The Suppression Head Impulse Paradigm in Clinical Vestibular Testing: An Interpretation-Focused Narrative Review

Suppression head impulse test (SHIMP) is a video head impulse test paradigm in which the visual target is head-fixed. Because the head impulse stimulus is identical to the conventional head impulse paradigm (HIMP; earth-fixed target), the 2 paradigms provide complementary information: HIMP primarily reveals vestibular hypofunction through compensatory catch-up saccades, whereas SHIMP elicits post-impulse...

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Audiologists and neurotologists performing video head impulse testing should review this interpretation guide for SHIMP, as misreading SHIMP vs. standard vHIT responses is a known clinical pitfall; this review may directly improve diagnostic accuracy.

SHIMP is increasingly available on commercial vHIT platforms, yet interpretation guidelines lag behind adoption, making a focused interpretation review clinically timely.

1. 01SHIMP uses a head-fixed visual target, unlike standard vHIT which uses a fixed target, generating distinct eye-movement patterns.
2. 02Review is focused on clinical interpretation rather than test methodology alone.
3. 03SHIMP-generated saccades differ from those in standard vHIT and require different interpretation rules.
4. 04Misinterpretation of SHIMP results is a recognized risk in routine clinical settings.
5. 05Published in the Journal of International Advanced Otology 2026.

PMID

42732638

DOI

10.65717/iao.2026.262416.

Journal

Journal of International Advanced Otology

Publication type

review

Evidence level

5

Population

Clinicians performing clinical vestibular testing (narrative review; no primary patient cohort)

Intervention

Suppression head impulse paradigm (SHIMP) as a clinical vestibular assessment tool

Comparator

Standard video head impulse test (vHIT)