Comparing Video Head Impulse Testing With Rotary Chair in Pediatric Patients: A Controlled Trial.

Objectives: To investigate the efficacy of video head impulse testing (VHIT) in detecting vestibular loss in pediatric patients with abnormal rotary chair testing, compared to a control group with normal rotary chair testing.

Study Design: Prospective, nonrandomized, controlled trial.

Setting: Pediatric vestibular program at tertiary level children's hospital.

Methods: Patients 3 to 18 years of age were recruited to undergo VHIT and rotary chair testing between September 2015 and November 2022. VHIT results were compared between an experimental group of 23 patients with vestibular symptoms and abnormal rotary chair testing results versus a control group of 14 patients without vestibular symptoms and with normal rotary chair testing results.

Results: The experimental group demonstrated reduced mean VHIT gain for the lateral semicircular canals (right = 0.83; left = 0.75) relative to the control group (right = 1.04, P = .005; left = 0.98, P < .001), but there was no significant difference between groups in superior and posterior canal responses. Among controls, there were no significant differences in mean gain values for each canal plane between age groups (3-7, 8-12, and 13-18 years) or between genders. A VHIT lateral canal gain value <0.85 and/or corrective saccades demonstrated 100% specificity and 100% positive predictive value for detecting vestibular loss on rotary chair, but only 69.6% sensitivity and 66.7% negative predictive value.

Conclusion: VHIT is a useful test for detecting impairment of the lateral semicircular canals in children, though its sensitivity is limited relative to rotary chair. Its role in detecting vertical canal dysfunction in pediatric patients may be more limited and warrants further study.