Order effects in caloric testing

Patients at the Department of ENT at the University Medical Center Mainz undergoing caloric tests in the standard order warm right (WR), warm left (WL), cold left (CL), cold right (CR) showed a higher response during warm irrigation on the left side compared to the right. Aim of the study was to examine, whether this observation could be confirmed and if the order of irrigation has an effect on the intensity of response.

22 patients without any history of vestibular disorders received 4 caloric tests in randomized order (WR, WL, CL, CR; WL, WR, CR, CL; CR, CL, WL, WR; CL, CR, WR, WL). The nystagmus was recorded by electronystagmography (ENG) and Slow Phase Velocity (SPV) as well as labyrinthine preponderance (LP) were calculated.

The response to the 2^nd warm irrigation was always more intense compared to the first. This was independent of the order of irrigation or the point in time of the caloric test. Additionally, a significant difference in labyrinthine preponderance was found depending on the first side of warm irrigation. The response on the right side was more intense, when the warm irrigation was applied on the left side first and vice versa.

There was no significant difference for the labyrinthine preponderance depending on whether cold irrigation was applied at the beginning or not.

The hypothesis of equal reactions of both labyrinths during caloric testing appears to be wrong. These findings may results in a systematic error of data interpretation.

Poster-PDF A-1290.pdf

Publication History

Article published online:
13 May 2021