Does vestibulo-ocular reflex gain measured by video head impulse test decrease with age?

Yijin Jereme Gan, Yih Meei Heng, Shailesh Khode, Aruni Seneviratna, Annabelle Leong


Backgrounds: The Video Head Impulse Test (vHIT) is used to test the function of each of the six semicircular canals. Each semicircular canal is tested by measuring eye rotation in response to head movements in the plane of the canal and is calculated as the Vestibulo-ocular reflex (VOR) gain. The aims of the study were firstly, to determine age-dependent normative values of VOR gain for the vHIT of semicircular canal function in healthy Asian subjects in each decade year of life. Secondly, to investigate if vHIT measured VOR gain decreases with age.

Methods: A prospective cohort study of 60 healthy voluntary community-dwelling subjects, between 21 to 80 years of age. Subjects with prior history of vertigo were excluded. vHIT was conducted on each subject and analysed with the Interacoustics (EyeSeeCam) video goggles by the senior audiologist. The VOR gain for all six semicircular canals were calculated for each subject.

Results: The mean (SD) vHIT (VOR) gain of all the 6 semicircular canals for the entire population were 1.18 (0.19). The mean of the VOR gain for each of the six semicircular canals were analysed to develop a normative guide. The mean VOR gain per decade year did not vary significantly with age (p=0.417). The correlation between age and mean VOR values was negligible (pearson’s r=0.121).

Conclusions: We propose that our normative age-dependent data guide be used to improve the differentiation between normal and abnormal values of VOR gain in an Asian population. Our study shows that VOR gain is not associated with aging.


Video head impulse test, Vestibulo-ocular reflex gain, Aging, Normative data

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Bösner S, Schwarm S, Grevenrath P, Schmidt L, Hörner K, Beidatsch D et al. Prevalence, aetiologies and prognosis of the symptom dizziness in primary care - a systematic review. BMC Fam Pract. 2018;19(1):33.

MacDougall HG, Weber KP, McGarvie LA, Halmagyi GM, Curthoys IS. The video head impulse test: diagnostic accuracy in peripheral vestibulopathy. Neurology. 2009;73(14):1134-41.

MacDougall HG, McGarvie LA, Halmagyi GM, Curthoys IS, Weber KP. Application of the video head impulse test to detect vertical semicircular canal dysfunction. Otol Neurotol. 2013;34(6):974-9.

MacDougall HG, McGarvie LA, Halmagyi GM, Curthoys IS, Weber KP. The video Head Impulse Test (vHIT) detects vertical semicircular canal dysfunction. PLoS One. 2013;8(4):e61488.

McGarvie LA, MacDougall HG, Halmagyi GM, Burgess AM, Weber KP, Curthoys IS. The Video Head Impulse Test (vHIT) of Semicircular Canal Function - Age-Dependent Normative Values of VOR Gain in Healthy Subjects. Front Neurol. 2015;6:154.

Yang CJ, Lee JY, Kang BC, Lee HS, Yoo MH, Park HJ. Quantitative analysis of gains and catch-up saccades of video-head-impulse testing by age in normal subjects. Clin Otolaryngol. 2016;41(5):532-8.

Ulmer E, Bernard-Demanze L, Lacour M. Statistical study of normal canal deficit variation range. Measurement using the Head Impulse Test video system. Eur Ann Otorhinolaryngol Head Neck Dis. 2011;128(5):278-82.

Matiño-Soler E, Esteller-More E, Martin-Sanchez JC, Martinez-Sanchez JM, Perez-Fernandez N. Normative data on angular vestibulo-ocular responses in the yaw axis measured using the video head impulse test. Otol Neurotol. 2015;36(3):466-71.

Paige GD. Senescence of human visual-vestibular interactions. 1. Vestibulo-ocular reflex and adaptive plasticity with aging. J Vestib Res. 1992;2(2):133-51.

Engström H, Bergström B, Rosenhall U. Vestibular sensory epithelia. Arch Otolaryngol. 1974;100(6):411-8.

Rosenhall U. Degenerative patterns in the aging human vestibular neuro-epithelia. Acta Otolaryngol. 1973;76(2):208-20.

Bergström B. Morphology of the vestibular nerve. 3. Analysis of the calibers of the myelinated vestibular nerve fibers in man at various ages. Acta Otolaryngol. 1973;76(5):331-8.

Hullar TE, Della Santina CC, Hirvonen T, Lasker DM, Carey JP, Minor LB. Responses of irregularly discharging chinchilla semicircular canal vestibular-nerve afferents during high-frequency head rotations. J Neurophysiol. 2005;93(5):2777-2786.

Alhabib SF, Saliba I. Video head impulse test: a review of the literature. Eur Arch Otorhinolaryngol. 2017;274(3):1215-1222.

Weber KP, Aw ST, Todd MJ, et al. Inter-ocular differences of the horizontal vestibulo-ocular reflex during impulsive testing. Prog Brain Res. 2008;171:195-198.900-6.