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<p>Peripheral vestibular disorders such as vestibular migraine (VM), Meniere’s disease (MD), and benign paroxysmal positional vertigo (BPPV) commonly present with overlapping clinical symptoms, which may complicate diagnosis based on history alone. Video head impulse test (vHIT) and caloric testing are widely used objective assessments of vestibular function; however, these tests evaluate different frequency domains of the vestibulo-ocular reflex, and discordant results are frequently encountered in clinical practice.&#xa0;To assess the frequency and pattern of discordance between vHIT and caloric test responses in patients with peripheral vertigo and to compare combined test patterns across VM, MD, and BPPV.&#xa0;This cross-sectional comparative study included 126 patients diagnosed with VM (<i>n</i> = 52), MD (<i>n</i> = 47), or BPPV (<i>n</i> = 27). All participants underwent horizontal canal vHIT and bithermal caloric testing. Based on test results, patients were categorised into four combined patterns: both tests normal (NN), normal vHIT with abnormal caloric response (NA), abnormal vHIT<?ColorInfoStart FFFFFF-Background1?> <?ColorInfoEnd FFFFFF-Background1?>with normal caloric response (AN), and both tests abnormal (AA). Descriptive statistics, chi-square testing, Spearman correlation, and Cohen’s kappa analysis were used for statistical evaluation.&#xa0;Abnormal vHIT responses were observed in 55 patients (43.65%), while caloric abnormalities were identified in 70 patients (55.56%). The most frequently encountered pattern was NA (29.37%), followed by NN (26.98%), AA (26.19%), and AN (17.46%). No statistically significant association was found between diagnosis and test pattern (χ² = 8.12, <i>p</i> = 0.229). Cohen’s kappa revealed poor agreement between vHIT and caloric testing (κ = 0.077), confirming marked discordance. Spearman correlation showed no significant correlation between mean vHIT gain and canal paresis percentage (ρ = 0.003, <i>p</i> = 0.971), indicating independent behaviour of high- and low-frequency vestibular function.&#xa0;Significant discordance exists between vHIT and caloric testing in patients with peripheral vertigo, with the NA pattern being most prevalent across all diagnostic groups. Reliance on a single vestibular test may therefore lead to incomplete assessment of vestibular function. The combined use of vHIT and caloric testing provides a more comprehensive evaluation and should be considered essential in the diagnostic workup of peripheral vestibular disorders.</p>

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Video Head Impulse Test and Caloric Responses Discordance in Peripheral Vestibular Disorders: A Comparative Study of Vestibular Migraine, Meniere’s Disease, and BPPV

  • 期刊论文

  • 发表日期：

    2026年2月28日

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  • Nitika Gupta,
  • Ruchika Agrawal,
  • Aman Gupta,
  • Advaita Sharma

摘要

Peripheral vestibular disorders such as vestibular migraine (VM), Meniere’s disease (MD), and benign paroxysmal positional vertigo (BPPV) commonly present with overlapping clinical symptoms, which may complicate diagnosis based on history alone. Video head impulse test (vHIT) and caloric testing are widely used objective assessments of vestibular function; however, these tests evaluate different frequency domains of the vestibulo-ocular reflex, and discordant results are frequently encountered in clinical practice. To assess the frequency and pattern of discordance between vHIT and caloric test responses in patients with peripheral vertigo and to compare combined test patterns across VM, MD, and BPPV. This cross-sectional comparative study included 126 patients diagnosed with VM (n = 52), MD (n = 47), or BPPV (n = 27). All participants underwent horizontal canal vHIT and bithermal caloric testing. Based on test results, patients were categorised into four combined patterns: both tests normal (NN), normal vHIT with abnormal caloric response (NA), abnormal vHIT with normal caloric response (AN), and both tests abnormal (AA). Descriptive statistics, chi-square testing, Spearman correlation, and Cohen’s kappa analysis were used for statistical evaluation. Abnormal vHIT responses were observed in 55 patients (43.65%), while caloric abnormalities were identified in 70 patients (55.56%). The most frequently encountered pattern was NA (29.37%), followed by NN (26.98%), AA (26.19%), and AN (17.46%). No statistically significant association was found between diagnosis and test pattern (χ² = 8.12, p = 0.229). Cohen’s kappa revealed poor agreement between vHIT and caloric testing (κ = 0.077), confirming marked discordance. Spearman correlation showed no significant correlation between mean vHIT gain and canal paresis percentage (ρ = 0.003, p = 0.971), indicating independent behaviour of high- and low-frequency vestibular function. Significant discordance exists between vHIT and caloric testing in patients with peripheral vertigo, with the NA pattern being most prevalent across all diagnostic groups. Reliance on a single vestibular test may therefore lead to incomplete assessment of vestibular function. The combined use of vHIT and caloric testing provides a more comprehensive evaluation and should be considered essential in the diagnostic workup of peripheral vestibular disorders.