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Related Experiment Video

Updated: Oct 31, 2025

Estimating Vestibular Perceptual Thresholds Using a Six-Degree-Of-Freedom Motion Platform
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Paradigm shift in acute dizziness: is caloric testing obsolete?

Miranda Morrison1, Athanasia Korda1, Ewa Zamaro1

  • 1Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, 3010, Bern, Switzerland.

Journal of Neurology
|June 30, 2021
PubMed
Summary

Video head impulse test (vHIT) is more accurate than caloric testing for diagnosing acute vestibular stroke versus neuritis. Caloric testing may lead to misdiagnosis in 25% of vestibular stroke cases.

Keywords:
Acute strokeCaloric testingDizzinessHead-impulse testNeuritisVertigo

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Area of Science:

  • Neurology
  • Otolaryngology
  • Diagnostic Imaging

Background:

  • Bithermal caloric testing, a long-standing gold standard for detecting peripheral vestibular hypofunction, has been used for over a century.
  • Its discovery was recognized with a Nobel Prize, highlighting its historical significance in vestibular diagnostics.

Purpose of the Study:

  • To compare the diagnostic accuracy of caloric testing with the video head impulse test (vHIT).
  • To differentiate between vestibular neuritis and vestibular strokes in patients presenting with acute dizziness.

Main Methods:

  • Prospective cross-sectional study involving 152 patients with acute vestibular syndrome.
  • Patients underwent caloric testing and vHIT, followed by MRI to confirm vestibular stroke.
  • The study assessed 58 patients with vestibular neuritis and 27 with stroke.

Main Results:

  • Caloric testing showed 75% sensitivity and 86.8% specificity for stroke detection, with a 25% misclassification rate.
  • vHIT demonstrated higher accuracy with 91.7% sensitivity and 88.7% specificity, and only an 8% misclassification rate.
  • A caloric asymmetry cut-off of 30.9% and a VOR gain cut-off of 0.685 were analyzed.

Conclusions:

  • vHIT is more accurate than caloric testing in distinguishing between vestibular stroke and neuritis in acute dizziness.
  • Asymmetric caloric responses can occur in vestibular strokes, potentially leading to misdiagnosis.
  • The study recommends replacing caloric testing with vHIT in acute settings, while acknowledging its utility in outpatient evaluations.