Prognostic value of the video head impulse test in sudden sensorineural hearing loss with vertigo: a systematic review and meta-analysis.

OBJECTIVES

To characterise the pattern of video head impulse test (vHIT) impairments in patients with sudden sensorineural hearing loss with vertigo (SSNHL-V), and to assess its correlation with audiological prognosis.

DESIGN

We systematically searched four databases (PubMed, Embase, Scopus, Cochrane Library) from inception to February 24, 2025, performed meta-analysis using Stata 18, and had the protocol prospectively registered with PROSPERO (CRD420251025900).

RESULTS

Among patients with SSNHL-V, impairment of the posterior semicircular canal (PSCC) was found to be more common than that of the horizontal semicircular canal (HSCC) or anterior semicircular canal (ASCC). The pooled prevalence of PSCC abnormality was 50% (95% CI: 0.40-0.60; I 2 = 87.65%, z = 14, p < 0.05). Regarding auditory prognosis, patients with reduced PSCC gain on vHIT had a 4.14-fold increased risk of poor hearing recovery (95% CI: 2.64-6.51; I 2 = 7%, p = 0.36; z = 6.17, p < 0.05). Similarly, reduced HSCC gain was associated with a 3.06-fold increased risk (95% CI, 1.72-5.44; I 2 = 0%, p = 0.96; z = 3.82, p < 0.05).

CONCLUSION

In patients with SSNHL-V, vHIT assessment revealed a higher rate of PSCC dysfunction compared to other semicircular canals, and impaired PSCC function serves as a significant predictor of auditory prognosis.