The HINTS exam

[@PeterJohns]

IMPORTANT!!! You should first screen your dizzy patients for central features that would not be expected in vestibular neuritis and may signify a central cause such as stroke. And they are: New Significant headache or neck pain Focal weakness or paresthesias Any dangerous D's - diplopia, dysarthria, dysmetria, dysphonia, dysphagia Vertical nystagmus at rest (not during the Dix-Hallpike test) Inability to walk unaided You should carefully consider a central cause if your patient has any of these central features, irregardless of their HINTS exam findings.

[@abril430]

thank you for this important update on Hints exam

[@curtisfoy6735]

I wish KZbin existed when I was in medical school. What a great teaching video thanks.!

[@PeterJohns]

Thank you. Videos are a great way to bring the patient to the learner.

[@nasonryan6760]

Can't agree more!!. Much better way to learn something than to read textbook and imagine how it works.

[@joeybacus6734]

For my wish... I hope medical school be more like KZbin. Its ironic that it will just take a series of free video to understand concepts I paid thousands in tuition fee to learn in medical school...

[@sunilkumarsoni4810]

Yes I wish the same

[@arthurleonepimenta2266]

Thank you for the excellent video, dr. Peter.

[@nancyonisko7118]

Outstanding video. Finally, someone explains properly why and "abnormal" test is reassuring. Thanks for making this Dr. Johns. Great work.

[@charlie1banks]

Oh my goodness .. I think I just died and gone to heaven!!! Wish all med school lectures had your flair for explanation and teaching! Thank you Dr Johns.. this video have upgraded my visual understanding of the assurance of abnormal testing. As students we don't often get to see normal and abnormal side by side (like this) so on the ward our confidence in diagnosis can be affected. My utmost gratitude and aspiration to you! Charlie

[@ahmedal-obaidi8305]

One of the most useful medical videos on KZbin. Period. Thank you. Update: I still go back to this video everytime I need a refresher of this important exam!

[@DrRussell]

This is not only the best video I have seen on this subject, it has also made me realise how I need to deploy slow-motion video in our medical media workflow, and how I need to demonstrate comparative presentations in our videos. Thank you so much for all your time and effort Dr Johns.

[@edtapia8580]

EXCELLENT video. We need more videos like this. Most of them talk about topics but do not show the actual practice with the patient taking place. Thank you sincerely.

[@faisalization]

I am a junior doctor working in the NHS, UK. I’ve always found it difficult to perform and interpret HINTS test on patients with Vertigo. I’ve seen loads of videos, read loads of posts and I think this is best video ever on HINTS test. Thank you so much!

[@myriambenaissa1984]

I will start my residency in ENT in a few months. This video helped me a lot in my studying! Thank you, Doctor, for making things easier for us !

[@davidliu4608]

Love this video as a second year resident. Fantastic instructions and the actual patient videos made it extremely clear.

[@PeterJohns]

Thanks!

[@KL-vb5qs]

The last question really helped to consolidate everything

[@johnvu719]

With 99% of medical school being online, can’t express how helpful this was. Especially with the real positive findings

[@PeterJohns]

Thanks, I'm glad you found it helpful.

[@user-ji1nt9pc3h]

This video is fantastic, and like many others here, I could not understand this concept after reading multiple articles. After this 8 minute video I now not only understand what to expect for normal/abnormal, but how to perform the test and apply the results to differentiate between vestibular neuritis vs a stroke. Thank you very much Dr. Johns!

[@matheussanches6964]

God, this is incredibly good! Im currently studying for a otorhinolaryngology test and ,at the vertigo class, my teacher just mentioned the HINTS test and didnt give too much of an importance to the matter.. Thanks for the intuitive teaching!

[@johannesbar9354]

Really good video ! Could not get a clear impression of the exam after reading several articles. Now its better. Unfortunately in reality this simple test is difficult to perform, needs a lot of experience. Thanks for the Video !

[@PeterJohns]

You are welcome!. You are right that it takes some thought and practice to understand when to use it, how to do it and how to interpret it. But this is true of reading ECG's, bedside u/s, x-ray interpretation, fundoscopy etc. Since missing a stroke is a very concerning issue for front line providers of vertigo assessment, I think it is worth putting the time in to understand HINTS. It's also important to know that if a patient has central features as described in my "Big 3 of vertigo" video kzbin.info/www/bejne/g6jFon2sgqmipLc they are need a workup for stroke/central causes no matter what the HINTS exam reveals. If a person also knows how to diagnose BPPV, and how to diagnose vestibular migraine, how to screen for central features, and how to perform and interpret the HINTS exam, I would call them vertigo competent. It's best to find someone locally who knows how to perform HINTS to watch you perform it and ensure you aren't making errors in your technique.

