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Can you Give Examples of the Clinical Applications of Head Impulse Testing?

Kamran Barin, PhD, Wendy Crumley-Welsh, MS, CCC-A

May 6, 2013

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Question

Can you give some examples of the clinical applications of head impulse testing? 

Answer

Kamran Barin: Sure.  For example, when clinicians or ear, nose and throat (ENT) physicians do gentamicin therapy for Meniere's disease, typically the protocol calls for serial auditory testing to determine when the administration of gentamicin should be stopped.  There is currently no monitoring of the vestibular function.  However, the whole purpose of gentamicin therapy is to kill the vestibular end organ or to destroy the hair cells, yet we have no direct evaluation of the labyrinth or the hair cells, mainly because we’ve never had suitable testing.   Caloric testing can’t really be used serially, so this is one application where head impulse testing can be used.  It is quite suitable for serial testing because it gives us absolute responses of the vestibular system, it takes very little time to perform and it does not result in adverse reactions from the patient.

The other clinical application would be in the area where you have bilateral caloric weakness and you want to know if it is a true bilateral vestibular hypofunction or whether this is just an artifact because of the heat-transfer issue. 

In the past, our gold standard was rotational chair testing, which requires a large space and expensive equipment.  Head impulse testing can be done at a fraction of the cost and also in a much smaller space.  The Otometrics ICS Impulse is a portable system for video head impulse testing, as you can see  in Figure 1.  You can take it to the bedside. 

Otometrics ICS Impulse unit with goggles

Figure 1. Otometrics ICS Impulse unit with goggles.

If you are monitoring ototoxicity, you can do this without the need for rotational chair.

There is also research being done about the role of head impulse testing in the diagnosis of an acute stroke.  There was a story done on the CBS Morning News about this application.

Wendy Crumley-Welsh: If you are interested in learning more about the head impulse test, we’re launching live seminars on how to perform the head impulse test starting in June so that the people interested in this device can learn about its clinical relevance and have a hands-on opportunity.  The first course is part of a VNG/ENG course presented by Kamran on May 18th at The Allerton Hotel in Chicago.  We will be adding more dates along the way.  For more information or to pre-register, please visit www.otometrics.com/impulse.  You may also visit the Otometrics Expo Page on AudiologyOnline.


kamran barin

Kamran Barin, PhD

Director of Balance Disorders Clinic at the Ohio State University Medical Center and Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Department of Speech and Hearing Science, and Biomedical Engineering Program

Kamran Barin, Ph.D. is the Director of Balance Disorders Clinic at the Ohio State University Medical Center and Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Department of Speech and Hearing Science, and Biomedical Engineering Program. He received his Master’s and Doctorate degrees in Electrical/Biomedical Engineering from the Ohio State University. He has taught national and international courses and seminars in different areas of vestibular assessment and rehabilitation. Kamran Barin is a consultant to Otometrics and provides courses and other educational material to the company


wendy crumley welsh

Wendy Crumley-Welsh, MS, CCC-A

Product Manager over the ICS line of products

Wendy Crumley has been involved in newborn hearing screening since June of 1996 following up with babies who referred their newborn screening.  In 1997, with the inception of the Sounds of Texas Project Wendy implemented Universal Infant Hearing Screening Programs in hospitals within the state of Texas as well as out of state. She educated pediatric staff, nursing staff, parent education coordinators, and designated infant hearing screeners regarding the importance of infant hearing screening and early identification of hearing loss, developed site specific daily and follow-up protocol, and trained designated infant hearing screeners using otoacoustic emissions and screening auditory brainstem response technologies.  She facilitated communication among the Sounds of Texas Project, the hospital, the local Early Childhood Intervention Agency (ECI), the local Department of Health Agency, and the area audiological clinic. 

During this same year after completing her Masters in Audiology, she worked at University of Texas Dallas/Callier Center where she performed infant diagnostic audiological evaluations, that included auditory brainstem response testing via air and bone conduction using click and tone burst stimuli, otoacoustic emissions, behavioral testing using behavioral observation and visual reinforcement conditioning, and hearing aid fittings. 

She worked for Bio-logic Systems Corp. as an Area Program Specialist for the past 5 years as well as Assistant Product Manager during the past 2 years. She trained Bio-logic distributors on screening and diagnostic equipment and used her past experiences and knowledge to help Bio-logic grow and meet the needs of nurses, audiologists, hospitals, and state programs in the realm of audiological screening and diagnostics.  She assisted in the development of new products by relaying end user feedback and needs to those writing product specifications, through the development and production of product manuals and marketing materials.  She also was in the forefront of Biologic’s education programs.

She joined the team at GN Otometrics in July 2006, as a professional trainer where she assists in the development of new products by relaying end user feedback.  She worked collaboratively with product managers on new product specifications primarily on fitting systems and audiometry.  She also developed education programs, from the development of new technology seminars, in-house trainings and online seminars as well as lecturing at national and regional conventions.  In June of 2007, she was promoted to Product Manager over the ICS line of products where her focus is balance and electrophysiology.



 


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