A Clinical Infrared Video-Oculoscopy Suppression Head Impulse (IR-cSHIMP) Test

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

An interesting idea, the test can be used in an acute setting. The results might not be as accurate as in the vHIT, however the cost of the device make it considerably more affordable by most ENT clinics, while the results can easily be interpreted by an A&E doctor, or an ENT trainee. 

Further research, including a larger number of patients will be necessary to establish scientific validity  

Author Response

Thank you very much for taking the time to review this manuscript. Obviously we agree that we need to test a large number of subjects to better evaluate the validity of the test.

Thank you again.

Reviewer 2 Report

Comments and Suggestions for Authors

REVIEW OF A CLINICAL INFRARED VIDEO OCULOSCOPY SUPPRESSION HEAD IMPULSE (IR-cSHIMP) TEST

 

The authors present their experience measuring with IR- VOG the anti-compensatory saccades in response to the SHIMP protocol. To measure the cSHIMP, the authors incorporated on a standard IR Video-Oculoscopy device and a mask that has two internal IR video cameras.

The patient wears the mask during the HIT test, the LED or LED’s inside the mask are switched on, and the subject is asked to stare carefully at them as the HIT is tested to demonstrate the anti-compensatory saccades in the event the a-VOR is normal.

The authors tested 22 volunteers, 18 patients with unilateral vestibulopathy and six patients with bilateral vestibulopathy related to CANVAS. They were able to demonstrate well-defined anti-compensatory saccades in the horizontal and importantly in the vertical plane in the normal volunteers and absence of anti-compensatory saccades in the patients with uni-or bilateral vestibulopathy. Importantly, none of the patients tested had spontaneous nystagmus with fixation block, as this could create difficulty assessing the anti-compensatory saccades.

The discussion is well written. I believe that a picture of the subject wearing the mask may be helpful to introduce a visual aid to the reader, and perhaps a Video of the subject wearing the mask during the SHIMP protocol and catching the anti-compensatory saccade.

Author Response

Thank you very much for taking the time to review this manuscript. We have attached four videos! One for normal subject, two for unilateral deficit and one for CANVAS! Probably something went wrong with the submission but we will immediately resend them. Without video everything actually remains unclear! Thanks for your observation. We will send it again.

Reviewer 3 Report

Comments and Suggestions for Authors

The manuscript presents an innovative approach to vestibular assessment through the proposed InfraRed clinical SHIMP (IR-cSHIMP) test, employing InfraRed Video-oculoscopy (IR-VOS) for the evaluation of semicircular canals (SCCs) function. The authors have delineated the test's application in both horizontal and vertical planes, which is commendable for its comprehensive approach. The introduction of IR-cSHIMP as a bedside method is a significant contribution to the field. Its potential to distinguish between healthy and pathological subjects with a simple and rapid procedure is a notable advancement. The study's methodology, involving a sample of normal subjects, unilateral, and bilateral vestibulopathy patients, appears robust. However, further details on the selection criteria and demographic data of the subjects would enhance the readers' understanding and the study's reliability. The findings indicating 100% agreement between clinical and instrumental tests in patients with vestibular deficits are remarkable. The results have yet to be verified. Nonetheless, the occurrence of false positives in the assessment of vertical SCCs warrants further investigation. A deeper analysis or discussion on these outliers could provide valuable insights. The authors assert the ease and effectiveness of the IR-cSHIMP, likening its skill requirement to the well-known clinical Head Impulse Test (cHIT). This requires a multicenter study to conclude. While the study is well-executed, I recommend a more detailed discussion on the limitations of the test, particularly concerning the false positives observed. Additionally, a comparison with existing vestibular assessment methods could contextualize the IR-cSHIMP's efficacy more distinctly. In conclusion, this manuscript provides a valuable contribution to vestibular testing methodologies. With some enhancements in detailing and discussion, it could offer significant implications for clinical practice.

1.     Could the authors provide a clear delineation of the differences and potential clinical implications between the IR-cSHIMP test, the Video Head Impulse Test (vHIT), and the Video Head Impulse Test with Suppression Head Impulse Paradigm (vSHIMP)? Specifically, it would be beneficial for the readers to understand how these tests compare in terms of their methodologies, diagnostic capabilities, and clinical applications. This comparison would greatly enhance the context and significance of the IR-cSHIMP test within the existing landscape of vestibular function assessments.

2.     While the manuscript highlights the use of IR-cSHIMP for vestibular function assessment, it is noted that vSHIMP is widely used in clinical settings due to its portability and relative ease of operation. Could the authors elucidate the specific advantages of IR-cSHIMP over vSHIMP? Are there particular scenarios or conditions where IR-cSHIMP is distinctly more effective or required as opposed to vSHIMP? Clarification on this matter would greatly assist in understanding the unique value and application scope of IR-cSHIMP in comparison to the more commonly employed vSHIMP.

