The Head Impulse, Nystagmus, Test of Skew (HINTS) examination is a widely recognized bedside tool for distinguishing peripheral vestibular disorders from central causes, such as stroke, in patients presenting with acute vestibular syndrome. However, despite its introduction in 2009, confusion persists regarding its proper application....
✦ The floor
Discussion
Signed responses from readers of the wire.
Audiologists and vestibular specialists who perform bedside dizziness assessment should review this guidance on appropriate HINTS application to avoid misclassifying central causes of dizziness as peripheral.
Clarifying the clinical indications for the HINTS exam could reduce missed strokes and unnecessary referrals, directly affecting triage in vestibular practice.
- 01Review published in JAMA Neurology on appropriate use of the HINTS (Head Impulse, Nystagmus, Test of Skew) examination.
- 02HINTS is a bedside tool used to distinguish inner-ear dizziness from central (brain-related) dizziness.
- 03Proper patient selection is critical — misapplication can lead to missed central pathology.
- 04Relevant for audiologists, vestibular therapists, and emergency clinicians managing acute dizziness.
- 05Review format synthesises existing evidence to produce clinical guidance rather than new primary data.
The HINTS examination can differentiate peripheral vestibular disorders from central causes of dizziness at the bedside.
guidelinesupportedPatient selection criteria determine the diagnostic accuracy of the HINTS exam.
guidelinesupported- PMID
- 42766300
- DOI
- 10.1001/jamaneurol.2026.2942.
- Journal
- JAMA Neurology
- Publication type
- review
- Evidence level
- 5
- Population
- Patients presenting with acute dizziness
- Intervention
- HINTS (Head Impulse, Nystagmus, Test of Skew) bedside examination
Primary outcomes
Appropriate clinical indications for HINTS; Differentiation of peripheral vs central dizziness