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What Is a Head Impulse Test (Vestibulo-Ocular)?

The head impulse test evaluates the vestibulo-ocular reflex, which stabilizes vision during head movement. The examiner rapidly turns the patient's head while observing eye response. A normal response keeps the eyes fixed on a target. Abnormal results suggest vestibular dysfunction. The test is commonly used in dizziness evaluation.

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What Is a Head Impulse Test (Vestibulo-Ocular)?

The head impulse test evaluates the vestibulo-ocular reflex, which stabilizes vision during head movement. The examiner rapidly turns the patient's head while observing eye response. A normal response keeps the eyes fixed on a target. Abnormal results suggest vestibular dysfunction. The test is commonly used in dizziness evaluation.

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What Does the Head Impulse Test Assess?

The test checks reflex coordination between the inner ear and eyes. It identifies peripheral vestibular deficits. Eye movement correction is closely observed. Results guide further balance testing. Interpretation requires clinical context.

Why Is the Head Impulse Test Performed?

This test helps distinguish vestibular causes of dizziness. It is used in several settings.

  • Evaluation of acute vertigo
  • Assessment of vestibular function
  • Differentiation of central vs peripheral causes
  • Bedside neurologic screening
  • Follow-up after vestibular injury

How Are Abnormal Results Interpreted?

Corrective eye movements indicate vestibular weakness. Direction matters for localization. Results are combined with symptoms. Imaging may follow abnormal findings.

How Do Head Impulse Test Findings Help Narrow the Cause of Dizziness?

The test checks whether your eyes stay fixed on a target during quick head turns, which reflects how well the vestibulo-ocular reflex is working. If your eyes slip off the target and then snap back with a corrective movement, it can point toward vestibular weakness on the side being tested. Clinicians compare responses in both directions and interpret results alongside your symptom timing and other bedside signs.

Frequently Asked Questions

Is the test safe?

Yes. It is brief and performed carefully.

Does it cause dizziness?

It can briefly provoke symptoms. Effects pass quickly.

Is equipment required?

No. It is a bedside test.

Does it test both ears?

Yes. Each direction evaluates one side.

References

1. Vestibulo-ocular reflex testing. American Academy of Ophthalmology. https://www.aao.org/eye-health. Accessed July 9, 2025.

2. Balance disorders overview. National Eye Institute. https://www.nei.nih.gov/learn-about-eye-health. Accessed July 9, 2025.

3. Head impulse test explained. Cleveland Clinic. https://my.clevelandclinic.org/health/diagnostics/21610-head-impulse-test. Accessed July 9, 2025.

4. Principles of Neurology. Ropper AH, Samuels MA. McGraw-Hill; 2019.

5. Vestibular Rehabilitation. Herdman SJ, Clendaniel RA. F.A. Davis; 2014.