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      Protocolo de evaluación y valores de referencia de la ganancia del reflejo vestíbulo-ocular (RVO) en el plano horizontal registrado mediante el video-Head Impulse Test (v-HIT) en población pediátrica Translated title: Assessment protocol and reference values of vestibulo-ocular reflex (VOR) gain in the horizontal plane recorded with video-Head Impulse Test (vHIT) in a pediatric population

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          Abstract

          RESUMEN Objetivo Elaborar un protocolo de evaluación y establecer valores de referencia de las ganancias del reflejo vestíbulo-ocular del canal semicircular horizontal obtenidas con el v-HIT en población pediátrica sin alteraciones vestibulares. Método Estudio cuantitativo, analítico, no experimental con muestreo no probabilístico por conveniencia. Se seleccionaron 39 sujetos entre 5 a 17 años, los cuales cumplieron los criterios de inclusión y exclusión. Resultados El promedio de la ganancia obtenida para el conducto semicircular horizontal derecho fue de 0,93 y para el conducto semicircular izquierdo fue de 1,08. Existen diferencias estadísticamente significativas entre oídos. No existen diferencias estadísticamente significativas entre los subgrupos de 5 a 10 años y 11 a 17 años. Conclusión La ganancia del reflejo vestíbulo-ocular en población pediátrica se acerca a los valores encontrados en la literatura científica internacional y de la población adulta. El protocolo confeccionado puede orientar a profesionales que están comenzando en la evaluación otoneurológica de esta población.

          Translated abstract

          ABSTRACT Purpose To develop an assessment protocol and establish reference values of vestibulo-ocular reflex gain of the horizontal semicircular canal obtained with vHIT in a pediatric population without vestibular changes. Methods Quantitative, non-experimental, analytical study with a non-probabilistic convenience sample. A total of 39 subjects aged 5 to 17 years were selected based on the inclusion and exclusion criteria. Results The mean gain obtained of the horizontal right semicircular canal was 0.93 and of the left one, 1.08, with statistically significant differences between the ears. There were no statistically significant differences between the 5-to-10-year and 11-to-17-year subgroups. Conclusion The vestibulo-ocular reflex gain in children neared the values found in the international scientific literature and the adult population. The protocol developed can guide beginning professionals in the otoneurological evaluation of children.

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          Most cited references23

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          A clinical sign of canal paresis.

          Unilateral loss of horizontal semicircular canal function, termed canal paresis, is an important finding in dizzy patients. To our knowledge, apart from head-shaking nystagmus, no clinical sign of canal paresis has yet been described and the term derives from the characteristic finding on caloric tests: little or no nystagmus evoked by either hot or cold irrigation of the affected ear. We describe a simple and reliable clinical sign of total unilateral loss of horizontal semicircular canal function: one large or several small oppositely directed, compensatory, refixation saccades elicited by rapid horizontal head rotation toward the lesioned side. Using magnetic search coils to measure head and eye movement, we have validated this sign in 12 patients who had undergone unilateral vestibular neurectomy.
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            The video head impulse test: diagnostic accuracy in peripheral vestibulopathy.

            The head impulse test (HIT) is a useful bedside test to identify peripheral vestibular deficits. However, such a deficit of the vestibulo-ocular reflex (VOR) may not be diagnosed because corrective saccades cannot always be detected by simple observation. The scleral search coil technique is the gold standard for HIT measurements, but it is not practical for routine testing or for acute patients, because they are required to wear an uncomfortable contact lens. To develop an easy-to-use video HIT system (vHIT) as a clinical tool for identifying peripheral vestibular deficits. To validate the diagnostic accuracy of vHIT by simultaneous measures with video and search coil recordings across healthy subjects and patients with a wide range of previously identified peripheral vestibular deficits. Horizontal HIT was recorded simultaneously with vHIT (250 Hz) and search coils (1,000 Hz) in 8 normal subjects, 6 patients with vestibular neuritis, 1 patient after unilateral intratympanic gentamicin, and 1 patient with bilateral gentamicin vestibulotoxicity. Simultaneous video and search coil recordings of eye movements were closely comparable (average concordance correlation coefficient r(c) = 0.930). Mean VOR gains measured with search coils and video were not significantly different in normal (p = 0.107) and patients (p = 0.073). With these groups, the sensitivity and specificity of both the reference and index test were 1.0 (95% confidence interval 0.69-1.0). vHIT measures detected both overt and covert saccades as accurately as coils. The video head impulse test is equivalent to search coils in identifying peripheral vestibular deficits but easier to use in clinics, even in patients with acute vestibular neuritis.
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              The Video Head Impulse Test

