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How Would Results of Head Impulse Testing Change Clinical Management?

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

July 22, 2013

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Question

How would results from the head impulse test change the clinical management of the patient?

Answer

Kamran Barin: A patient who comes in with vertigo, spontaneous nystagmus but no hearing loss would have been diagnosed with vestibular neuritis in the past after caloric testing because there was no other way of separating vestibular nerve abnormalities from the canal abnormalities.  However, if you do head impulse testing and oVEMPs and cVEMPs together, for the first time, you can separate vestibular nerve abnormalities from canal abnormalities.  Vascular issues are one of the underdiagnosed causes of dizziness that affect the inner ear.  We have never been able to see those before.  But now, with the addition of this group of tests, we can make a distinction between a nerve issue and a canal issue.  The more likely cause of isolated canal abnormalities is what’s called a transient ischemic attack.  These are the people who are at risk for later stroke.  So if we simply diagnose them with vestibular neuritis, we are missing the bigger picture, which is that the patient is at risk for a stroke.  That’s pretty serious. 

Wendy Crumley-Welsh: The other thing we had an ENT point out to us was that the calorics are flawed, meaning you can have temperature effects.  They’re really dependent on how well the tester is doing the test.  There is variability from one clinic to the next clinic, so even though calorics are considered somewhat of a gold standard, they come with several issues.  By adding the head impulse test, it gives you more information and helps you clarify a diagnosis in the case where there are issues with the calorics.

Kamran Barin: We aren’t suggesting that this is going to replace the caloric testing.  We need more time, but it’s likely that in the future we could do away with the caloric testing if this test proves to be as sensitive as we believe it will be, or at least it can reduce the number of calorics we are performing now.

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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