# Transformer-Based Detection and Clinical Evaluation System for Torsional Nystagmus

## TL;DR

A new system using a Transformer model accurately detects torsional nystagmus, aiding in the diagnosis of BPPV.

## Contribution

The Torsion Transformer model introduces a self-supervised learning framework for precise torsional nystagmus detection.

## Key findings

- The Torsion Transformer achieved 89.99% sensitivity and 86.36% specificity in detecting torsional nystagmus.
- The model's performance is comparable to established methods for horizontal and vertical nystagmus detection.
- The system shows promise as a clinical decision support tool for diagnosing BPPV.

## Abstract

Motivation: Benign paroxysmal positional vertigo (BPPV) is characterized by torsional nystagmus induced by changes in head position, where accurate quantitative assessment of subtle torsional eye movements is essential for precise diagnosis. Conventional videonystagmography (VNG) techniques face challenges in accurately capturing the rotational components of pupil movements, and existing automated methods typically exhibit limited performance in identifying torsional nystagmus. Methodology: The objective of this study was to develop an automated system capable of accurately and quantitatively detecting torsional nystagmus. We introduce the Torsion Transformer model, designed to directly estimate torsion angles from iris images. This model employs a self-supervised learning framework comprising two main components: a Decoder module, which learns rotational transformations from image data, and a Finder module, which subsequently estimates the torsion angle. The resulting torsion angle data, represented as time-series, are then analyzed using a 1-dimensional convolutional neural network (1D-CNN) classifier to detect the presence of nystagmus. The performance of the proposed method was evaluated using video recordings from 127 patients diagnosed with BPPV. Findings: Our Torsion Transformer model demonstrated robust performance, achieving a sensitivity of 89.99%, specificity of 86.36%, an F1-score of 88.82%, and an area under the receiver operating characteristic curve (AUROC) of 87.93%. These results indicate that the proposed model effectively quantifies torsional nystagmus, with performance levels comparable to established methods for detecting horizontal and vertical nystagmus. Thus, the Torsion Transformer shows considerable promise as a clinical decision support tool in the diagnosis of BPPV. Key Findings: Technical performance improvement in torsional nystagmus detection; System to support clinical decision-making for healthcare professionals.