Relationship of the head impulse test and head-shake nystagmus in reference to caloric testing

Am J Otol. 1997 Mar;18(2):207-13.


Objective: The objective of this study was to determine the usefulness of the head impulse test (HIT) and head-shake nystagmus (HSN), two easily performed office maneuvers, in the evaluation of the dizzy patient with reference to caloric irrigation results.

Objective and setting: This was a prospective double-blind trial conducted at an outpatient academic tertiary referral center.

Patients: The study population was composed of 105 patients (35 male, 70 female) who presented for evaluation of dizziness and ranged in age from 13 to 87 years (mean 52.1).

Intervention: The intervention was HIT and HSN evaluation followed by bithermal binaural air caloric irrigations.

Main outcome measures: The main outcome measures were sensitivity, specificity, and predictive values of HIT and HSN evaluation (individually and in combination) in relation to caloric results.

Results: Sensitivity of the tests was equally low (35%), whereas specificity was high (HIT 95%, HSN 92%). The positive predictive value for the two tests in combination (80%) was greater than for each individually (HIT 64%, HSN 50%). Negative predictive values remained stable when considering each test individually (HIT 86%, HSN 86%) or in combination (88%).

Conclusions: The low sensitivity renders both tests inadequate as a screening tool for peripheral vestibular disease based on caloric results. However, when HIT and HSN results are both abnormal, there is a high likelihood of a significant caloric deficit.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Caloric Tests*
  • Double-Blind Method
  • Electrooculography
  • Female
  • Fixation, Ocular
  • Head Movements*
  • Humans
  • Male
  • Middle Aged
  • Nystagmus, Physiologic*
  • Peripheral Nerves / physiopathology
  • Prospective Studies
  • Retrospective Studies
  • Vestibular Diseases / diagnosis
  • Vestibular Diseases / physiopathology