              In 1988, we introduced impulsive testing of semicircular canal (SCC) function measured with scleral search coils and showed that it could accurately and reliably detect impaired function even of a single lateral canal. Later we showed that it was also possible to test individual vertical canal function in peripheral and also in central vestibular disorders and proposed a physiological mechanism for why this might be so. For the next 20 years, between 1988 and 2008, impulsive testing of individual SCC function could only be accurately done by a few aficionados with the time and money to support scleral search-coil systems—an expensive, complicated and cumbersome, semi-invasive technique that never made the transition from the research lab to the dizzy clinic. Then, in 2009 and 2013, we introduced a video method of testing function of each of the six canals individually. Since 2009, the method has been taken up by most dizzy clinics around the world, with now close to 100 refereed articles in PubMed. In many dizzy clinics around the world, video Head Impulse Testing has supplanted caloric testing as the initial and in some cases the final test of choice in patients with suspected vestibular disorders. Here, we consider seven current, interesting, and controversial aspects of video Head Impulse Testing: (1) introduction to the test; (2) the progress from the head impulse protocol (HIMPs) to the new variant—suppression head impulse protocol (SHIMPs); (3) the physiological basis for head impulse testing; (4) practical aspects and potential pitfalls of video head impulse testing; (5) problems of vestibulo-ocular reflex gain calculations; (6) head impulse testing in central vestibular disorders; and (7) to stay right up-to-date—new clinical disease patterns emerging from video head impulse testing. With thanks and appreciation we dedicate this article to our friend, colleague, and mentor, Dr Bernard Cohen of Mount Sinai Medical School, New York, who since his first article 55 years ago on compensatory eye movements induced by vertical SCC stimulation has become one of the giants of the vestibular world.
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                Author and article information

                Journal
                codas
                CoDAS
                CoDAS
                Sociedade Brasileira de Fonoaudiologia (São Paulo, SP, Brazil )
                2317-1782
                2021
                : 33
                : 4
                : e20200076
                Affiliations
                [01] Viña del Mar Santiago de Chile orgnameUniversidad Santo Tomás orgdiv1Facultad de Salud orgdiv2Escuela de Fonoaudiología Chile
                [04] Santiago Santiago de Chile orgnameUniversidad de Las Américas orgdiv1Facultad de Ciencias de la Salud orgdiv2Escuela de Fonoaudiología Chile
                [02] Viña del Mar orgnameHospital Dr. Gustavo Fricke orgdiv1Unidad de Otorrinolaringología Chile
                [03] Santiago Santiago de Chile orgnamePontificia Universidad Católica de Chile orgdiv1Facultad de Medicina orgdiv2Departamento de Ciencias de la Salud Chile
                Article
                S2317-17822021000400304 S2317-1782(21)03300400304
                10.1590/2317-1782/20202020076
                87055f48-78f3-420b-9549-02399593d75e

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 02 April 2020
                : 11 August 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 23, Pages: 0
                Product

                SciELO Brazil

                Categories
                Artículo Original

                Educación Primaria y Secundaria,Conductos Semicirculares,Pruebas de Función Vestibular,Prueba de Impulso Cefálico,es,Education Primary and Secondary,Child Health,Semicircular Ducts,Vestibular Function Tests,Head Impulse Test,Salud del Niño

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