Tests · Balance
vHIT: the quick balance test
vHIT is the video head impulse test. You wear goggles fitted with a camera while the examiner makes rapid, short movements of your head as you fixate on a point. The equipment compares head movement with eye movement and shows whether each semicircular canal is responding. It is quick and does not provoke the dizziness of the caloric test.
Medically reviewed by Prof. Aline Bittencourt, MD, PhD, CRM-MA 7562 · RQE 1832 Updated on
What does vHIT assess?
Inside the inner ear there are six semicircular canals, three on each side, which detect rotational movements of the head. When the head turns, they trigger a reflex that moves the eyes in the opposite direction, keeping the image stable. This is the vestibulo-ocular reflex.
vHIT tests precisely that reflex. If a canal does not respond well, the eyes fail to follow the movement accurately and need a rapid corrective movement to find the target again. It is that correction the equipment detects.
How is it carried out?
- You put on lightweight goggles fitted with a high-speed camera and a motion sensor.
- You fixate on a point on the wall in front of you.
- The examiner holds your head and makes short, rapid, unpredictable movements, sideways and in the diagonal planes.
- The equipment compares, millisecond by millisecond, how far the head moved and how far the eyes moved.
The test takes about fifteen minutes. There are no electrodes, no needles and no stimulation with water or air.
vHIT or videonystagmography?
| vHIT | Videonystagmography | |
|---|---|---|
| What it tests | Each semicircular canal, under rapid movement | Eye movements, positional testing and the caloric response of each labyrinth |
| Dizziness during the test | Minimal | The caloric test provokes brief dizziness |
| Duration | About 15 minutes | 40 to 60 minutes |
| Requires neck mobility | Yes | No |
The two tests answer different questions and are frequently requested together. Which comes first depends on the suspicion raised at the consultation.
When is it indicated?
- Acute vertigo, to help distinguish peripheral from central causes.
- Suspected vestibular neuritis.
- Follow-up of labyrinthine recovery over time.
- Before and after vestibular rehabilitation, for comparison.
- Where the caloric test is poorly tolerated or contraindicated.
Where it is carried out
At Clínica Rhinus, in the Renascença district of São Luís, as part of the neurotologic assessment. The result is interpreted at the consultation, alongside the history and the other tests.
This test is carried out on a self-pay basis only. The consultation and the other tests follow the rules of your health plan. Contact our team to arrange booking.
How should I prepare for this test?
- Bring the medical request: it is required.
- Stop medication for dizziness and sedatives as advised by the doctor who requested the test — never on your own initiative.
- Avoid alcohol for 24 hours beforehand.
- Do not wear eye make-up or false lashes: they interfere with camera tracking.
- Contact lenses may interfere; prefer to come wearing glasses and tell us on arrival.
- Tell us if you have neck pain, restricted movement or recent neck surgery.
Sources: Brazilian Association of Otorhinolaryngology and Cervico-Facial Surgery (ABORL-CCF) · Flint PW, Francis HW, Haughey BH, et al. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Elsevier; 2020. · Bento RF, Bittencourt AG, Voegels RL. Seminários em Otorrinolaringologia. Fundação Otorrinolaringologia.
Frequently asked questions
Questions about balance
Does vHIT cause dizziness?
Very little, and that is one of its advantages. Unlike the caloric test in videonystagmography, it does not stimulate the labyrinth with water or air. The head movements are rapid and of small amplitude, and most people finish the test without symptoms.
How does it differ from videonystagmography?
They assess different things and complement each other. vHIT tests the response of each semicircular canal to rapid movement, close to what happens in daily life. Videonystagmography assesses eye movements, positional testing and the response of each labyrinth separately in the caloric test. The physician chooses according to the suspicion.
Who should not have this test?
The test requires neck mobility, because it involves rapid head movements. Anyone with significant neck pain, restricted movement, cervical spine instability or recent neck surgery should say so beforehand — in those cases the physician assesses whether the test is safe or whether another approach is preferable.
What does an abnormal result indicate?
That the response of one or more semicircular canals is reduced, pointing to peripheral involvement of the vestibular system on that side. The finding is interpreted alongside the history, the physical examination and the other balance tests, and does not on its own establish the cause of dizziness.