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Monothermal caloric testing in the screening of vestibular function
Avi Shupak1, Margalit Kaminer, Peter Gilbey
1Unit of Otoneurology, Lin Medical Center, Haifa, Israel. shupak@internet-zahav.net
Aviation, Space, and Environmental Medicine
|April 10, 2010
Summary
Monothermal caloric testing (MT) can predict alternate binaural bithermal caloric test (ABBT) results when electronystagmography (ENG) is normal. However, a 10% false-negative rate for warm MT lateralization < 32% prevents its routine clinical use for screening vestibular deficits.
Area of Science:
- Neurology
- Otolaryngology
- Vestibular System Assessment
Background:
- The alternate binaural bithermal caloric test (ABBT) is the gold standard for evaluating dizzy patients.
- Monothermal caloric testing (MT) offers potential benefits like reduced testing time and patient discomfort.
Purpose of the Study:
- To investigate the efficacy of monothermal caloric testing (MT) as a screening tool for predicting alternate binaural bithermal caloric test (ABBT) outcomes.
Main Methods:
- Retrospective analysis of ABBT results from 218 patients with normal otoneurological exams, hearing, and ENG to establish norms.
- Calculation of MT sensitivity and specificity for predicting normal ABBT in 197 dizzy patients.
Main Results:
- Optimal prediction of ABBT by MT occurred with normal ENG (oculomotor integrity, no nystagmus).
- Warm MT lateralization < 32% demonstrated 90% sensitivity and 92% specificity for predicting normal ABBT under these conditions.
Conclusions:
- Warm MT lateralization < 32% with normal ENG can suggest normal ABBT but carries a 10% false-negative risk.
- This false-negative rate limits routine clinical use of MT for screening vestibular deficits in healthy populations.
- Adjusting the cut-off for response asymmetry and omitting directional preponderance could potentially increase sensitivity.
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