Head Impulse Test to Check for Vestibular Hypofunction Causing Dizziness

Fauquier ENT
Fauquier ENT
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Published 2024-07-03
Normally with head movement, the eyes and the inner ear balance system work together to ensure that the eyes can maintain a fixed position gaze regardless of head position. Known as the vestibulo-ocular reflex, we know that the right inner ear balance system pushes the eyes to the left when we move our heads to the right… and the left inner ear balance system pushes the eyes to the right when we move our heads to the left.

For patients suffering from dizziness, an examination called the head impulse test takes advantage of this information to help determine if there is a weakness in the connection between the inner ear balance system and the eyes.

The head impulse test (aka head thrust test) first described in 1988 starts by flexing the patient’s head down slightly and moving their head slowly back and forth while having their eyes maintain fixed focus straight ahead. The head is then moved quickly and unexpectedly to one side while the patient tries to maintain straight target focus. The test is considered normal if the eyes stay focused on target without slippage.

However, if the eyes are dragged off the straight ahead target, even briefly, the test would be considered abnormal.

Video demonstrates normal and abnormal head impulse test.

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Video created by Dr. Christopher Chang:
www.FauquierENT.net/

Actor Credit:
MJ Gordon ‪@marinjayden‬
Certified Yoga Alliance Instructor (RYP500, RPYT, Yin)
Certified Fitness Instructor NCEP
www.MJ-Gordon.com/

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References:
A clinical sign of canal paresis. Arch Neurol (1988) 45:737–9. pubmed.ncbi.nlm.nih.gov/3390028/

A clinical evaluation of head impulse testing. Clin Otolaryngol Allied Sci 1998; 23:117. pubmed.ncbi.nlm.nih.gov/9597280/

Optimizing the sensitivity of the head thrust test for identifying vestibular hypofunction. Phys Ther 2004; 84:151. pubmed.ncbi.nlm.nih.gov/14744205/

A clinical evaluation of head impulse testing. Clin Otolaryngol Allied Sci 1998; 23(2): 117-22. pubmed.ncbi.nlm.nih.gov/9597280/

More than a 50% canal paresis is needed for the head impulse test to be positive. Otol Neurotol 2005; 26(2): 318-9. pubmed.ncbi.nlm.nih.gov/15793428/

#dizziness #vertigotreatment #vertigo
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