Reevaluating Order Effects in the Binaural Bithermal Caloric Test

Burnette, Elizabeth; Piker, Erin G.; Frank‐Ito, Dennis O.

doi:10.1044/2017_aja-17-0028

Cited by 5 publications

(5 citation statements)

References 8 publications

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“…For DP, a difference between the right and left beating nystagmus of more than 30% (DP ≥ 30%) was considered pathological. The Cal test was considered normal when both canal paresis and DP were normal [ 33 , 34 ].…”

Section: Methodsmentioning

confidence: 99%

Presence of Spontaneous Nystagmus, Benign Paroxysmal Positional Vertigo, and Tumarkin Fall in Patients With Primary Headache and Their Responses to Caloric and Video Head Impulse Tests

Zhang,

Yu,

Zhou

et al. 2024

J Clin Med Res

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Background Migraine, vestibular migraine (VM) and tension-type headache (TTH) are the most common disorders in dizziness and headache clinics, associated with dizziness or vertigo and postural imbalance, causing a substantial burden on the individual and the society. The objective of this research was to examine the presence of spontaneous nystagmus, comorbidity of benign paroxysmal positional vertigo (BPPV), and Tumarkin fall in patients; additionally, the study focused on assessing the patients’ responses to bithermal caloric irrigation and video head impulse test (vHIT). Methods Consecutive patients diagnosed with migraine, VM, and TTH according to the International Classification of Headache Disorders, third edition (beta version (ICHD-3β)), who were referred to Dizziness and Headache Clinic were enrolled. BPPV and Tumarkin fall were assessed by questionnaires. The presence of BPPV was further evaluated through Dix-Hallpike or head roll maneuver, while spontaneous nystagmus was monitored using video-oculography during interictal period. Lastly, patients’ responses to bithermal caloric irrigation and vHIT were analyzed. Results There was a significantly higher incidence of spontaneous nystagmus in VM compared to both migraine and TTH. The drop attack episodes were slightly more frequent in VM than in TTH and migraine, though not statistically significant. The prevalence of BPPV was significantly higher in VM than in migraine and TTH. Unilateral vestibular paresis was more common in the VM group than in migraine and TTH. There was profound unilateral weakness (UW) in VM patients than in migraine, but no significant difference was found between VM and TTH. In VM, the percentage of saccades along with reduced vHIT gain was significantly higher than in migraine. Lastly, the percentage of abnormal response in vHIT was significantly lower than the percentage of abnormal UW in caloric irrigation across all groups. Conclusions In VM patients, the prevalences of decompensated peripheral damage and BPPV were higher than in migraine and TTH patients as disclosed by the presence of peripheral spontaneous nystagmus and abnormal vHIT during the interictal period. Our findings suggest that the peripheral vestibular system acts as a significant mechanism in the pathogenesis of VM, and it might also be involved in migraine and TTH cases without vertigo symptoms.

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Section: Methodsmentioning

confidence: 99%

Presence of Spontaneous Nystagmus, Benign Paroxysmal Positional Vertigo, and Tumarkin Fall in Patients With Primary Headache and Their Responses to Caloric and Video Head Impulse Tests

Zhang,

Yu,

Zhou

et al. 2024

J Clin Med Res

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“…The most important parameter for the quantitative evaluation of caloric test is the maximum Slow-Phase Velocity (SPV) of the nystagmus in degrees per second. 15 - 19 …”

Section: Methodsmentioning

confidence: 99%

“…The most important parameter for the quantitative evaluation of caloric test is the maximum Slow-Phase Velocity (SPV) of the nystagmus in degrees per second. [15][16][17][18][19] The 4 responses were represented by the subsequent codes: WR-warm stimulus in right ear; WL-warm stimulus in left ear; CR-cool stimulus in right ear; CL-cool stimulus in left ear. 20,21…”

Section: Methodsmentioning

confidence: 99%

Can Type of Dizziness Influence the Vestibular Caloric Test Result?

Felipe

Staggs

Hunnicutt

2021

J Prim Care Community Health

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Background: The broad range of vestibular tests used to diagnose labyrinth diseases allows for a functional assessment of the vestibular system. Among the many tests performed, the caloric test is considered the gold standard by providing an objective measurement of the vestibular function for each labyrinth. Objective: to correlate the different types of dizziness with the caloric test result. Methods: a descriptive study was performed based on the previous records of vestibular tests performed on patients with body balance disorders evaluated at Audiology Service between 2000 and 2020. The variables evaluated were sex, age, hearing loss, tinnitus, and caloric test result. Results: the sample was composed of 892 patients, 654 (73.4%) women, and 238 (26.6%) men. Normal results were obtained for 57.4% (N = 514) of the individuals, while peripheral disease 40.1% (N = 357), and central disease 2.5% (N = 21) accounted for the remaining. Complaint of vertigo was not common in central disorders ( P = .02; OR = 0.17) and instability was associated with bilateral vestibular weakness ( P = 0.02; OR = 5.92). Vertigo associated with tinnitus and/or hearing loss was more frequent in the caloric test with peripheral abnormality ( P = 0.008). Conclusion: complaints of vertigo associated with tinnitus and/or hearing loss must be directed for clinical observation of unilateral peripheral lesion and instability to central disease or bilateral peripheral lesion.

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“…To optimize stimulation, horizontal canals are aligned with the vertical plane by asking the test subject in a supine position to tilt the head 20°-30° [64]. Irrigations of sufficient volume (> 250 ml) should last at least 30 s and can be performed in any order [65][66][67]. For the sake of standardization, it is advised to use cold irrigation first on the right, followed by cold on the left, then warm on the right, and finally warm on the left.…”

Section: Caloric Testingmentioning

confidence: 99%

Diagnosing vestibular hypofunction: an update

et al. 2020

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Unilateral or bilateral vestibular hypofunction presents most commonly with symptoms of dizziness or postural imbalance and affects a large population. However, it is often missed because no quantitative testing of vestibular function is performed, or misdiagnosed due to a lack of standardization of vestibular testing. Therefore, this article reviews the current status of the most frequently used vestibular tests for canal and otolith function. This information can also be used to reach a consensus about the systematic diagnosis of vestibular hypofunction.

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Reevaluating Order Effects in the Binaural Bithermal Caloric Test

Abstract: This experiment demonstrated that while there is great inter-individual and intra-individual variability in caloric test results, the order of irrigations had no significant effect in the test. Future studies may explore the effects of nonphysiological factors on test results.

Cited by 5 publications

References 8 publications

Presence of Spontaneous Nystagmus, Benign Paroxysmal Positional Vertigo, and Tumarkin Fall in Patients With Primary Headache and Their Responses to Caloric and Video Head Impulse Tests

Presence of Spontaneous Nystagmus, Benign Paroxysmal Positional Vertigo, and Tumarkin Fall in Patients With Primary Headache and Their Responses to Caloric and Video Head Impulse Tests

Can Type of Dizziness Influence the Vestibular Caloric Test Result?

Diagnosing vestibular hypofunction: an update

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