[@PeterJohns]

See my most reason video on the most important part of the HINTS exam, the HIT! kzbin.info/www/bejne/opzNiJ18iLt5fa8

[@ZantherStone]

So, if patient comes in with 30 minutes of constant vertigo, for example, would you do neither exam? Could it help evaluate a stroke?

[@Ella.T2015]

This is the most clearly presented information I have ever found on the HINTS exam I love it!

[@tonysmedventures6360]

By far the best explanation I have seen on the HiNTS exam, thank you!

[@hayderjumaah2992]

Just amazing, and I will start performing these tests on my patients in ED as appropriate.

[@tomstaple1500]

I am currently a paramedic student doing a case study on dealing with vertigo in the pre-hospital environment. This is a brilliant video to expand on differential diagnosis and look at whether hospital admission is appropriate. Many thanks for this video. Well put together and explained so even quite a dim person like me can understand.

[@annahernandez3690]

I learned the acronym INFARCT to memorize the results suggesting a vascular cause: Impulse Normal / Fast-Phase Alternating / Refixation on Cover Test. Thanks for the class!!

[@PeterJohns]

Yes, David Newman-Toker does like his acronyms. :) I personally think that if you need an acronym to remember how to interpret the results, you probably don't understand how to perform and interpret the tests well enough to reply on them. For instance, "Refixation on Cover Test" fits into the "INFARCT" acronym perfectly in terms of the letters "RTC" but in fact doesn't describe the vertical or slanted skew which is what you are looking for. And "Fast phase Alternating" is another example of the descriptive words being changed to fit the acronym. So it's more of a backronym than an acronym. In my opinion, it would be better to refer to a chart such as I made in my Big 3 of vertigo video.kzbin.info/www/bejne/g6jFon2sgqmipLc .

[@danielleottodpt2374]

I am just diving into the world of vestibular rehab as a physical therapist and I appreciate this video so much! Seeing actual video clips of people with abnormal findings and your explanations is invaluable! THANK YOU so much!!

[@einashussein6774]

What an amazing teaching video 👏 I had to perform it on a patient yesterday and I'm glad I've seen this video

[@magedg]

medical resident here, absolutely fantastic explanation, thank you.

[@pedroschmidtfigueiredo5182]

Fantastic video! I've never seen this so well explained in visual terms. I'am starting in neurology residency in a few weeks and that just cheered me a lot. Thank you for sharing this!

[@Dr-Mido]

Amazing! Just amazing. I am speechless. I keep coming back to watch this over and over again ever now and then. Thank you so much. Very clear, simply the best.

[@benjfilm]

Great video! Clear explanations and examples. But as a vestibular rehab physical therapist in acute care, I do both HINTS exam, other oculomotor testing as well as Dix-Hallpike. I have had several patients with an acute vestibular neuritis or labyrinthitis as well as BPPV. On the flip side, I have had doctors write an order to do an Epley Maneuver for BPPV when the patient actually had a neuritis. Patients with a history of neuritis or labyrinthitis are more likely to have a secondary BPPV in the future.

[@PeterJohns]

I agree there are rare occasions where one might do both the HINTS exam and positional testing in the same person. But for the vertigo novice, it's a way to get a false positive HINTS exam in a patient with BPPV, or torture a patient with vestibular neuritis with a Dix-Hallpike test. Sounds like you're not a vertigo novice :)

[@delbenoza5199]

Thank you. I am a physical therapist in Florida and learned a lot from your video.

[@adriennboros8394]

This was one of my favourites medical video I have ever seen! My last neurology exam will be in two weeks, and you helped me a lot with this video!! I am so grateful for these excellent teaching videos like this!

[@IceDr4gonfly]

This is by far one the best, if not the best, video on HINTS exam. Thank you, sir. Very well done! I will share with colleagues and medical students.

[@sharifuldr53]

What a great video. I have watched it many, many times. How clearly did he explain ! I really appreciate this gentleman's effort.

[@TheJakili]

Amazzzing. I read about it but this makes a world of difference. You sir have earned my man of the day vote. Thank you very much

[@PeterJohns]

Hey, glad you found it useful! Thanks so much for your remarks.

[@courtneyban4156]

Learned about this exam during the vestibular unit of my neuro dysfunction class in PT school, so grateful that my professor shared the link to this video as a recommendation for comprehension!

[@luizavizafonseca3293]

Excellent video. The most clearly presented information I've ever found on the HINTS exam. Thank you!

[@moscourussie]

As a neurologist, I always was kinda worried when I had to assess the ENT origin of a vertigo ; now thanks to your video it all looks so simple ! None ever told me about the HINTS, and I only knew Dix/Hallpike or Fukuda, that are of course really harder to perform on a stretcher in emergency room (and apparently a lot less relevant...) Thanks a lot for your great work Dr Johns !

