Comparison of test results from two separate video head impulse test systems in a cohort of patients diagnosed with a unilateral vestibular schwannoma



Video head impulse testing (vHIT) is a relatively new technology enabling evaluation of vestibular function. The aim of this study was to compare the test results from two separate vHIT systems in a group of patients diagnosed with a unilateral vestibular schwannoma (VS) with regards to sensitivity, specificity and inter-examiner differences.


Forty-two patients were examined with two separate vHIT systems: EyeSeeCam® (system A) and ICS Impulse® (system B), by one of two examiners. All six semicircular canals (SCCs) were tested under standardized conditions, and strict criteria were set up for post-test interpretation.


With the majority of test parameters, the two test systems were in agreement. Vestibular deficits were found in 40.5% (system A) to 45% (system B) of patients with a VS on the tested side; corresponding to a positive predictive value (PPV) of 86.4% (system B) to 94.4% (system A). The specificity was 97.6% for system A and 92.9% for system B. An overall agreement between the two vHIT systems measured as kappa was computed to be 0.61. There were no significant inter-examiner differences. When testing the vertical SCCs, a tendency of too high mean gain values was seen with system A but not with system B.


In patients with unilateral VS, vHIT is a test with moderate sensitivity and high specificity in regard to identification of a vestibular deficit. There were no significant differences in test results between the two vHIT systems.

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Data availability

All data were stored and registered in the electronic data capture systems provided by the manufacturers and stored in the Regional Electronic Data Record Systems provided by the University Hospital.


  1. 1.

    Curthoys IS et al (2014) The video head impulse test (vHIT). In: Balance function assessment and management, 2nd edn. Plural Publishing, San Diego, Ca, pp 391–430

  2. 2.

    Walther LE (2017) Current diagnostic procedures for diagnosing vertigo and dizziness. GMS Curr Top Otorhinolaryngol Head Neck Surg 16:02.

    Article  Google Scholar 

  3. 3.

    Taylor RL, Kong J, Flanagan S et al (2015) Prevalence of vestibular dysfunction in patients with vestibular schwannoma using video head-impulses and vestibular-evoked potentials. J Neurol 262(5):1228–1237.

    Article  PubMed  Google Scholar 

  4. 4.

    Halmagyi GM, Chen L, MacDougall HG, Weber KP, McGarvie LA, Curthoys IS (2017) The video head impulse test. Front Neurol.

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    McGarvie LA, MacDougall HG, Halmagyi GM, Burgess AM, Weber KP, Curthoys IS (2015) The video head impulse test (vHIT) of semicircular canal function—age-dependent normative values of VOR gain in healthy subjects. Front Neurol 6(JUL):1–18.

    Article  Google Scholar 

  6. 6.

    Welgampola MS, Akdal G, Halmagyi GM (2017) Neuro-otology- some recent clinical advances. J Neurol 264(1):188–203.

    Article  PubMed  Google Scholar 

  7. 7.

    Korsager LEH, Schmidt JH, Faber C, Wanscher JH (2016) Reliability and comparison of gain values with occurrence of saccades in the EyeSeeCam video head impulse test (vHIT). Eur Arch Oto-Rhino-Laryngol 273(12):4273–4279.

    Article  Google Scholar 

  8. 8.

    Alhabib SF, Saliba I (2017) Video head impulse test: a review of the literature. Eur Arch Oto-Rhino-Laryngol 274(3):1215–1222.

    Article  Google Scholar 

  9. 9.

    Cleworth TW, Carpenter MG, Honegger F, Allum JHJ (2017) Differences in head impulse test results due to analysis techniques. J Vestib Res Equilib Orientat 27(2–3):163–172.

    Article  Google Scholar 

  10. 10.

    Abrahamsen ER, Christensen A, Hougaard DD (2018) Intra- and interexaminer variability of two separate video head impulse test systems assessing all six semicircular canals. Otol Neurotol. 39(2):e113–e122.

    Article  PubMed  Google Scholar 

  11. 11.

    Janky KL, Patterson JN, Shepard NT, Thomas MLA, Honaker JA (2017) Effects of device on video head impulse test (vHIT) gain. J Am Acad Audiol 28(9):778–785.

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Khrais T, Romano G, Sanna M (2017) Nerve origin of vestibular schwannoma: a prospective study. J Laryngol Otol.

    Article  Google Scholar 

  13. 13.

