Department of Audiology, Boys Town National Research Hospital, Omaha, NE.
Am J Audiol. 2020 Dec 9;29(4):898-906. doi: 10.1044/2020_AJA-20-00079. Epub 2020 Nov 17.
Purpose Conflicts among video head impulse testing (vHIT) and rotary chair have occurred; therefore, the purpose of this study was to determine the relationship between rotary chair and vHIT outcome parameters to understand when these two tests disagree and determine if one or both test outcomes are needed in children. Method Data from 141 child and young adult subjects (73 males, 68 females, = 15 years, range: 6-35) were retrospectively reviewed. Of those, 56 had a cochlear implant and 85 were normal controls. All subjects completed rotary chair and vHIT, which were categorized as (a) normal vestibular function, (b) unilateral vestibular loss, or (c) bilateral vestibular loss. vHIT tracings were analyzed to determine if gain and corrective saccade velocity, frequency, or latency were helpful parameters for determining vestibular loss. Results Of the 141 subjects, the misclassification rate was 13/141 (9%). All normal control subjects were classified as having normal rotary chair and normal vHIT. In subjects with a cochlear implant ( = 56), the misclassification rate was 13/56 (23%). There were four misclassification patterns. Using rotary chair as the gold standard, receiver operating characteristic analysis revealed optimal cut-points for vHIT gain (< 0.84), corrective saccade frequency (≥ 50%), amplitude (≥ 75°/s), and latency (≤ 320 ms). Using these vHIT cut-points improved the agreement between rotary chair and vHIT, resulting in an overall misclassification rate of 10/141 (7%) and 9/56 (16%) in subjects with a cochlear implant. Conclusions When testing children, caloric testing is often not an option due to tolerability or time. However, discordant results occur between rotary chair and vHIT. These data suggest vHIT is a sufficient first-tier assessment. If abnormal, rotary chair is not necessary. If normal, rotary chair can be helpful for uncovering other indicators of vestibular loss. When interpreting vHIT, including gain and all corrective saccade outcomes may improve sensitivity.
视频头脉冲测试（vHIT）与转椅之间存在目的冲突；因此，本研究旨在确定转椅与 vHIT 结果参数之间的关系，以了解这两种测试何时出现分歧，并确定是否需要对儿童进行一项或两项测试。
回顾性分析 141 名儿童和青少年受试者（73 名男性，68 名女性，年龄 = 15 岁，范围：6-35 岁）的数据。其中 56 例有耳蜗植入物，85 例为正常对照。所有受试者均完成转椅和 vHIT 检查，分为（a）前庭功能正常、（b）单侧前庭损失或（c）双侧前庭损失。分析 vHIT 轨迹以确定增益和矫正性扫视速度、频率或潜伏期是否有助于确定前庭损失。
在 141 名受试者中，误分类率为 13/141（9%）。所有正常对照组受试者的转椅和 vHIT 均被归类为正常。在有耳蜗植入物的受试者（= 56）中，误分类率为 13/56（23%）。有四种误分类模式。以转椅为金标准，受试者工作特征分析显示 vHIT 增益（<0.84）、矫正性扫视频率（≥50%）、幅度（≥75°/s）和潜伏期（≤320 ms）的最佳截断点。使用这些 vHIT 截断点可提高转椅与 vHIT 之间的一致性，从而使植入耳蜗的受试者的总体误分类率从 141 名受试者中的 10/141（7%）降至 56 名受试者中的 9/56（16%）。
在对儿童进行测试时，由于耐受性或时间的原因，热刺激检查往往不是一个选择。然而，转椅与 vHIT 之间会出现结果不一致的情况。这些数据表明 vHIT 是一种充分的一线评估方法。如果异常，则无需进行转椅测试。如果正常，则转椅可以帮助发现其他前庭损失的指标。在解释 vHIT 时，包括增益和所有矫正性扫视结果可能会提高敏感性。
