PP1509 - DVA and vHIT: Are Both Needed in the Pediatric Vestibular Evaluation?

Posters

Location: Halls 4EF

Lead Presenter(s)

Katheryn Bachmann, PhD (she/her/hers)

Coordinator of Research for the Pediatric Balance Center
Cincinnati Children's Hospital Medical Center
University of Cincinnati
Loveland, Ohio

Financial Disclosures: I do not have any relevant financial relationships with anything to disclose.
Non-Financial Disclosures: I do not have any relevant non-financial relationships with anything to disclose.

PDF Slides

Contributor(s)

AH

Alexandra Hanna, AuD (she/her/hers)

Dayton VAMC

Financial Disclosures: I do not have any relevant financial relationships with anything to disclose.
Non-Financial Disclosures: I do not have any relevant non-financial relationships with anything to disclose.
Lisa L. Hunter, PhD (she/her/hers)

Scientific Director
Cincinnati Children's Hospital Medical Center
University of Cincinnati
Cincinnati, Ohio

Financial Disclosures: I do not have any relevant financial relationships with anything to disclose.
Non-Financial Disclosures: I do not have any relevant non-financial relationships with anything to disclose.
Violette Lavender, AuD (she/her/hers)

Pediatric Audiologist
Cincinnati Children’s Hospital
Liberty Township, Ohio

Disclosure(s): AAA: Speaker/Honoraria (Ongoing)
Micheal Castiglione, AuD

Pediatric Audiologist
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio

Financial Disclosures: I do not have any relevant financial relationships with anything to disclose.
Non-Financial Disclosures: I do not have any relevant non-financial relationships with anything to disclose.
John H. Greinwald, Jr., MD

Professor of Otolaryngology and Genetics
Cincinnati Childrens Hospital
Cincinnati, Ohio

Financial Disclosures: I do not have any relevant financial relationships with anything to disclose.
Non-Financial Disclosures: I do not have any relevant non-financial relationships with anything to disclose.
Gretchen A. Mueller, PT, DPT

Physical Therapist
Cincinnati Children's
Springboro, Ohio

Financial Disclosures: I do not have any relevant financial relationships with anything to disclose.
Non-Financial Disclosures: I do not have any relevant non-financial relationships with anything to disclose.

Abstract: The video head impulse test (vHIT) and dynamic visual acuity (DVA) are both tests used to evaluate the vestibulo-ocular reflex (VOR) and confirm a patient’s vestibular function for all 6 semicircular canals and their respective planes. The aim of this study was to determine the agreement between results obtained on the vHIT and DVA tests in children with chief complaint of dizziness and determine if both tests are needed in the assessment and diagnosis of pediatric vestibular dysfunction or if one of the tests may be eliminated from the lengthy pediatric vestibular test battery.

Summary:

Background: Pediatric vestibular dysfunction has become more widely recognized over the past two decades. Tests such as the video head impulse test (vHIT) and the dynamic visual acuity (DVA) test are both used to evaluate the vestibulo-ocular reflex (VOR) and confirm a patient’s vestibular function for all 6 semicircular canals and their respective planes. The aim of this study was to determine the agreement between results obtained on the vHIT and DVA tests in children with chief complaint of dizziness and determine if both tests are needed in the assessment and diagnosis of pediatric vestibular dysfunction or if one of the tests may be eliminated from the lengthy pediatric vestibular test battery. Study design: A retrospective chart review was completed for thirty-two pediatric patients with chief complaint of dizziness who were evaluated in the Pediatric Balance Center at Cincinnati Children’s Hospital Medical Center (CCHMC) from January, 2018 to January, 2022. Only charts with results for both vHIT and DVA evaluations were included in the study. DVA results for left, right, up, and down directions were compared to vHIT results for left and right lateral, right anterior, left posterior, left anterior, and right posterior head thrusts.

Results: Results showed that, of the dizzy children with a normal vestibular evaluation, vHIT was normal 100% of the time while DVA was normal only 50% of the time. Of the eleven patients with central vestibular pathway dysfunction, 0% had abnormal vHIT findings while DVA was abnormal in 91% of cases. This finding is in agreement with reports of high specificity for vHIT with regard to peripheral vestibular dysfunction. That is, normal functioning semicircular canals yields normal vHIT results. Of the children identified with a peripheral pathology on the vestibular evaluation, 43% had an abnormal vHIT result in at least one semicircular canal while DVA was abnormal in one or more directions in 71% of patients.

Conclusions: These results suggest that, while both vHIT and DVA are dependent on normal peripheral function and a normally functioning VOR, higher level central vestibular pathways and cortical function are also likely assessed with DVA and contribute to the results. Interestingly, normal peripheral and/or central vestibular function yields normal vHIT, which measures VOR function at the level of the peripheral end organ and nerve for each SCC, but does not necessarily result in normal DVA in children with complaints of dizziness. Thus, it appears that both tests are useful in the pediatric vestibular evaluation. While vHIT is useful in determining the function of the semicircular canals and nerves to high frequency head movements, DVA results more closely align with the patient’s complaint of dizziness, but findings are non-localizing and may represent dysfunction occuring in the peripheral vestibular system or the central vestibular pathways and higher cortical centers of the brain. It is clear then that both tests are needed in the pediatric vestibular test battery and neither one should be eliminated.

Learning Objectives:

Upon completion, participants will be able to classify vestibular diagnoses using the combination of vHIT and DVA results