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Hot or cold? Is monothermal caloric testing useful and cost-effective?
Matthew L Bush1, Christopher M Bingcang, Edward T Chang
1Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA.
The Annals of Otology, Rhinology, and Laryngology
|July 11, 2013
Summary
Monothermal caloric testing effectively screens for unilateral vestibular weakness (UVW), but cannot predict other abnormal Videonystagmography (VNG) findings. This method offers a time-efficient approach to balance dysfunction assessment.
Area of Science:
- Otolaryngology
- Neurology
- Vestibular Science
Background:
- Videonystagmography (VNG) is crucial for assessing balance dysfunction.
- The complete VNG test battery is lengthy and can cause patient discomfort.
- Evaluating the efficiency of abbreviated VNG protocols is essential.
Purpose of the Study:
- To assess monothermal caloric testing's predictive value for unilateral caloric weakness (UVW).
- To determine its efficacy in predicting abnormal VNG vestibular and nonvestibular eye movements.
- To consider the time and reimbursement implications of VNG testing.
Main Methods:
- Retrospective review of 645 patients undergoing comprehensive VNG with bithermal caloric testing.
- Calculation of specificity, sensitivity, and predictive values for monothermal caloric testing.
- Comparison of monothermal results against bithermal caloric and noncaloric VNG findings.
Main Results:
- Warm-air monothermal caloric testing showed 87% sensitivity and 90% negative predictive value for UVW (25% interear difference).
- Sensitivity increased to 95% and negative predictive value to 92% with a 10% UVW definition.
- Positive predictive value for noncaloric VNG findings was 85%, with a 18% negative predictive value.
Conclusions:
- Monothermal caloric testing is a sensitive screening tool for unilateral vestibular weakness (UVW).
- It is insufficient for predicting noncaloric VNG abnormalities.
- Optimizing VNG protocols requires balancing diagnostic yield with patient experience and resource allocation.
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