respectively. The difference between the significant effective group and the ineffective group was statistically significant（P<0.01）. The gain of horizontal semicircular canal was positively correlated with EI（r=0.538 5, P<0.01） 。②The occurrence rate of the anti-compensatory saccade in the significant effective group, the effective group, and the ineffective group was（51.23±19.59）, （33.64±17.68）, and（13.78±11.81）, respectively. Pairwise comparisons between each group showed statistical significance（P<0.05）. The occurrence rate of anti-compensatory saccade was positively correlated with EI（r=0.658 2, P<0.01）. Conclusion:The horizontal semicircular canal gain and the occurrence rate of the anti-compensatory saccade in SHIMP for patients with acute vestibular neuritis were closely correlated with decrease in DHI score.
目的：探讨视频头脉冲抑制试验（suppression head impulse paradigm，SHIMP）的参数与眩晕障碍量表（dizziness handicap inventory，DHI）评分改变的相关性，以期通过SHIMP的相关参数来评估急性前庭神经炎的眩晕程度及预后。 方法：选取急性前庭神经炎患者33例，行DHI量表评估、vHIT和SHIMP检查，病程达2周且不伴自发性眼震时再次行DHI量表评估。以第二次DHI评分的下降幅度，作为疗效指标（efficacy index，EI）。将所有患者按照疗效分为显效、有效和无效3组。比较3组患者SHIMP的前庭眼反射增益值及反代偿扫视波出现率之间的差异。 结果：显效组13例，有效组11例，无效组9例。①在各组水平半规管增益均值比较中，显效组增益均值为（0.50±0.11）；有效组增益均值为（0.44±0.12）；无效组增益均值为（0.34±0.08）。显效组与无效组增益均值差异有统计学意义（P<0.01）。水平半规管增益值与EI呈正相关（r=0.538 5，P<0.01）；②在各组水平半规管反代偿扫视波出现率均值比较中，显效组反代偿扫视波出现率均值为（51.23±19.59）；有效组反代偿扫视波出现率均值为（33.64±17.68）；无效组反代偿扫视波出现率均值为（13.78±11.81）。各组间两两比较均差异有统计学意义（P<0.05）。水平半规管反代偿扫视波出现率与EI呈正相关（r=0.658 2，P<0.01）。 结论：急性前庭神经炎患者SHIMP检查中的增益值以及反代偿扫视波出现率与DHI评分下降幅度密切相关。.

暂无摘要。

BACKGROUND: The cochlear implant (CI) is effective for rehabilitating patients with severe to profound sensorineural hearing loss. However, its placement and use have been associated with various complications, such as those affecting the vestibular system. The objective of this study was to compare vestibular function using the video head impulse test (vHIT) in pediatric patients before and after CI placement.
METHODS: A descriptive and retrospective study was conducted. The outcomes of 11 pediatric patients of both sexes with a history of profound hearing loss were evaluated. The results of vestibular-ocular reflex (VOR) gain, saccades, asymmetry, Pérez Rey (PR) index, and VOR/saccade ratio for both ears obtained by the vHIT test before and after CI placement were compared.
RESULTS: Of the 11 patients evaluated, the VOR gain showed that 81.8% had normal function, 18.2% had hypofunction, and no patients had hyperfunction before implantation. No statistically significant differences were found when compared with post-implant off and post-implant on conditions (p > 0.05). The extracted variables, asymmetry, PR index, and the VOR/saccades ratio also showed no statistically significant differences between the pre- and post-implant conditions, whether off or on.
CONCLUSIONS: The vestibular function of pediatric patients did not show significant changes before and after CI placement. The vHIT test is a valuable tool for assessing vestibular function and could be considered a criterion for surgical and rehabilitation decisions in patients undergoing CI placement.
UNASSIGNED: El implante coclear es un dispositivo eficaz para la rehabilitación de pacientes con hipoacusia neurosensorial severa a profunda. Sin embargo, su colocación y uso se ha asociado a diversas complicaciones, entre ellas a nivel del sistema vestibular. El objetivo del presente estudio fue comparar la función vestibular mediante la prueba de videoimpulso cefálico (vHIT) de pacientes pediátricos antes y después de la colocación del implante coclear.
UNASSIGNED: Se llevó a cabo un estudio descriptivo y retrospectivo. Se evaluaron los resultados de 11 pacientes pediátricos de ambos sexos con antecedente de hipoacusia profunda. Se compararon los resultados de ganancia del VOR, sacadas, asimetría, índice PR así como la relación VOR/sacadas para ambos oídos obtenidos mediante la prueba vHIT antes y después de la colocación del implante coclear.
RESULTS: De los 11 pacientes evaluados, la ganancia del VOR mostró que el 81.8% tenía normofunción, 18.2% hipofunción y ningún paciente hiperfunción antes del implante. Al compararlo con la ganancia post implante apagado y post implante encendido no se encontraron diferencias estadísticamente significativas (p > 0.05). Las variables sacadas, asimetría, índice PR así como la relación VOR/sacadas tampoco mostraron diferencias estadísticamente significativas entre las condiciones pre y pos implante ya sea apagado o encendido.
CONCLUSIONS: La función vestibular de pacientes pediátricos no mostró cambios significativos previo y posterior a la colocación del implante coclear. La prueba vHIT es una herramienta útil que permite evaluar la función vestibular y que podría considerarse como criterio para tomar decisiones quirúrgicas en pacientes que se encuentran en protocolo para implante coclear.

OBJECTIVE: The purpose of this study was to evaluate the value of asymmetry values, gain, and pathological saccades of the video head impulse test (vHIT) in sudden sensorineural hearing loss (SSNHL).
METHODS: Retrospective study.
METHODS: Tertiary referral center.
METHODS: A total of 226 individuals diagnosed with unilateral definite SSNHL were hospitalized. The assessment included a comprehensive evaluation of medical history, pure-tone test, acoustic impedance, positional test, video nystagmography (VNG), vHIT, vestibular evoked myogenic potentials (VEMPs) and magnetic resonance.
METHODS: vHIT, VNG, cVEMP, oVEMP. Statistical analysis was performed with SPSS version 22.0 for Windows.
METHODS: The asymmetry values, gain, and pathological saccades of the vHIT.
RESULTS: The abnormal gain of vHIT in anterior, horizontal, and posterior canal in SSNHL patients with vertigo were revealed in 20 of 112 (17.9%), 24 of 112 (21.4%), and 60 of 112 (53.6%), respectively. The vHIT pathological saccades (overt + covert) of anterior, horizontal, and posterior canal in SSNHL patients with vertigo were observed in 5 of 112 (4.6%), 52 of 112 (46.4%), and 58 of 112 (51.8%), respectively. Multivariate analysis indicated that the prognosis of patients with vertigo was correlated with vHIT gain of posterior canal, pathological saccade in horizontal canal, asymmetric ratio of horizontal canal gain, asymmetric ratio of posterior canal gain, Canal paresis (%) on caloric test and spontaneous nystagmus.
CONCLUSIONS: In the vHIT of patients with SSNHL with vertigo, the posterior canal is most easily affected. Reduced gain of posterior canal, pathological saccade of horizontal canal, and larger asymmetric gain of posterior canal and horizontal canal may be negative prognostic factors.