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Sex differences in caloric nystagmus intensity: Should reference values be updated?
Johannes Gerb1,2, Sandra Becker-Bense1, Doreen Huppert1
1German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Munich, Germany.
Annals of the New York Academy of Sciences
|March 6, 2025
Summary
Bithermal caloric testing reveals sex-based differences in vestibular reactivity. Current diagnostic criteria for vestibular disorders may need updating due to these sex-specific variations in caloric excitability.
Area of Science:
- Neuroscience
- Otolaryngology
- Diagnostic Medicine
Background:
- Bithermal caloric irrigation is crucial for diagnosing peripheral vestibular hypofunction.
- Current diagnostic criteria for unilateral vestibulopathy (UVP), bilateral vestibulopathy (BVP), and presbyvestibulopathy (PVP) use gender-neutral metrics.
- Sex-specific differences in vestibular function may impact diagnostic accuracy.
Purpose of the Study:
- To analyze sex-based differences in total caloric reactivity (TR) using bithermal caloric irrigation data.
- To evaluate the impact of these differences on the diagnosis of UVP, BVP, and PVP.
- To determine if current diagnostic criteria require revision to account for sex-specific variations.
Main Methods:
- Analysis of 11,332 bithermal water caloric examinations from the German Center for Vertigo and Balance Disorders (DSGZ) (07/2018–01/2024).
- Calculation of total caloric reactivity (TR) and collection of patient age and sex.
- Application of international diagnostic criteria for UVP, BVP, and PVP, analyzing both absolute and relative metrics.
Main Results:
- Females exhibited significantly higher TR compared to males (mean difference: 6.41°/s, p<0.001).
- Diagnosis of UVP, BVP, and PVP using absolute cut-offs showed a male predominance.
- Diagnosis of UVP based on relative asymmetries revealed no significant sex differences (OR -0.08, p = 0.06).
Conclusions:
- Significant sex differences exist in caloric excitability, with females showing higher TR.
- Current diagnostic criteria for UVP, BVP, and PVP relying on absolute caloric excitability may be biased.
- Revisions to diagnostic criteria are recommended to incorporate sex-specific differences for accurate vestibular disorder diagnosis.
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