What Is a Video Head Impulse Test (vHIT)?

Many people undergoing assessment for dizziness or vertigo are recommended a Video Head Impulse Test (vHIT). Although the name sounds technical, the test is quick, non-invasive and provides valuable information about how well your balance organs are functioning.

What Is a Video Head Impulse Test (vHIT)?

The Video Head Impulse Test (vHIT) is an advanced assessment used to measure how well the balance organs of the inner ear are working.

During the test, lightweight goggles equipped with a high-speed camera record your eye movements while your clinician makes a series of small, quick head movements.

The test measures the Vestibulo-Ocular Reflex (VOR), a reflex that keeps your vision stable when you move your head.

A healthy vestibular system allows your eyes to remain fixed on a target even during rapid head movements. If one or more balance organs are not functioning normally, the eyes may briefly move away from the target before making a corrective movement, known as a catch-up saccade.

Why Might I Need a vHIT?

Your clinician may recommend a vHIT if you experience:

• Vertigo

• Persistent dizziness

• Feeling off balance

• Motion sensitivity

• Blurred vision during movement (oscillopsia)

• Unexplained falls

• Suspected vestibular weakness

• Dizziness following an ear infection or viral illness

The test is particularly useful for identifying reduced function of the semicircular canals.

What Does the Test Measure?

The inner ear contains six semicircular canals, three in each ear. These canals detect rotational head movements in different directions.

Unlike caloric testing, which mainly assesses the horizontal canal at very low frequencies, vHIT measures the function of all six semicircular canals during rapid, natural head movements. This makes it one of the most valuable modern vestibular investigations.

What Happens During the Test?

The assessment is simple and usually takes around 10 minutes.

You will be asked to:

• Wear lightweight infrared video goggles.

• Focus on a small target directly in front of you.

• Keep your eyes fixed on the target while your clinician performs a series of small, rapid head movements.

The head movements are:

• Quick

• Gentle

• Unpredictable

• Safe

The goggles record your eye movements hundreds of times per second, allowing very precise measurement of the vestibulo-ocular reflex.

Does the Test Make Me Dizzy?

Most people tolerate the test extremely well. Unlike caloric testing, vHIT usually causes little or no dizziness because the head movements are brief and closely resemble everyday movements.

Some patients with acute vestibular disorders may experience mild temporary symptoms, but these usually settle within seconds.

What Conditions Can vHIT Help Diagnose?

vHIT provides valuable information when investigating:

• Vestibular neuritis

• Labyrinthitis

• Bilateral vestibular loss

• Ménière's disease

• Vestibular hypofunction

• Superior Semicircular Canal Dehiscence (when interpreted alongside other tests)

• Ototoxicity

• Persistent dizziness following concussion

• Certain central vestibular disorders

The results are always interpreted alongside your clinical history and other vestibular investigations.

What Are Catch-Up Saccades?

If a balance organ is not working normally, your eyes may briefly fail to stay fixed on the target during a head movement. Your brain compensates by making a rapid corrective eye movement called a catch-up saccade.

These tiny eye movements are usually invisible to the patient but are detected by the high-speed cameras within the vHIT goggles. Their presence can help identify which semicircular canal has been affected.

Is vHIT Better Than Caloric Testing?

Neither test is "better"—they simply measure different aspects of vestibular function.

vHIT

• Tests all six semicircular canals

• Measures rapid, natural head movements

• Usually causes very little dizziness

• Quick and comfortable

Caloric Testing

• Assesses each horizontal canal separately

• Measures very low-frequency vestibular function

• More sensitive for some chronic vestibular weaknesses

• May temporarily provoke vertigo

For many patients, both tests are complementary and provide a much more complete picture of vestibular function.

How Should I Prepare?

Preparation is straightforward.

You may be asked to:

• Avoid vestibular suppressant medication (if medically appropriate)

• Remove glasses during testing

• Avoid excessive eye make-up if possible

• Wear comfortable clothing

Your clinician will advise you if any specific preparation is required.

What Do the Results Mean?

The results help determine whether:

• One balance organ is weaker than the other.

• Both vestibular systems are functioning normally.

• More than one semicircular canal has been affected.

• Additional vestibular testing is required.

A normal vHIT does not rule out all vestibular disorders. Some conditions, such as vestibular migraine or Persistent Postural-Perceptual Dizziness (PPPD), often have normal vHIT results and require diagnosis based on clinical assessment.

Is vHIT Performed Alongside Other Tests?

Yes. At Northern Balance Clinic, vHIT is usually combined with other investigations, including:

• Videonystagmography (VNG)

• Caloric testing

• Vestibular Evoked Myogenic Potentials (VEMP)

• Computerised Dynamic Posturography

• Hearing tests

Combining these tests provides a detailed understanding of how your vestibular system is functioning.

How Can Northern Balance Clinic Help?

At Northern Balance Clinic, we use state-of-the-art vHIT technology as part of our comprehensive vestibular assessment.

Our experienced vestibular clinicians use vHIT alongside other advanced diagnostic tests to investigate conditions including:

• Vestibular neuritis

• Labyrinthitis

• Ménière's disease

• Bilateral vestibular loss

• Vestibular migraine

• Benign Paroxysmal Positional Vertigo (BPPV)

• Persistent Postural-Perceptual Dizziness (PPPD)

• Dizziness following concussion or head injury

By identifying the underlying cause of your symptoms, we can recommend the most appropriate treatment and rehabilitation.

Book a Comprehensive Vestibular Assessment

If you are experiencing persistent dizziness, vertigo or balance problems, our specialist vestibular clinicians can perform a detailed assessment, including the Video Head Impulse Test (vHIT), to help determine the cause of your symptoms.