Suppression Head Impulse Test (SHIMP) versus Head Impulse Test (HIMP) When Diagnosing Bilateral Vestibulopathy

Tessa van Dooren*, Dmitrii Starkov, Florence Lucieer, Bieke Dobbels, Miranda Janssen, Nils Guinand, Angelica Pérez Fornos, Herman Kingma, Vincent Van Rompaey, Raymond van de Berg

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


The Suppression Head Impulse (SHIMP) test was introduced as an alternative to the Head Impulse Paradigm (HIMP) to overcome challenges in VOR gain calculation due to the interference of covert saccades. The objectives of this study were (1) to determine if SHIMP, compared to HIMP, reduces covert saccades in BV patients and (2) to define the agreement on diagnosing BV between SHIMP and HIMP. First, the number of covert saccades was compared between SHIMP and HIMP. Secondly, VOR gain was compared between SHIMP and HIMP. Lastly, the agreement between SHIMP and HIMP on identifying BV (horizontal VOR gain <0.6) was evaluated. A total of 98 BV patients were included. To our knowledge, this is the largest study population on SHIMP testing in BV patients. Covert saccades were significantly reduced, and a lower VOR gain was found during SHIMP compared to HIMP (p < 0.001). However, the clinical relevance of these statistically significant differences is small. In 93% of the patients, an agreement was found between the two paradigms regarding the diagnosis of BV, and both paradigms detect BV in the vast majority of patients.

Original languageEnglish
Article number2444
Number of pages10
JournalJournal of Clinical Medicine
Issue number9
Publication statusPublished - 26 Apr 2022


  • HIMP
  • VHIT
  • VOR gain
  • bilateral vestibulopathy
  • compensatory saccades
  • covert saccades

Cite this