3.     In the 'Materials and Methods' section of the manuscript, I have noticed that the paragraphs are numerous and quite brief, which appears to disrupt the logical flow and makes it challenging for the reader to follow. I would suggest reorganizing this section to enhance clarity and coherence. Grouping related information together and expanding on key points would greatly facilitate understanding. Could the authors consider revising this section to improve its readability and logical progression?

4.     In the manuscript, it is mentioned that 'Each subject first underwent a vestibular examination,' but the specific types of tests used, apart from vHIT and vSHIMP, are not detailed. Could the authors provide information on the other vestibular function tests that were employed in this study? Including data and findings from a broader spectrum of vestibular assessments could enrich the study, offering a more comprehensive understanding of each subject's vestibular function and potentially enhancing the contextual relevance of the IR-cSHIMP test results. Such information would be valuable for readers in understanding the full scope of vestibular evaluations used in this research.

5.     In the discussion section of the manuscript, I observed that the information is presented across numerous paragraphs, which unfortunately appear to lack a coherent logical flow. This fragmentation makes it challenging to follow the argument and understand the broader implications of your findings. I recommend a thorough restructuring of this section to enhance its logical progression. Grouping related points together, creating a more thematic or sequential flow, and ensuring that each paragraph transitions smoothly to the next would greatly improve readability and comprehension.

6.     The abbreviation 'SCCs'、“SHIMP” and so on are mentioned in the abstract without its full form. Please ensure the full name is provided the first time it appears in the main text. Check the entire document for consistency.

 

7.     What mean of the abbreviation “VM” in line 164？

 

Comments on the Quality of English Language

Moderate editing of the English language required

Author Response

Above all, thank you for your time. We have responded to all your correct observations and have modified the text accordingly.

1. Could the authors provide a clear delineation of the differences and potential clinical implications between the IR-cSHIMP test, the Video Head Impulse Test (vHIT), and the Video Head Impulse Test with Suppression Head Impulse Paradigm (vSHIMP)? Specifically, it would be beneficial for the readers to understand how these tests compare in terms of their methodologies, diagnostic capabilities, and clinical applications. This comparison would greatly enhance the context and significance of the IR-cSHIMP test within the existing landscape of vestibular function assessments.

We followed your suggestion by editing the introduction and detailing it as indicated.

2. While the manuscript highlights the use of IR-cSHIMP for vestibular function assessment, it is noted that vSHIMP is widely used in clinical settings due to its portability and relative ease of operation. Could the authors elucidate the specific advantages of IR-cSHIMP over vSHIMP? Are there particular scenarios or conditions where IR-cSHIMP is distinctly more effective or required as opposed to vSHIMP? Clarification on this matter would greatly assist in understanding the unique value and application scope of IR-cSHIMP in comparison to the more commonly employed vSHIMP.

We have taken up your suggestion and, in the introduction paragraph, we have tried to explain better the reason for devising the IR-cSHIMP while, in the discussion section, we have tried to outline its specific advantages over instrumental tests as well as, of course, its limitations.

3. In the 'Materials and Methods' section of the manuscript, I have noticed that the paragraphs are numerous and quite brief, which appears to disrupt the logical flow and makes it challenging for the reader to follow. I would suggest reorganizing this section to enhance clarity and coherence. Grouping related information together and expanding on key points would greatly facilitate understanding. Could the authors consider revising this section to improve its readability and logical progression?

We reorganized the "materials and methods" paragraph, following your right indications.

4. In the manuscript, it is mentioned that 'Each subject first underwent a vestibular examination,' but the specific types of tests used, apart from vHIT and vSHIMP, are not detailed. Could the authors provide information on the other vestibular function tests that were employed in this study? Including data and findings from a broader spectrum of vestibular assessments could enrich the study, offering a more comprehensive understanding of each subject's vestibular function and potentially enhancing the contextual relevance of the IR-cSHIMP test results. Such information would be valuable for readers in understanding the full scope of vestibular evaluations used in this research.

We have accepted your suggestion detailing the vestibular examination procedure that we routinely carry out in the materials and methods section. In the results section we have expanded the data relating to the results of the other vestibular tests.

5. In the discussion section of the manuscript, I observed that the information is presented across numerous paragraphs, which unfortunately appear to lack a coherent logical flow. This fragmentation makes it challenging to follow the argument and understand the broader implications of your findings. I recommend a thorough restructuring of this section to enhance its logical progression. Grouping related points together, creating a more thematic or sequential flow, and ensuring that each paragraph transitions smoothly to the next would greatly improve readability and comprehension.

We have reorganized the "discussion" paragraph, following your right indications.

6. The abbreviation 'SCCs'、“SHIMP” and so on are mentioned in the abstract without its full form. Please ensure the full name is provided the first time it appears in the main text. Check the entire document for consistency.

Cheked

7. VM: Vincenzo Marcelli

 

Thank you again

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

The author fixed most of the problems. Accept in present form.