1
2
5
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X

Caloric stimulation
Definition:
A test which uses differences in temperature to diagnose ear nerve damage as a cause of dizziness or vertigo. Damage to the vestibular portion of the acoustic nerve (the nerve of the inner ear) is one of the more common causes of vertigo.

Alternative Names:
Caloric test; ENG (electronystagmogram)

How the test is performed:

Each ear is tested separately using a computerized caloric stimulation machine. Nystagmus (quick movement of both eyes in response to certain stimuli which is necessary for normal vision and balance) is measured using electrodes around the eye and recorded for analysis by the computer. Cold water (30 degree C) is instilled in the ear canal with a bulb syringe. This should cause nystagmus. This test is then repeated using warm water (44 degree C). The nystagmus should occur in the opposite direction (towards the warm water then slowly away, rather than away from the water and slowly back). This test is analyzed by the computer for both cold and warm water response for each ear and differences between ears as well as between cold and warm water responses are calculated. Occasionally warm and cold air (in cases with hole in the ear drum) or ice cold water (in absence of any response) is used for this test.
How to prepare for the test:

Adults:
Avoid eating a heavy meal before the test. Avoid caffeine, alcohol, allergy medications, and sedatives at least 24 hours prior to the test (as that can affect the results). Ask for written instructions from your doctor prior to the test.

Infants and children:
The physical and psychological preparation you can provide for this or any test or procedure depends on your child's age, interests, previous experiences, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child's age:
How the test will feel:
There is minimal discomfort. Some people find cold water in the ear uncomfortable. Brief, but severe vertigo may occur during the test.
Why the test is performed:
Caloric stimulation is performed to evaluate the acoustic nerve, which provides hearing and helps with balance. This test may be recommended when someone is experiencing dizziness or vertigo, when there is impaired hearing, with suspected toxicity from certain antibiotics, with some anemias, when psychological causes of vertigo are suspected, and to determine the presence or extent of brain damage in a comatose person.
Normal Values:
Nystagmus should occur after instillation of cold or warm water into the ear. The nystagmus should be similar on both sides.
What abnormal results mean:

If nystagmus does not occur after cold or warm water is instilled or there is a difference between the responses of each ear or between cold and warm water response, there may be some damage to the nerve of the inner ear, which controls balance. If nystagmus does not occur even after ice cold water is instilled, permanent damage to the nerve has probably occurred.

Any disease or injury that damages the acoustic nerve can cause vertigo. This may include congenital disorders; trauma; rubella; vascular (blood vessel) disorders with hemorrhage (bleeding), thrombosis (clots), or atherosclerosis of the blood supply of the ear; cholesteatoma and other ear tumors; some poisons; and ototoxic (toxic to the ear nerves) medications including aminoglycoside antibiotics, some antimalarial drugs, loop diuretics, and salicylates.

Additional conditions for which the test may be performed:

What the risks are:
Excessive water pressure can injure a previously damaged eardrum, but this rarely occurs since the amount of water to be used is measured in advance. Caloric stimulation should not be performed if the eardrum is perforated because of the risk of causing ear infection. Caloric testing should not be performed during an acute vertigo episode as it can make symptoms worse.
Special considerations:
Caloric stimulation is approximately 80% accurate in differentiating nerve damage as a cause of vertigo. Other tests may be required to confirm the diagnosis.
Review Date: 11/28/2001
Reviewed By: Ashutosh Kacker, M.D., Department of Otolaryngology, New York Presbyterian Hospital, New York, NY. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2003 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com