Performing the HINTS-Exam Using a Mixed-Reality Head-Mounted Display in Patients with Acute Vestibular Syndrome: a Feasibility Study

Nadia Sadok^1*Gijs Luijten^2,3*Fin H. Bahnsen²Christina Gsaxner³Lorenz Peters⁴Theda Eichler¹Theresa Rombach¹Stephan Herbert Lang¹Sameh Khattab²Jens Kleesiek^2,5,6,7Dagny Holle-Lee⁸Moritz Meyer¹Jan Egger^2,3,9

• ¹Department of Otolaryngology - Head and Neck Surgery, University Hospital Essen, Essen, Germany
• ²Institute for Artificial Intelligence in Medicine (IKIM), Essen University Hospital (AöR), Girardetstraße 2, 45131, Essen, Germany, Essen, Germany
• ³Institute of Computer Graphics and Vision (ICG), Graz University of Technology, Inffeldgasse 16/II, 8010, Graz, Austria, Graz, Austria
• ⁴Institute for Medical Education, Essen University Hospital (AöR), Hufelandstraße 55, 45147, Essen, Germany, Essen, Germany
• ⁵Cancer Research Center Cologne Essen (CCCE), West German Cancer Center Essen, University Hospital Essen (AöR), Hufelandstraße 55, 45147, Essen, Germany, Essen, Germany
• ⁶German Cancer Consortium (DKTK), Partner site Essen, Hufelandstraße 55, 45147, Essen, Germany, Essen, Germany
• ⁷Department of Physics, TU Dortmund University, Otto-Hahn-Straße 4, 44227 Dortmund, Germany, Dortmund, Germany
• ⁸Department of Neurology, Westgerman Headache and Vertigo Center, Essen University Hospital (AöR), Hufelandstraße 55, 45147, Essen, Germany, Essen, Germany
• ⁹Center for Virtual and Extended Reality in Medicine (ZvRM), University Hospital Essen, Hufelandstraße 55, North Rhine-Westphalia, 45147, Essen, Germany, Essen, Germany

Background: In patients with acute vestibular syndrome (AVS) differentiating between benign acute peripheral vestibular disorders and possible life-threatening central, causes such as stroke, can be challenging due to similar symptoms. AVS patients experience dizziness, vertigo, imbalance, nausea, vomiting, and abnormal eye movements. This research evaluates the feasibility of using the eyetracking capability of a mixed reality optical-see-through head-mounted display (MR-OST-HMD) to detect pathological eye movement patterns in patients with AVS.Methods: Conducted at University Hospital Essen, this study assessed patients with AVS using a MR-OST-HMD during the HINTS-Exam. The feasibility study included 21 healthy subjects, seven patients with acute peripheral vestibular dysfunction and two stroke patients. Eye gaze, head position, and orientation were captured using a MR-OST-HMD and an in-house developed application designed to simulate the HINTS-Exam. The eye-tracking technology determined gaze direction and position, while the internal measurement unit and gyroscope recorded head movements in terms of position and velocity.Results: The MR-OST-HMD detected abnormal eye movements, including nystagmus, saccades, and skew deviation effectively. The device proved effective even for patients with severe nausea and elderly participants, who completed the eye calibration and HINTS-Exam without difficulty. The MR-OST-HMD HINTS-Exam was quick to perform (approximately five minutes) and was easily integrated into clinical practice after a single demonstration for medical staff.Conclusions: MR-OST-HMD can detect pathological eye movements in AVS patients. Future research should validate these findings in larger cohorts and explore machine learning integration to enhance diagnostic accuracy.