The minimal ice water caloric test compared with established vestibular caloric test procedures

Abstract

Caloric testing of the vestibular labyrinth is usually performed by classical caloric test procedures (CCTP) using water warmed to 30°C and 44°C. Ice water irrigation (4°C) is usually not performed, although it might be useful as a bedside test. To verify the validity of the Minimal Ice Water Caloric Test (MIWCT), comparative video-oculographic investigations were performed in 22 healthy subjects using ice water (0.5 ml, 1.0 ml, 2 ml), CCTP, and cold air (27°C). Frequency, amplitude, slow phase velocity (SPV), the onset, and the duration of nystagmus were documented. After addition of three ice cubes, the temperature of conventional tap water (16°C) fell within 13 min to 4°C. In pessimum position the subjects demonstrated no nystagmus response. Compared to CCTP, MIWCT was associated with a significantly later onset of nystagmus and a significant prolongation of the nystagmus reaction. In contrast to air stimulation (27°C), a significant Spearman's correlation was noted between MIWCT (1 and 2 ml) and established CCTP in respect of essential nystagmus parameters (frequency, amplitude and SPV). Furthermore, MIWCT (0.5 and 1 ml) showed a higher sensitivity and specificity with regard to the detection of canal paresis based on Jongkees' formula compared to stimulation with air 27°C. Thus, MIWCT appears to be a suitable procedure for bedside investigation of vestibular function outside the vestibular laboratory, e.g. in a hospital ward, where bedridden patients with vertigo occasionally require vestibular testing.

Altered Resting‐State Intranetwork and Internetwork Functional Connectivity in Patients With Chronic Unilateral Vestibulopathy

“…CUVP was diagnosed according to the caloric test, UVP was defined as a reduced response of >25% (i.e. canal paresis [CP] > 25%) on one side, as calculated using Jongkees' formula 14 . Exclusion criteria were patients who had ophthalmic disease, eye movement disorders or who were unable to see objects; patients who had severe cervical spondylosis, severe cardiovascular disease, severe central nervous system disease; patients with contraindication to MRI, such as claustrophobia; and patients who had previous history of acute vestibular syndrome accompanied by auditory symptoms (such as hearing loss or tinnitus), central vestibular disorders, head injury, severe anxiety or depression.…”

Video-Oculography-Assisted Head Impulse Test and Caloric Testing for Detecting Stroke in Acute Vertigo Patients via Modified HINTS Plus

“…Therefore, our results need to be interpreted with caution and we cannot comment on the feasibility of caloric-testing-assisted vertigo assessment at initial presentation to the emergency room. However, modified caloric testing protocols were shown to provide a feasible procedure for swift bedside evaluation of vestibular function outside the vestibular laboratory [15]. Viewed in conjunction with our data, these advances form a basis for follow-up research in a larger sample of AVS to determine the feasibility and diagnostic accuracy of rapid caloric testing as part of the proposed Cal-NTS plus algorithm to detect underlying stroke.…”

Oral Administration of TrkB Agonist, 7, 8–Dihydroxyflavone Regenerates Hair Cells and Restores Function after Gentamicin–Induced Vestibular Injury in Guinea Pig

“…A stopwatch and digital infrared charge-coupled device (CCD) video camera (DVSA10FHDIR, Kenko, Japan) were used to record the duration of the induced nystagmus. Quantitative data were derived using the standard Jonkee’s formula for canal paresis (CP) utilizing the duration of the induced nystagmus responses on the GM-treated and unaffected sides [ 47 ].…”