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Towards an optimized monothermal caloric screening test: comparing stimuli and thresholds.
Halil Erdem Özel1, Ahmet Taha Karakuzu1, Hümeyra Temir2
1Department of Otolaryngology, University of Health Sciences, Kocaeli City Hospital, Kocaeli, Turkey.
International Journal of Audiology
|October 6, 2025
Summary
Warm air monothermal caloric testing (MCT) is an effective screening tool for vestibular weakness. It offers high accuracy and can reduce the need for more extensive bithermal caloric testing (BCT).
Area of Science:
- Vestibular System Physiology
- Otolaryngology
- Neurology
Background:
- Monothermal caloric testing (MCT) is a potential screening method for vestibular disorders.
- Optimal stimulus type and diagnostic thresholds for MCT require further clarification.
Purpose of the Study:
- To determine the most effective stimulus (air vs. water, warm vs. cool) for MCT.
- To identify the optimal cut-off threshold (15% or 25%) for maximizing MCT's diagnostic performance.
Main Methods:
- Retrospective analysis of bithermal caloric test (BCT) data from 202 adults.
- MCT results were evaluated at 15% and 25% thresholds, comparing sensitivity, specificity, and accuracy against BCT as the reference standard.
Main Results:
- Warm air MCT showed the highest sensitivity (86.7%) and diagnostic accuracy (94%) at the 25% threshold, with a low false negative rate (6%).
- Cool water MCT offered the highest specificity (78.7%) at the 25% threshold.
- A 15% threshold slightly increased accuracy but also increased referrals for BCT.
Conclusions:
- Warm air MCT is an efficient screening tool for unilateral vestibular weakness.
- This method provides high diagnostic accuracy and can potentially decrease the necessity for comprehensive BCT.
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