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Special Test

Head Impulse Test

The Head Impulse Test (HIT) is used to diagnose decreased vestibular function in one ear or the other. It’s also called the Vestibular Head Impulse Test (VHIT) or the Halmagyi Curthoys Head Impulse Test.

How do you perform the Head Impulse Test?

The examiner stands facing the patient. The patient sits on an examining table and is told to fixate on the examiner’s nose. The examiner holds the patient’s head to enable the patient to relax the neck muscles and abruptly accelerates and then decelerates the head moving rapidly approximately 20° to the right or left. After stopping the movement, the examiner watches the patient’s eyes to see whether or not a refixation saccade occurs to get the patient’s eyes onto the examiner’s nose.

If the test is positive, it is probably an inner ear problem.

See Also: Dix Hallpike Test & Maneuver
Vestibular Head Impulse Test

Sensitivity & Specificity

A clinical evaluation of HIT, where one hundred and fifty patients were examined and the head impulse test results were compared to results from bithermal caloric testing. Results show that the overall sensitivity of the HIT is 34% with a specificity of 100%. The test does not detect mild or moderate vestibular weaknesses but is very sensitive to the presence of a severe paresis (87.5%). 

References & More

  1. Orthopedic Physical Assessment by David J. Magee, 7th Edition.
  2. Beynon GJ, Jani P, Baguley DM. A clinical evaluation of head impulse testing. Clin Otolaryngol Allied Sci. 1998 Apr;23(2):117-22. doi: 10.1046/j.1365-2273.1998.00112.x. PMID: 9597280. Pubmed
  3. MacDougall HG, Weber KP, McGarvie LA, Halmagyi GM, Curthoys IS. The video head impulse test: diagnostic accuracy in peripheral vestibulopathy. Neurology. 2009 Oct 6;73(14):1134-41. doi: 10.1212/WNL.0b013e3181bacf85. PMID: 19805730; PMCID: PMC2890997. Pubmed
  4. Neurotological emergencies: a narrative review – Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/Head-impulse-test-During-the-head-impulse-test-the-healthy-subject-is-able-to-maintain_fig2_372959366 [accessed 2 Feb, 2024]
  5. The Clinical Differentiation of Cerebellar Infarction from Common Vertigo Syndromes – Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/Head-impulse-test-A-The-right-ear-has-intact-peripheral-vestibular-function-When-the_fig1_40834307 [accessed 2 Feb, 2024]
Last Reviewed
February 2, 2024
Contributed by
OrthoFixar

Orthofixar does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice.

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