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. 2022 Nov-Dec;88 Suppl 3(Suppl 3):S177-S184.
doi: 10.1016/j.bjorl.2022.03.003. Epub 2022 May 20.

The clinical application of head-shaking test combined with head-shaking tilt suppression test in distinguishing between peripheral and central vertigo at bedside vs. examination room

Huiying Sun  1 , Yinping Wang  2 , Hong Jiang  1 , Zhiqiang Gao  1 , Haiyan Wu  3
Affiliations

The clinical application of head-shaking test combined with head-shaking tilt suppression test in distinguishing between peripheral and central vertigo at bedside vs. examination room

Huiying Sun et al. Braz J Otorhinolaryngol. 2022 Nov-Dec.

Abstract

Objectives: To investigate the clinical value of using Head-Shaking Test (HST)+Head-Shaking Tilt Suppression Test (HSTST) to distinguish between peripheral and central vertigo as well as to analyze the consistency of findings between tests at the bedside vs. in the examination room.

Methods: We retrospectively analyzed patients who presented for central or peripheral vertigo from July 2019 to July 2021. The results were compared between HST and HST+HSTST. The concordance between bedside and examination room outcomes was analyzed.

Results: Forty-seven (58.8%) patients in the peripheral vertigo group and 33 (41.2%) patients in the central vertigo group were included. In the peripheral group, 44 (both examination room and bedside: 93.6%) patients had horizontal Head-Shaking Nystagmus (hHSN), most of which were suppressed in HSTST. However, in the central group, most cases had perverted HSN (pHSN; examination room: 72.7%; bedside: 66.7%), which was seldomly suppressed in HSTST. The HST+HSTST showed a >20% higher specificity in identifying peripheral vertigo than HST alone. The bedside results were consistent with the examination room results using the kappa test (p<0.001).

Conclusions: Suppressed hHSN was a strong indicator of peripheral vertigo. Conversely, pHSN was more often seen in central vertigo, which was not readily suppressed in HSTST. The bedside results of HST+HSTST yielded qualitative agreement with the tests in the examination room. HST+HSTST could be used as reliable methods in the clinic to distinguish between peripheral and central vestibular disorders.

Level of evidence: Level 3.

Keywords: Central vertigo; Head-shaking test; Head-shaking tilt suppression test; Peripheral vertigo.

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Figures

Figure 1
Figure 1
The diagnosis of patients in the peripheral vertigo group and central vertigo group.
Figure 2
Figure 2
HST and HSTST results of peripheral vertigo group and central vertigo group. (A) Using VNG in the examination room; (B) Using a video goggle at the bedside.
Figure 3
Figure 3
Three cases with peripheral or central vertigo. (A) A patient with peripheral vertigo: the hHSN was suppressed from 25°/s to 7°/s in HSTST, TSI = 28.0%. (B) A patient with central vertigo: the hHSN was not suppressed in HSTST, TSI = 107.7%. (C) Another patient with central vertigo: the horizontal component of pHSN was suppressed slightly; TSI = 72.7%, and the vertical component of pHSN was increased from 9°/s to 12°/s, TSI = 133.3%. TSI, Tilt Suppression Index; RB, Right Beat; LB, Left Beat; DB, Down Beat. The upper line represented horizontal nystagmus and the lower line represented vertical nystagmus.
Figure 4
Figure 4
The ROC curves for HST only vs. HST + HSTST. (A) Using VNG in the examination room; (B) Using a video goggle at the bedside. AUC, Area Under Curve.
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