Caloric stimulation and video-head impulse testing in Ménière's disease and vestibular migraine

Both the bithermal caloric test and the video-head impulse test (vHIT) were more often abnormal in Ménière's disease (MD) than in vestibular migraine (VM). Horizontal vestibulo-ocular reflex (hVOR) evaluation with caloric test (low-frequency test) was significantly more often abnormal than vHIT (high-frequency test). Therefore, both tests can be used in a complementary way for frequency-selective testing of peripheral vestibular function.

To compare the results of caloric testing and vHIT in MD and VM and to determine which test is more sensitive to uncover peripheral vestibular hypofunction.

Patients with MD (n=30) or VM (n=23) were examined with the caloric test and vHIT. The parameters analyzed were the canal paresis factor for the caloric test and the hVOR gain on both sides in vHIT.

The caloric test was abnormal in 67% of patients with MD and in 22% with VM (p=0.002), while the vHIT showed an hVOR deficit in 37% in MD and 9% in VM (p=0.025). In all, 28% of patients with an abnormal caloric test had a normal vHIT, whereas 6% of those with an abnormal vHIT had a normal caloric test. The sensitivity of vHIT compared with caloric testing was 55% for MD and 40% for VM. Neither the caloric test nor vHIT could detect significant differences between early (<5 years) or advanced stages (>5 years) of MD or VM.