Korda Athanasia, Sauter Thomas C, Caversaccio Marco Domenico, Mantokoudis Georgios
Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
Department of Emergency Medicine, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
Front Neurol. 2021 Jan 22;11:615651. doi: 10.3389/fneur.2020.615651. eCollection 2020.
The video head impulse test (vHIT) is nowadays a fast and objective method to measure vestibular function. However, its usability is controversial and often considered as a test performed by experts only. We sought to study the learning curve of novices and to document all possible mistakes and pitfalls in the process of learning. In a prospective cohort observational study, we included 10 novices. We tested their ability to perform correctly horizontal head impulses recorded with vHIT. We assessed vHITs in 10 sessions with 20 impulses per session giving a video instruction after the first session (S1) and individual feedback from an expert for session 2 (S2) up to session 10 (S10). We compared VOR gain, the HIT acceptance rate by the device algorithm, mean head velocity, acceleration, excursion, and overshoot between sessions. A satisfying number of accepted HITs (80%) was reached after an experience of 160 vHITs. Mean head velocity between sessions was always in accepted limits. Head acceleration was too low at the beginning (S1) but improved significantly after the video instruction ( = 0.001). Mean head excursion and overshoot showed a significant improvement after 200 head impulses ( < 0.001 each). We showed that novices can learn to perform head impulses invHIT very fast provided that they receive instructions and feedback from an experienced examiner. Video instructions alone were not sufficient. The most common pitfall was a low head acceleration.
视频头脉冲试验（vHIT）如今是一种测量前庭功能的快速且客观的方法。然而，其可用性存在争议，并且常被认为是只有专家才能进行的测试。我们试图研究新手的学习曲线，并记录学习过程中所有可能的错误和陷阱。在一项前瞻性队列观察性研究中，我们纳入了10名新手。我们测试了他们正确执行vHIT记录的水平头脉冲的能力。我们在10个阶段中评估vHIT，每个阶段进行20次脉冲，在第一阶段（S1）后提供视频指导，并从第二阶段（S2）到第十阶段（S10）由专家提供个人反馈。我们比较了各阶段之间的视动反射增益、设备算法的HIT接受率、平均头部速度、加速度、偏移和过冲。在经历160次vHIT后达到了令人满意的接受HIT数量（80%）。各阶段之间的平均头部速度始终在可接受范围内。开始时（S1）头部加速度过低，但在视频指导后有显著改善（ = 0.001）。在进行200次头部脉冲后，平均头部偏移和过冲有显著改善（每次均 < 0.001）。我们表明，新手只要从经验丰富的检查者那里获得指导和反馈，就能非常快速地学会在vHIT中执行头部脉冲。仅视频指导是不够的。最常见的陷阱是头部加速度过低。
