Korda Athanasia, Carey John Patrick, Zamaro Ewa, Caversaccio Marco Domenico, Mantokoudis Georgios
University Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Otorhinolaryngology, Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Ear Hear. 2020 Nov/Dec;41(6):1747-1751. doi: 10.1097/AUD.0000000000000894.
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.
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.
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).
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.
进行水平头脉冲试验（HIT）的临床医生要寻找矫正性扫视。检测此类扫视是一项挑战。本研究的目的是评估专家在患有前庭功能减退的受试者中检测矫正性扫视的可能性。
在一家三级转诊医院进行的前瞻性队列观察研究中，我们从7名单侧或双侧前庭眼反射（VOR）功能不足患者的便利样本中，评估了一位专家神经耳科医生临床进行的365次水平HIT。所有HIT均通过眼震电图同时记录，作为金标准。我们评估了扫视潜伏期和幅度、头部速度及增益。
扫视幅度在统计学上是扫视检测最重要的参数（p<0.001）。向病变侧进行HIT时扫视检测的概率高出8倍（p = 0.029）。此外，扫视幅度增加导致检测概率增加（每度优势比[OR]为1.77[1.31至2.40]，p<0.001）。检测1度扫视幅度的敏感性为92.9%，特异性为79%。扫视潜伏期和VOR增益对医生识别扫视的概率没有显著影响（每延长10毫秒潜伏期的OR为1.02[0.94至1.11]，每增加0.1 VOR增益的OR为0.84[0.60至1.17]）。
在临床进行的头脉冲试验中，扫视幅度是准确检测扫视的最重要因素。与当前认知相反，扫视潜伏期和VOR增益在扫视检测中起次要作用。
