The Occurrence of Directional Preponderance in some Intracranial Disorders A Study of the Fitzgerald-Hallpike Caloric Test

This study defines the normal limits of day-to-day variation in vestibular function. A short-acting caloric test was used and nystagmus intensity was measured by means of an interactive computerized technique. Data were analyzed from 30 normal subjects tested on three successive days and from ten of these subjects who were also tested on 11 additional occasions. Individual caloric test scores generally remained between 55% and 170% of their initial value; narrower ranges resulted when scores were averaged together. There was very little habituation of caloric responses. The upper normal limits of test-retest variation in scores for right-left difference and directional preponderance of caloric responses were 24% and 22%, respectively.

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The Caloric Test: A Review of Its Principles and Practice with Especial Reference to the Phenomenon of Directional Preponderance

The Vestibular System and Its Diseases ◽

10.9783/9781512808698-012 ◽

1966 ◽

Author(s):

C. S. Hallpike

Keyword(s):

Caloric Test ◽

Especial Reference ◽

Directional Preponderance

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Directional Preponderance (DP) of Caloric Test in Patients with Various Inner Ear Lesions.

Equilibrium Research ◽

10.3757/jser.53.247 ◽

1994 ◽

Vol 53 (2) ◽

pp. 247-251

Author(s):

Motohisa Ikeda ◽

Isamu Watanabe ◽

Jiro Muto

Keyword(s):

Inner Ear ◽

Caloric Test ◽

Directional Preponderance

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Hallpike’s Caloric Test

10.1093/med/9780190600129.003.0015 ◽

2016 ◽

Author(s):

Robert W. Baloh

Keyword(s):

Body Temperature ◽

Inner Ear ◽

Caloric Test ◽

Ear Canal ◽

Caloric Testing ◽

Minute Period ◽

Rapid Flow ◽

Series Of Experiments ◽

Directional Preponderance

Charles Hallpike decided that greater precision could be obtained with the caloric test by measurement of one or more attributes of the responses to some suitably graded stimulus. He chose to measure the duration of induced nystagmus. Hallpike chose water at 30°C and 44°C (7°C below and above body temperature, respectively) and allowed it to flow for 40 seconds. These temperatures were generally well tolerated, and the comparatively large quantity of water and rapid flow minimized errors due to misdirecting the stream within the ear canal. A simple chart was used to summarize the results of the bithermal caloric test. The chart consisted of two continuous lines, each representing a total of a 3-minute period, subdivided into 10-second intervals. Hallpike conducted a series of experiments on the phenomenon of directional preponderance with caloric testing and emphasized the importance of vestibular tonus originating from the inner ear receptors.

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A head-tilt caloric test for evaluating the vertical semicircular canal function

Acta Oto-Laryngologica ◽

10.3109/00016480902721402 ◽

2009 ◽

Vol 129 (11) ◽

pp. 1226-1231 ◽

Cited By ~ 6

Author(s):

Sachiko Aoki ◽

Yasuko Arai ◽

Keiko Yoda ◽

Suguru Nishida

Keyword(s):

Semicircular Canal ◽

Head Tilt ◽

Caloric Test ◽

Vertical Semicircular Canal

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The impact of vestibular symptoms and electronystagmography results on recovery from sudden sensorineural hearing loss

Journal of Basic and Clinical Physiology and Pharmacology ◽

10.1515/jbcpp-2020-0354 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Gaelle Vofo ◽

Marrigje Aagje de Jong ◽

Michal Kaufman ◽

Julia Meyler ◽

Ron Eliashar ◽

...

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Small Sample Size ◽

Small Sample ◽

Sudden Sensorineural Hearing Loss ◽

Sensorineural Hearing ◽

Caloric Test ◽

Routine Identification ◽

The Impact ◽

Caloric Tests

Abstract Objectives Idiopathic sudden sensorineural hearing loss (SSNHL) represents a frequently encountered otological entity, of various types and severity, with an array of associated symptoms including vertigo. This is a devastating life-changing condition with a blurry prognosis. The objective of this study was to determine the clinical association of vestibular impairment by electronystagmography (ENG) and caloric tests, and their ability to predict prognosis. Methods An observational, crossectional study was carried out amongst patients admitted with SSNHL. Each consenting patient had an audiometry test performed on admission as well as ENG and caloric tests. Treatment included oral steroids and carbogen with intratympanic steroids used only as salvage treatment. Follow-up was completed after 6 months when hearing gains were evaluated. Finally, an association was sought between the rate of recovery and ENG and caloric test results. Results Of 35 patients included, marked recovery was seen in patients without vertigo when compared to those with vertigo (p=0.003). A statistically significant association was found between the presence of vertigo and hearing deterioration (p=0.008). More so, normal electronystagmography results were associated with marked recovery (p=0.04). Conclusions The vestibular end organs are both subjectively and objectively affected in SSNHL as demonstrated by the abnormal ENG and caloric tests in our study despite the small sample size. Concomitant vestibular involvement carries poorer prognosis and routine identification may help foresee the recovery of patients with SSNHL and as such, aid in patient counseling. ENG and caloric tests are easily available and may be recommended for all patients with SSNHL.

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