How Good Are We in Evaluating a Bedside Head Impulse Test?

Athanasia Korda, John Patrick Carey, Ewa Zamaro, Marco Domenico Caversaccio, Georgios Mantokoudis

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objectives: Clinicians performing a horizontal head impulse test (HIT) are looking for a corrective saccade. The detection of such saccades is a challenge. The aim of this study is to assess an expert's likelihood of detecting corrective saccades in subjects with vestibular hypofunction. Design: In a prospective cohort observational study at a tertiary referral hospital, we assessed 365 horizontal HITs performed clinically by an expert neurootologist from a convenience sample of seven patients with unilateral or bilateral deficient vestibulo-ocular reflex (VOR). All HITs were recorded simultaneously by video-oculography, as a gold standard. We evaluated saccades latency and amplitude, head velocity, and gain. Results: Saccade amplitude was statistically the most significant parameter for saccade detection (p < 0.001).The probability of saccade detection was eight times higher for HIT toward the pathological side (p = 0.029). In addition, an increase in saccade amplitude resulted in an increased probability of detection (odds ratio [OR] 1.77 [1.31 to 2.40] per degree, p < 0.001). The sensitivity to detect a saccade amplitude of 1 degree was 92.9% and specificity 79%. Saccade latency and VOR gain did not significantly influence the probability of the physician identifying a saccade (OR 1.02 [0.94 to 1.11] per 10-msec latency and OR 0.84 [0.60 to 1.17] per 0.1 VOR gain increase). Conclusions: The saccade amplitude is the most important factor for accurate saccade detection in clinically performed head impulse tests. Contrary to current knowledge, saccade latency and VOR gain play a minor role in saccade detection.

Original languageEnglish (US)
Pages (from-to)1747-1751
Number of pages5
JournalEar and hearing
Issue number6
StatePublished - Nov 11 2020


  • Bedside head impulse test
  • Corrective saccades
  • Head impulse test
  • Video head impulse test

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Speech and Hearing


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