# Evaluation of Semicircular Canal Function Using the Video Head Impulse Test in a Case of Relapsing Polychondritis and Otitis Media With Effusion

## TL;DR

This case study shows how the video head impulse test (vHIT) can assess balance issues in a patient with relapsing polychondritis and middle ear inflammation.

## Contribution

The study demonstrates the usefulness of vHIT in evaluating vestibular dysfunction in relapsing polychondritis when traditional tests are not feasible.

## Key findings

- vHIT revealed bilateral semicircular canal dysfunction in a patient with relapsing polychondritis and otitis media with effusion.
- Vestibular function did not improve in parallel with hearing recovery following treatment.
- vHIT is a minimally invasive and repeatable method for assessing vestibular function in such cases.

## Abstract

Relapsing polychondritis (RP) is a rare, immune-mediated disorder characterized by recurrent inflammation of cartilaginous structures, often affecting the ears, nose, and respiratory tract. Vestibular dysfunction in RP is uncommon but clinically significant, resulting from inner ear involvement. We describe a case of an 81-year-old man with RP who presented with fever, bilateral hearing loss, vertigo, and ocular inflammation. Bilateral otitis media with effusion (OME) was identified on imaging and otoscopy, precluding the use of caloric testing. Video head impulse test (vHIT) revealed bilateral semicircular canal dysfunction, with decreased vestibulo-ocular reflex gains and catch-up saccades. The patient was treated with corticosteroid pulse therapy, oral prednisolone, azathioprine, and bilateral myringotomies. While hearing thresholds improved significantly following treatment, vestibular function remained impaired on serial vHIT assessments conducted before and after therapy. This case highlights the utility of vHIT in assessing vestibular dysfunction in RP, especially when middle ear pathology renders traditional caloric testing unreliable. Compared to caloric testing, vHIT offers a minimally invasive, repeatable, and well-tolerated method for evaluating high-frequency vestibular function. Incorporating vHIT into the diagnostic and follow-up process may facilitate earlier recognition of vestibular involvement in RP and provide a useful tool for monitoring treatment response. Given that vestibular dysfunction may not improve in parallel with hearing recovery, early detection and longitudinal evaluation are essential for comprehensive patient care.