Patient guide · Neuro-otology
Video head impulse test (vHIT), the bedside test of high-frequency vestibular function.
The video head impulse test (vHIT) quantifies vestibulo-ocular reflex gain across all six semicircular canals — foundation of acute vestibular syndrome, vestibular neuritis and bilateral vestibulopathy workup.
Key facts
The essentials — at a glance.
A short, clinically reviewed reference — what vHIT is, how long it takes, and where it fits alongside caloric and VEMPs.
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Definition
Video head impulse test — quantifies vestibulo-ocular reflex (VOR) gain using lightweight goggles and small, unpredictable head thrusts.
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15–20 minute test
A short, well-tolerated bedside test — no sedation, no recovery.
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All 6 semicircular canals
Horizontal, anterior and posterior canals on both sides — the full peripheral vestibular map.
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VOR gain < 0.8 abnormal
Eye velocity / head velocity — the number that decides whether the canal is working.
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Complements caloric and VEMPs
Different frequencies, different canals — the three tests answer different questions.
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HINTS-plus bedside test
Central to the HINTS-plus algorithm for separating vestibular neuritis from posterior-circulation stroke.
How the test is done
From consultation to plan — what happens, in order.
A single visit, consultant-led, with a canal-by-canal report and a structured plan you can act on.
- 01
Vestibular consultation
History, examination and the clinical question the vHIT is being asked to answer.
- 02
Goggles fitted
Lightweight goggles with a high-speed camera track the right eye during small, passive head thrusts.
- 03
Head impulses in each canal plane
Small, unpredictable thrusts in the horizontal, RALP and LARP planes cover all six canals.
- 04
VOR gain measured
Eye velocity / head velocity — a gain below 0.8 flags a canal that is not working.
- 05
Corrective saccade analysis
Overt and covert catch-up saccades quantify the vestibular deficit in real terms.
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Structured report
A vestibular consultant issues a canal-by-canal report with gain values and saccade characterisation.
- 07
Structured plan
Rehabilitation, medical therapy, imaging or onward referral — an action plan, not just a number.
What it shows
The patterns vHIT identifies.
vHIT answers a specific question — which semicircular canals are working, and how well. These are the patterns most often seen in clinic.
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Reduced horizontal VOR gain
The classic pattern in vestibular neuritis affecting the superior vestibular nerve.
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Reduced anterior canal gain
Isolated anterior canal loss — uncommon but characteristic when present.
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Reduced posterior canal gain
Posterior canal involvement — pattern points to inferior vestibular neuritis.
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Overt catch-up saccades
Refixation saccades that occur after the head thrust — visible to the clinician at the bedside.
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Covert catch-up saccades
Refixations during the head thrust — only visible with high-speed video, and clinically important.
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Bilateral vestibulopathy
Reduced gain in every canal on both sides — the diagnosis behind unsteady gait and oscillopsia.
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Meniere’s pattern
Often normal or fluctuating gain — vHIT alongside VEMPs and caloric shapes the picture.
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Red flag: normal vHIT + acute vertigo — stroke rule-out
In acute vestibular syndrome, a normal vHIT with nystagmus is a HINTS-plus red flag for posterior stroke.
Treatment options
What follows an abnormal vHIT.
Treatment depends on the diagnosis the vHIT helped make. These are the routes most often chosen by our neuro-otology partners.
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Vestibular rehabilitation
Consultant-led, physiotherapy-delivered — the cornerstone of recovery after peripheral vestibular loss.
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Anti-migraine therapy
Lifestyle, triggers and preventive medication where vestibular migraine is the driver.
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Diuretic + salt restriction (Meniere’s)
First-line medical therapy for definite Meniere’s disease.
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Intratympanic steroid
Local steroid delivery for Meniere’s and selected inflammatory presentations.
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Intratympanic gentamicin
Selective vestibular ablation for treatment-refractory Meniere’s — reserved and consultant-led.
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Stroke pathway (positive HINTS-plus)
Acute vertigo with a HINTS-plus stroke pattern is an emergency, not a private slot.
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ENT / neuro-otology referral
Onward referral for surgical or complex diagnostic workup.
