Video head impulse test (vHIT)
A quick balance test that uses lightweight goggles to check how well your eyes keep a target in focus when your head is turned quickly.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It checks the reflex that keeps your vision steady when your head moves quickly, for each inner-ear canal.
- It is usually quick and well tolerated, with far less dizziness than the caloric test.
- A normal result does not rule out every cause of dizziness; it is one part of the assessment.
- Tell the clinician about neck problems, as the test involves quick, small head turns.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Checks each balance canal in both ears, including ones the caloric test cannot reach.
It is the wrong first step for sudden vertigo with stroke-like features (such as new weakness, slurred speech or a severe headache), which needs urgent...
You feel quick, small head turns while keeping your eyes on a target. Any dizziness is usually mild and brief.
A clear explanation of what your result means alongside your symptoms, not in isolation.
You feel quick, small head turns while keeping your eyes on a target. Any dizziness is usually mild and brief.
Most people feel normal and can leave without resting. A few feel slightly off-balance for a short time.
The clinician may comment on the day, but the formal report usually goes to the doctor who referred you to discuss...
What is a video head impulse test (vHIT)?
A video head impulse test (vHIT) checks a reflex that keeps your vision steady when you move your head. Normally, when your head turns, your eyes automatically move the opposite way by the same amount so the world stays in focus. This is called the vestibulo-ocular reflex, and it relies on the balance organs in your inner ears.
You wear lightweight goggles with a small camera that records your eyes. The clinician holds your head and turns it quickly by a small amount in different directions while you keep looking at a target. The goggles measure whether your eyes keep up with each head turn.
The test can check each of the balance canals in both ears, including ones that older tests cannot reach. It looks at the reflex at fast, natural head speeds. It is usually quick and most people tolerate it well, with much less dizziness than the caloric test.
Like all balance tests, it checks one part of the system. A normal result does not rule out every cause of dizziness, so it is read alongside your history, examination and sometimes other tests.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
vHIT vs caloric testing
| Feature | vHIT | Caloric test |
|---|---|---|
| Head speeds tested | Fast, natural speeds | Low frequencies only |
| Canals checked | All semicircular canals | Horizontal canal |
| How it feels | Quick head turns, usually well tolerated | Briefly dizzy, sometimes sick |
| Time | Shorter | Longer |
The tests give different information and are often used together; one being normal does not make the other unnecessary.
Preparing for your test
- Ask whether to pause any balance or anti-sickness medicines beforehand, as advice varies between clinics — never stop a medicine without checking.
- Do not wear eye make-up, as it can stop the goggles tracking your eyes accurately.
- Tell the clinic about neck or back problems, recent neck injury or surgery, as the test involves quick head turns.
- Bring details of your glasses or contact lenses and a list of your medicines.
- Wear comfortable clothing and tie long hair back so the goggles fit snugly.
- Mention if you have very dry eyes or difficulty keeping your eyes open, as this can affect recording.
What happens
You sit upright and wear lightweight goggles fitted snugly to your head. The camera in the goggles is set up to track your eyes, and a small calibration step is done first.
The clinician asks you to keep looking at a fixed target, usually a dot on the wall. They hold your head and give quick, small, unpredictable turns in different directions. Each turn is brief. The goggles record whether your eyes stay locked on the target or briefly slip and then catch up.
The whole test usually takes around 15 to 30 minutes. There is little or no lasting dizziness, and most people can carry on with their day straight afterwards.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- It is the wrong first step for sudden vertigo with stroke-like features (such as new weakness, slurred speech or a severe headache), which needs urgent assessment, not an outpatient balance test.
- Quick head turns may be unsuitable or need adapting if you have significant neck instability, recent neck injury or surgery.
- It may be unreliable if your eyes cannot be tracked well, for example with very droopy lids, heavy eye make-up or certain eye conditions.
- On its own it cannot diagnose BPPV, which is assessed with positioning tests such as the Dix-Hallpike.
Delay or rearrange if…
- You have a recent neck injury, neck surgery or unstable neck symptoms.
- You have an active ear or eye infection affecting the test.
- You are acutely unwell or unable to sit and focus on a target.
- Your symptoms are rapidly worsening or you have new neurological symptoms needing urgent assessment first.
Alternatives to discuss
- Caloric testing, which checks the horizontal canal at low frequencies and tests each ear separately.
- Vestibular evoked myogenic potentials (VEMP), which check different (otolith) parts of the inner ear.
- Positioning tests such as the Dix-Hallpike if BPPV is suspected.
- Clinical bedside head impulse testing by an experienced clinician, sometimes with a hearing test.
- Imaging if a central (brain-related) cause is suspected.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Checks each balance canal in both ears, including ones the caloric test cannot reach.
- Tests the balance reflex at fast, natural head speeds.
- Usually quick and well tolerated, with little dizziness.
- Helps tell apart inner-ear causes of dizziness from other causes.
- Can help confirm a weak balance organ after an inner-ear illness and guide balance retraining.
Risks & complications
- Mild, brief dizziness during the head turns in some people
- Slight neck awareness from the quick movements
- Needing the goggles re-fitted or the test repeated if eye tracking is poor
- A short period of feeling off-balance afterwards
- A result that is unclear and needs another test
- Aggravation of a pre-existing neck problem, which is why neck issues should be mentioned beforehand
The test is low-risk and usually causes little dizziness. The main limitation is that it checks one part of the balance system, so a normal result does not rule out every cause of dizziness. If you have a significant neck problem, tell the clinician so the head turns can be adjusted or avoided.
