Execution
- 1Apply HINTS only in continuous acute vestibular syndrome with ongoing spontaneous nystagmus, nausea or vomiting, and gait unsteadiness.
- 2Perform the head impulse test and record whether it is normal or abnormal.
- 3Observe spontaneous and gaze-evoked nystagmus for direction-fixed versus direction-changing behavior.
- 4Perform alternate cover testing to assess skew deviation.
- 5Classify central pattern as any one of normal head impulse, direction-changing gaze-evoked nystagmus, or skew deviation in the correct clinical context.
Positive outcome
HINTS is positive for central cause when there is a normal head impulse, direction-changing gaze-evoked nystagmus, or a positive skew deviation in acute vestibular syndrome. A peripheral pattern is abnormal head impulse with unidirectional horizontal-torsional nystagmus and no skew. HINTS should not be used for brief triggered positional vertigo or nonspecific intermittent dizziness.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Kattah et al. (2009) | prospective cross-sectional AVS study | 100 | 96 | 25.0 | 0.0 |
| Gottlieb et al. (2023) | Cochrane review | 94 | 87 | 7.2 | 0.07 |
CommentHINTS is high value only when applied to the correct population: continuous acute vestibular syndrome with spontaneous nystagmus. It is not a general dizziness screen and can be dangerous if applied to episodic BPPV-like presentations. Training and examiner expertise strongly affect accuracy.
High Clinical Value