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MDT review
Multi-disciplinary review where audiology, neuro-otology and imaging need to sit around the same table.
Red flags
When vHIT alone isn’t enough.
Patterns that mandate escalation — to imaging, to neurology, or to emergency care.
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Normal vHIT + acute vertigo (stroke)
In acute vestibular syndrome, a normal vHIT with nystagmus is a HINTS-plus red flag — treat as posterior-circulation stroke until proven otherwise.
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Bilateral vestibulopathy
Reduced VOR gain in every canal on both sides — imbalance and oscillopsia that warrants specialist workup.
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Cerebellar stroke
Acute vertigo with cerebellar signs — vHIT alone does not rule this out; imaging is mandatory.
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Vestibular schwannoma
Asymmetric vestibular findings with unilateral hearing loss — MRI internal auditory meati indicated.
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Post-labyrinthectomy vertigo
Persistent symptoms after surgical labyrinthectomy — vHIT quantifies residual function.
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Persistent postural-perceptual dizziness
Chronic functional dizziness — vestibular tests are usually normal; the diagnosis is clinical.
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Post-concussion syndrome
Head injury with persistent dizziness — vHIT helps separate peripheral from central causes.
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Post-COVID vestibular dysfunction
Post-viral vestibular loss — vHIT quantifies the deficit and shapes rehab.
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Meniere’s with drop attacks
Tumarkin otolithic crises — urgent neuro-otology review.
Frequently asked
Everything we get asked about vHIT.
Quick answers on what the test measures, how VOR gain works, and where vHIT sits alongside caloric and HINTS-plus.
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What is a video head impulse test (vHIT)?
A short bedside test that quantifies your vestibulo-ocular reflex — the reflex that keeps your eyes still on a target while your head moves. Lightweight goggles with a high-speed camera track your eye during small, unpredictable head thrusts across the plane of each semicircular canal.
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How long does the test take?
The vHIT itself takes 15–20 minutes; with consultation, fitting and reporting, allow 45–60 minutes in clinic.
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What does VOR gain mean?
VOR gain is eye velocity divided by head velocity during the head thrust. A gain of 1.0 is perfect. A gain below 0.8 is abnormal in most laboratories and, together with catch-up saccades, indicates a functional deficit in that canal.
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Is vHIT the same as caloric testing?
No. Caloric testing assesses low-frequency horizontal-canal function; vHIT assesses high-frequency function across all six canals. They complement rather than replace each other — many neuro-otology workups need both.
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What is HINTS-plus?
HINTS-plus is a bedside algorithm for acute vestibular syndrome — Head Impulse, Nystagmus, Test of Skew, plus new hearing loss. A central HINTS-plus pattern is more sensitive than early MRI for posterior-circulation stroke and mandates emergency assessment.
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Can vHIT rule out a stroke?
No. A normal vHIT in a patient with acute vertigo and nystagmus is itself a red flag — it is one component of HINTS-plus, not a stand-alone stroke test. Emergency imaging and neurology assessment remain the standard where central signs are present.
Sources
Guidelines that shape this page.
Reviewed 2026-07-30 · Next review 2027-07-30 · Reviewed by Pulse Atlas Editorial Board, .
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In practice, in London
The honest picture around video head impulse test in London
With video head impulse test, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. The NHS route for video head impulse test is thorough, but the queue is real. Most patients we speak with have been told to expect anywhere from a handful of weeks to several months, depending on their local trust and how the referral is graded. Going private in London usually collapses that window to a matter of days — often the same week if the diary allows. It isn’t about jumping a queue so much as buying time back while you still have the flexibility to plan around it.
A typical private booking for video head impulse test in London starts with a consultant conversation — sometimes in person on Harley Street or Marylebone, sometimes on video if that suits better. Any imaging or diagnostics happen at a nearby CQC-registered facility, and reports usually land within 24 to 72 hours. The whole loop, from first call to written report, is often done inside a fortnight. For video head impulse test specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
Where a good concierge earns its keep is in the matching. There are dozens of consultants in London who see video head impulse test — but not all of them are the right fit for every case. We narrow it down based on subspecialty, insurer coverage, the specific question being asked, and whether continuity into treatment matters. The right first appointment saves you from repeating yourself later.