Published figures to discuss
vHIT is a low-risk test, so meaningful complication rates are not the main issue. What varies is how well it detects problems, which depends on the condition, the canals tested and recording quality. Normal reflex (gain) values change with age, and results can be affected by eye-tracking problems. Exact accuracy figures vary widely by the condition being looked for, so none are given here.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Physical harm from vHIT | Very low | The test uses quick, small head movements; it is non-invasive. | Guide sourcesClinical context |
| Neck discomfort or unsuitable neck movement | Patient-specific | Neck pain, instability or recent injury should be discussed before testing. | vHIT and horizontal semicircular canal function — review (PubMed)pubmed.ncbi.nlm.nih.govSource-linked context |
| False or poor-quality result | Recognised | Goggle slippage, blinking, poor calibration or guarding can affect gain and saccade measurements. | Guide sourcesClinical context |
| Normal vHIT does not exclude all vestibular disease | Core limitation | vHIT tests high-frequency vestibulo-ocular reflex; caloric testing and other tests may show different abnormalities. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is usually no recovery needed. Most people feel fine straight after the test and can drive and carry on as normal, though a few feel briefly off-balance.
- Little or no dizziness for most people
- Possibly a brief off-balance feeling
- Mild neck awareness from the head turns
- No lasting effects from the test itself
Aftercare
- Carry on with your day as normal if you feel well.
- If you feel briefly off-balance, sit until it passes before driving.
- Restart any paused medicines only as your clinician advised.
- Note any questions to ask when you get your results.
- Report any new or worsening symptoms to your clinician.
- Checked whether any medicines needed pausing
- Came without eye make-up
- Mentioned any neck or back problems
- Brought glasses or contact lens details
- Tied long hair back
- Noted questions for your results discussion
⚠ Get urgent help if…
- A sudden, severe or 'worst ever' headache, especially with dizziness
- Slurred speech, drooping face, or weakness or numbness in an arm or leg
- Double vision or loss of vision
- Fainting, chest pain or a very irregular pulse
- New deafness in one ear with the dizziness
- Severe, unrelenting dizziness rather than your usual symptoms
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A normal result means your eyes kept up with the head turns, suggesting the tested balance canals are working. If your eyes slipped and had to catch up (a 'corrective saccade') and the measured reflex was reduced, this suggests a weaker balance organ on that side or for that canal.
The result is read alongside your symptoms and other tests. A normal vHIT does not prove your whole balance system is fine, and a weak canal does not always cause ongoing symptoms because the brain often compensates. Your clinician will explain what your result means for you.
The result reflects how your balance reflex is working around the time of the test. If symptoms change, worsen or new ones appear, the test may be repeated or a different test used. A single normal result does not guarantee you will not develop balance problems later.
Related tests, treatments or support
vHIT is often done alongside videonystagmography and caloric testing, and sometimes VEMP, because each checks the balance system differently. A hearing test is frequently done at the same visit.
Follow-up & long-term care
Your results are usually sent to the doctor who referred you, who explains what they mean and discusses any treatment, such as balance retraining, further tests or referral. Ask when you will get your results and who to contact if symptoms change.
Repeat, follow-on and what comes next
- The test sometimes needs repeating if eye tracking, goggle fit or technique made the result unreliable.
- A borderline or unclear result may lead to a different balance test rather than a repeat.
- A normal result with ongoing symptoms often prompts further assessment rather than reassurance alone.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear explanation of what your result means alongside your symptoms, not in isolation.
- A named route to ask questions and to report if symptoms change or worsen.
- A sensible plan if the result is normal but symptoms continue, including further tests or balance retraining.
- Joined-up interpretation if vHIT was done with other balance tests.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether vHIT is done alone or as part of a fuller balance test battery
- Whether caloric testing, VEMP and a hearing test are done at the same visit
- The seniority of the audiologist or specialist running and interpreting the test
- Whether a written report and a follow-up consultation to explain results are included
- The clinic or hospital facility fees
- Whether further tests or scans are recommended afterwards
- Exactly which balance tests are included in the price
- Whether interpretation and a written report are included
- Whether a consultation to explain the results is included or charged separately
- What happens, and what it costs, if the test is inconclusive and needs repeating
- Whether any recommended follow-up tests are quoted
- The clinic's cancellation and rescheduling policy
On the NHS? Video head impulse testing is available on the NHS when clinically indicated; private testing may be chosen for faster access, choice of provider or a second opinion.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Being given a 'normal' result as full reassurance without explaining what the test cannot check.
- Not being asked about neck problems before quick head turns.
- Bundling many balance tests together without explaining why each is needed.
- No clear plan for who explains the result and what happens next.
Marketing red flags
- Claims that one balance test can find the cause of all dizziness.
- Promising a diagnosis from the test alone, without history and examination.
- Selling a long panel of tests without justifying each one.
- Implying a normal result guarantees nothing is wrong.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What are you hoping this test will show in my case?
- What will the result change about my diagnosis or treatment?
- Will the head turns be a problem given my neck?
- What happens if the result is normal, abnormal or unclear?
- Will I need other balance tests as well, and why?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Does the vHIT hurt or make me very dizzy?
Can I drive home afterwards?
Is it available on the NHS?
What if I have a neck problem?
What if my result is normal but I still feel dizzy?
Why do I have to keep my eyes on the target?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Dizziness NICE CKS — Vertigo Newcastle Hospitals NHS — Vestibular (balance) assessment vHIT and horizontal semicircular canal function — review (PubMed) vHIT detects vertical semicircular canal dysfunction — PMC British Society of Audiology — practice guidance and recommended procedures
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Caloric testing · Vestibular evoked myogenic potentials (VEMP) · Dix-Hallpike test for BPPV · Vestibular rehabilitation therapy · Acoustic reflex testing