    Stangerup S-E, Caye-Thomasen P (2012) Epidemiology and natural history of vestibular schwannomas. Otolaryngol Clin North Am 45(2):257–268.

    Article  PubMed  Google Scholar 

  14. 14.

    Sass HCR, West N, Møller MN, Cayé-Thomasen P (2018) Udredning og behandling af vestibularisschwannomer. Ugeskr Læger 2–4. Accessed 6 Nov 2018

  15. 15.

    Humphriss RL, Baguley DM, Axon PR, Moffat DA (2006) Preoperative audiovestibular handicap in patients with vestibular schwannoma. Skull Base 16(4):193–200.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Halliday J (2017) An update on the treatment of vestibular schwannoma. Expert Rev Neurother 60(2):131–140.

    Article  Google Scholar 

  17. 17.

    Sahyouni R, Moshtaghi O, Haidar YM et al (2017) Vertigo in vestibular schwannoma patients due to other pathologies. Otol Neurotol.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Møller MN, Hansen S, Caye-Thomasen P (2015) Peripheral vestibular system disease in vestibular schwannomas. Otol Neurotol 36(9):1547–1553.

    Article  PubMed  Google Scholar 

  19. 19.

    Kjærsgaard JB, Szeremet M, Hougaard DD (2019) Vestibular deficits correlating to dizziness handicap inventory score, hearing loss, and tumor size in a danish cohort of vestibular schwannoma patients. Otol Neurotol 40(6):813–819.

    Article  PubMed  Google Scholar 

  20. 20.

    Kanzaki J, Tos M, Sanna M, Moffat DA, Monsell EM, Berliner KI (2003) New and modified reporting systems from the consensus meeting on systems for reporting results in vestibular schwannoma. Otol Neurotol 24:642–648 (discussion 648-9)

    Article  Google Scholar 

  21. 21.

    Sun X, Xu W (2014) Fast implementation of delong’s algorithm for comparing the areas under correlated receiver operating characteristic curves. IEEE Signal Process Lett 21(11):1389–1393.

    Article  Google Scholar 

  22. 22.

    (2018) R: a language and environment for statistical computing. R foundation for statistical computing, R Core Team, Vienna. Accessed 2 Feb 2019

  23. 23.

    Tranter-Entwistle I, Dawes P, Darlington CL, Smith PF, Cutfield N (2016) Video head impulse in comparison to caloric testing in unilateral vestibular schwannoma. Acta Otolaryngol 136(11):1110–1114.

    Article  PubMed  Google Scholar 

  24. 24.

    Batuecas-Caletrio A, Santa Cruz-Ruiz S, Muñoz-Herrera A, Perez-Fernandez N (2015) The map of dizziness in vestibular schwannoma. Laryngoscope 125(12):2784–2789.

    Article  PubMed  Google Scholar 

  25. 25.

    West N, Sass H, Klokker M, Cayé-Thomasen P (2020) Video head impulse test results in patients with a vestibular schwannoma—sensitivity and correlation with other vestibular system function tests, hearing acuity, and tumor size. Otol Neurotol.

    Article  PubMed  Google Scholar 

  26. 26.

    Rey-Martinez J, Burgess AM, Curthoys IS (2018) Enhanced vestibulo-ocular reflex responses on vHIT. Is it a casual finding or a sign of vestibular dysfunction? Front Neurol 9:866

    Article  Google Scholar 

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Correspondence to Mathilde Aalling.

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The authors declare no conflicts of interest.

Ethical approval

Complete vHIT testing and fulfillment of the Dizziness Handicap Questionnaire is part the standard clinical evaluation of patients diagnosed with a vestibular schwannoma and both types of vHIT equipment used in this study are already approved for clinical testing. Furthermore, no patients had to undergo randomization to additional treatments or examinations. Therefore, a formal application to the North Denmark Region Committee on Research Ethics was not deemed necessary.

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All subjects were thoroughly informed about the vHIT testing prior to the test.

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Aalling, M., Skals, R.K., Abrahamsen, E.R. et al. Comparison of test results from two separate video head impulse test systems in a cohort of patients diagnosed with a unilateral vestibular schwannoma. Eur Arch Otorhinolaryngol 277, 3185–3193 (2020).

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  • Video head impulse test
  • vHIT
  • Vestibular schwannoma
  • Vestibular function
  • Test agreement
  • Sensitivity