Disease-Specific Patterns of Multidimensional Video Head Impulse Test Parameters in Peripheral Vestibular Disorders.

Video Head Impulse Test (vHIT) multidimensional parameters-namely vestibulo‑ocular reflex (VOR) gain, gain asymmetry (GA), and compensatory saccades (CS)-are core indicators for assessing peripheral vestibular dysfunction. The combined use of vHIT and caloric testing facilitates differential diagnosis of various vertigo syndromes. In this retrospective study, 310 adult patients with unilateral peripheral vestibular disorders were enrolled, comprising 170 cases of Ménière's disease (MD), 110 cases of sudden sensorineural hearing loss accompanied by vertigo (SSHL‑V), and 30 cases of vestibular neuritis (VN). All participants underwent vHIT and a caloric test within 72 hours of symptom onset, prior to any therapeutic intervention. Analysis of vHIT metrics revealed distinct impairment patterns across the three disorders. Ménière's disease was primarily characterized by CS abnormalities in the lateral semicircular canal (SCC), with a low gain reduction rate. Sudden sensorineural hearing loss with vertigo presents multi-planar impairment affecting both the lateral and posterior SCCs. Vestibular neuritis displayed concurrent abnormalities in VOR gain and compensatory saccades in the lateral SCC. In patients with normal VOR gain, unilateral weakness (UW) values were significantly elevated in CS‑positive groups for most semicircular canals. Age-stratified analysis revealed that age did not exert a discernible confounding effect on VOR gain or CS. This study systematically delineates the distinct vHIT parameter profiles of three common peripheral vestibular disorders, explores the possible relationship between compensatory saccades and early high-frequency vestibular dysfunction, and examines their relationship with caloric test outcomes.