[@PeterJohns]

Thanks for the compliment. I find it easy to perform the Dix-Hallpike test in the emergency department. The key is to turn them around in the stretcher so that their head hangs off the foot of the stretcher. And to get a stool and sit down when doing it. And of course the most important thing is to only perform it on patients with less than 2 min episodes of vertigo and no spontaneous or gaze evoked nystagmus!

[@AlexanderRoux]

Best video on the HI/N/TS exam on the net. Thanks for this Dr Johns

[@daniafatani936]

This is THE BEST video of the Hints exam. Thank you so much !!!

[@josemamartinez1168]

Great video, professor! I am from Uruguay and this video was deeply helpful. Could not imagine someone explaining it better. Congrats on the dedication and how articulate you are!

[@bravonline3052]

Awesome explanation with patients...live long and spread knowledge

[@Ranayal]

Thank you, Neurologists have the the most fun clinical exams

[@PeterJohns]

We have lots of fun stuff in emergency medicine too!

[@jonmsweet]

Outstanding

[@PeterJohns]

Thanks!

[@drcrystalpt5519]

Fantastic! I'm so impressed by all your videos. This is super clear instruction with great demonstrations. Thank you so much.

[@ezralimm]

This video is gold. Recommending to other ED Registrars.

[@jbrokawmd]

Most learning I've done about EM in years! Thanks!

[@PeterJohns]

Thank you for your kind words.

[@gummyypeach]

year 3 medical student here and this helped me sooooo much thank you :)

[@anonymouselephant6540]

very very helpful for my ENT case presentation this week! thank you doctor

[@Pseudosapien29]

Thank you so much sir, that was very crisp to the point and informative at the same time

[@astaraeld]

What wonderful clarity in your explanations. :) I think I learned more in 20 minutes of these videos than in 10 hours of lectures ^^

[@PeterJohns]

What a nice compliment! I’m glad you found it useful.

[@gabriellaximenes9475]

i love your channel so much im watching all your videos on a friday night. Thank you for this content, i´ve been reading about this tests but nothing is like watching someone doing and learning from them. a friend from brazil.

[@mojini2671]

Best video on this examination I have found! Thank you.

[@sealyme01]

Definitely the best video out there on this stuff, which is poorly explained elsewhere. Videos were great. Thanks!

[@PeterJohns]

Thank you!

[@ranjitrajandr]

Great series of teaching videos dealing with a tough subject! Hearty congratulations!

[@PeterJohns]

Thanks!

[@klaymen8559]

Amazing video! Straight to the point explanation. 10/10

[@furyfaerie]

Thank you so much for this Dr Johns, my doubts on how to perform the exam steps have been cleared!

[@peacederm]

That is very clear " bedside teaching", thank you.

[@mariaaziz3496]

An amazing video to understand the differentiation of vertigo .

[@josepbelmonte4791]

Couldn't find better explanation. Great video and great job!

[@MarsW13]

Thank you for the video, it's really informative, the examples with the patients were the highlight! Greetings from Brazil!

[@KFire]

Thank you for providing an example of abnormals.

[@isardesai]

Thank you for your video. (I cannot recall if I've commented before, I tend to be more of a silent viewer). But your video is immensely helpful, and I direct a lot of my more junior colleagues to watch it for their learning too. Thanks for sharing your knowledge and skills.

[@rumit9946]

Excellent demonstration. Thanks for taking the trouble to make these videos.

[@javierdomingolopez7846]

Fantastic video . A pleasure to the eyes

[@Dfl87165]

Abnormal HIT occurs with rapid head movement towards the affected ear, which is away from the direction of the spontaneous nystagmus. Spontaneous nystagmus direction is away from the affected ear, patient usually drifts/falls towards the affected ear, away from the nystagmus direction. HINTS+: hearing test with bilateral finger rub in front of each ear. Unfortunately, the ER often treats indiscriminately with benzodiazepines and/or meclizine. Spontaneous nystagmus can then be significantly suppressed, making the dx more difficult, especially after repeated dosing. In that case you can often still see small amplitude spontaneous nystagmus during the fundoscopic exam!

[@PeterJohns]

Yes, I explained which ear is affected in this video. kzbin.info/www/bejne/n3aZkGVvgcqnb8k I also have a video on HINTS plus. I don't know of any study that showed that the use of drugs can suppress nystagmus to the point where it is not visible. I suggest using a piece of paper to remove fixation. See this video. kzbin.info/www/bejne/m3jGhoecmq2pkMk

[@Dfl87165]

@@PeterJohns Don’t know of any studies either. Just my personal observation, especially in patients waiting for several days before presenting, then getting benzos or meclizine without ER doc even bothering to look for spontaneous nystagmus. Not every ER doc has your vestibular skills😃. Great video series!

