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Triple test as predictive screen for unilateral weakness on caloric testing in routine practice.

Christian Rohrmeier¹, Otto Richter, Michael Schneider

¹Department of Otorhinolaryngology, University of Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, Germany. christian.rohrmeier@ukr.de

Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [And] European Academy of Otology and Neurotology

|February 28, 2013

Summary

The bedside triple test effectively screens for vertigo, reliably ruling out unilateral weakness and pronounced canal paresis. This rapid assessment aids in diagnosing vestibular disorders in routine practice.

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Area of Science:

Neurology
Otolaryngology
Vestibular System Diagnostics

Background:

Vertigo is a common symptom requiring accurate diagnosis.
Caloric testing is a standard but time-consuming diagnostic method for vestibular disorders.
A rapid bedside assessment could improve diagnostic efficiency.

Purpose of the Study:

To evaluate the predictive accuracy of a triple bedside test for normal caloric testing results in vertigo patients.
To determine the negative predictive value (NPV) of the triple test.

Main Methods:

Prospective, single-blind diagnostic study.
151 patients with acute or recent vertigo symptoms.
Triple bedside test (spontaneous nystagmus, head-shaking nystagmus, head impulse test) compared to caloric testing.

Main Results:

The triple test demonstrated an 80.4% NPV for unilateral weakness (>=25%) and a 94.1% NPV for pronounced canal paresis (>=50%).
Sensitivity and specificity varied depending on the severity of caloric test abnormalities.
Examiner experience influenced test results (p < 0.05).

Conclusions:

The triple bedside test is a valuable screening tool for vertigo.
It reliably excludes unilateral weakness and pronounced canal paresis, simplifying vestibular assessment.
This test enhances diagnostic efficiency in routine clinical practice.