[@meganh5878]

Thank you for this Video. I actually saw these examples in another online web course but your explanation is more detailed and easy to follow

[@PeterJohns]

Thanks for that! Very kind of you to say so.

[@jasonjamesramcharan8075]

Very good video...precise and easy to understand

[@supernatural787]

This was a very well explained video! Many thanks for the details and distinctions !

[@stranger5088]

Glad to find this video. I had the Hints test but no clue what it actually was. Very reassuring that mine came out not worrisome. Starting PT tomorrow for the nuritius. Hopefully I can get it fixed pretty quickly.

[@asdfasfsadfasfdasfda]

excelente video, clear, no beating around the bush; directly to indispensable knowledge. Thank you

[@PeterJohns]

Ha! Thank you! People who know me would certainly agree that I don't beat around the bush!

[@alysuleman5900]

Fantastic video!! I've always struggled with tests for vertigo but finally understand it !

[@Sickdude420]

Fantastic video, God bless Peter Johns

[@lavin1817]

best video of hints and explanation i've found so far! Thank you!!

[@IanHockett-qm3fg]

Great video, very informative and clear

[@paulakearns6214]

oh wow, oh wow!!! clarity at last - can i show this to my medical students? they will love it. i can only imagine the chatter...will keep us discussing for ages. thank you

[@PeterJohns]

Of course!

[@commanderortega]

Great video explaining normal and abnormal and I was thinking about the question you posted at the end of the video before it was posted! Greetings from a Mexican Dr that just passed the step 1!

[@BJPdarkhistoryINDIA]

Exception video, loved your presentation 😊

[@diosif]

A great video, both for students and professionals alike! I am an ENT specialist and, though I perform all those test routinely, I enjoyed your video!

[@PeterJohns]

Thanks, we need more cooperation between ENT, neurology and emergency medicine to help educate all physicians about vertigo. Glad you enjoyed the video!

[@king0alknogg]

very beneficial video, this can save hours of reading

[@shruthikaaram7202]

This is an amazing video and explained it very clearly. Keep up the great work. I will add to my presentation for the juniors.

[@gravityclarity]

This can be kinda confusing if you don’t know what the head impulse test being abnormal means. It’s to distinguish between central and peripheral vertigo in pts who are symptomatic (i.e., dizzy). An abnormal test (catch up saccades occur) is reassuring in that it tells you that the vertigo is peripheral (nerve problem) as opposed to central (brain problem-posterior circulation stroke, tumor, etc.).

[@PeterJohns]

Yes, and as I emphasized, the patient must have sustained dizziness AND nystagmus in order to apply HINTS.

[@kennethmoore3783]

Excellent video. Hardest part is getting patient with acute vertigo to cooperate with testing.

[@PeterJohns]

Interesting comment. I find most patients with AVS tolerate the HINTS exam pretty well. Some benefit from an anti-emetic.

[@rodrigovilloutagutierrez529]

Saludos desde Chile... muy buen video para explicar correctamente como evaluar a pacientes con este motivo de consulta tan frecuente. Muchas gracias!

[@PeterJohns]

Eres muy bienvenido!

[@Fatimehghan]

such an amazing video. this helped me so much in my neurology-course at medschool. thank you so much

[@faroukraquib9527]

You made HINTS exam so simple. Thank you.

[@vergilbrown7617]

Excellent! Thank you and please thank your patients as well.

[@AmitKumar-yf3ei]

Superb teaching

[@user-ek3mq1lu4m]

Спасибо за видео, очень здорово и информативно! Всегда делаю этот тест пациентам с головокружением

[@arijitganguly1758]

Best video on the topic

[@soufianehaltout4073]

Thank you doctor for your beautiful explanations !

[@MrThomasAgf]

Great video, using this as clarification on methods in my 5th year of medical school in Denmark. Thank you!

[@faxm9061]

This was god sent. Thank u, good sir!

[@stewartmusk5147]

What an excellent teaching video - so clear! Thank you very much!

[@migatarosita]

Excellent Video Dr.Johns, Thank You.

[@SYEDIHTISHAMULHAQ]

A crisp and comprehensive video 👌

[@PeterJohns]

That's what I try and do, thanks!

[@filipefernandesjustus9733]

Lovely video! Congratulations!

[@gautamphulara6866]

Excellent presentation sir

[@Fstlmnte]

Loved the video. Cleared up everything. Keep them coming!

[@ianblease4135]

great video with excellent explanation - thanks

[@heathercruz65]

You did an excellent job explaining this. Thank you!

[@guywilko]

Fantastic, Very Helpful

[@sshh778]

Best explained I have ever seen!

[@adnanhussain4813]

Thank you for the explanations and great demonstrations on your patients. Subscribed!