Caloric test: methodology, principles, and general concepts

Czech version

Authors: Maja Stříteská ^1-3; K. Kozynkina-Marchenko ^1,4; Michal Homoláč ^1,2
Authors‘ workplace: Klinika otorinolaryngologie a chirurgie hlavy a krku, Fakultní nemocnice Hradec Králové ¹; Univerzita Karlova, Lékařská fakulta v Hradci Králové ²; Otorinolaryngologická klinika, Fakultní nemocnice Královské Vinohrady, Praha ³; Otorinolaryngologické oddělení, Orlickoústecká nemocnice ⁴
Published in: Otorinolaryngol Foniatr, 74, 2025, No. 4, pp. 324-331.
Category: Review Article
doi: https://doi.org/10.48095/ccorl2025324

Overview

The literature review summarizes the principles and methodology of the caloric test, a unique vestibular examination that allows for the separate evaluation of the excitatory and inhibitory functions of the vestibulo-ocular reflex (VOR) on each side of the peripheral vestibular system, specifically the lateral semicircular canals (LSCC). The article describes how the caloric test induces nystagmus based on the convection current of endolymph in the LSCC, depending on the temperature used. It explains the significance of evaluating unilateral weakness and directional preponderance as the main comparative results of the test. Furthermore, it addresses the interpretation of the absolute values of the caloric test. The caloric test, despite being time-consuming in routine clinical practice, remains an irreplaceable tool for the detailed assessment of the function of the peripheral vestibular end organ. Modern videonystagmography technology and sophisticated software for the analysis of recordings have significantly improved the accuracy and sensitivity of the test.

Keywords:

vestibuloocular reflex – caloric test – unilateral weakness – Jongkees’ formula – calorization – canal paresis – stronger ear formula – directional preponderance

Sources

1. Bárány R. Untersuchuangen uber das Verhalten des Vestibularapparates bei Kopftraumen und ihre praktische Bedeuntung. 1907.

2. Jongkees LBW, Maas JPM, Philipszoon AJ. Clinical Nystagmography. Orl 1962; 24 (2): 65–93. Doi: 10.1159/000274383.

3. Jongkees LB. The caloric test and its value in evaluation of the patient with vertigo. Otolaryngol Clin North Am 1973; 6 (1): 73–93.

4. Fitzgerald G, Hallpike CS. Studies in human vestibular function: I. Observations on the directional preponderance (“NYSTAGMUSBEREITSCHAFT”) of caloric nystagmus resulting from cerebral lesions. Brain 1942; 65 (2): 115–137. Doi: 10.1093/brain/65.2.115.

5. Jongkees LB, Philipszoon AJ. Electronystagmography. Acta Otolaryngol Suppl 1964; 189.

6. Ewald JR. Physiologische Untersuchungen uber das Endorgan des Nervus Octavus. Wiesbaden: J. F. Bergmann 1982.

7. Baloh RW, Honrubia V, Konrad HR. Ewald‘s second law re-evaluated. Acta Otolaryngol 1977; 83 (5–6): 475–479. Doi: 10.3109/0001 6487709128874.

8. Halmagyi GM, Curthoys IS, Cremer PD et al. Head impulses after unilateral vestibular deafferentation validate Ewald‘s second law. J Vestib Res 1990; 1 (2): 187–197.

9. Feldmann H, Huttenbrink KB, Delank KW. Heat radiation –⁠ an essential factor of heat transport in caloric vestibular tests? Current experimental findings. Laryngorhinootologie 1991; 70 (10): 521–531. Doi: 10.1055/s-2007-998090.

10. Cunha LC, Felipe L, Carvalho SA et al. Validity of the monothermal caloric testing when compared to bithermal stimulation. Pro Fono 2010; 22 (1): 67–70. Doi: 10.1590/s0104-56872010 000100013.

11. Barber HO, Wright G, Demanuele F. The hot caloric test as a clinical screening device. Arch Otolaryngol 1971; 94 (4): 335–337. Doi: 10.1001/archotol.1971.00770070527008.

12. Brookler KH. Importance of simultaneous binaural bithermal caloric testing. Ear Nose Throat J 2002; 81 (4): 199.

13. Brookler KH. Simultaneous bilateral bithermal caloric stimulation in electronystagmography. Laryngoscope 1971; 81 (7): 1014–1019. Doi: 10.1288/00005537-197107000-00003.

14. Furman JM, Wall C jr, Kamerer DB. Alternate and simultaneous binaural bithermal caloric testing: a comparison. Ann Otol Rhinol Laryngol 1988; 97 (4 Pt 1): 359–364. Doi: 10.1177/000348948809700406.

15. Barber HO, Stockwell CW. Autho. Manual of electronystagmography. C. V. Mosby 1980.

16. Barber HO, Stockwell CW. Autho. Manual of electronystagmography. Mosby 1976.

17. Jacobson GP, Shepard NT, Barin K et al. Balance Function Assessment and Management. Plural Publishing, Incorporated 2020.

18. Wexler DB. Nonlinearity of the Jongkees difference equation for vestibular hypofunction. Otolaryngol Head Neck Surg 1994; 111 (4): 485–487. Doi: 10.1177/019459989411100416.

19. Barin K. Caloric Testing. In: Balance Function Assessment and Management. San Diego, California: Plural Publishing 2021 : 257–282.

20. Striteska M, Wexler D, Tichacek O et al. Vestibular asymmetry in caloric and video head impulse testing: Do we interpret it correctly? J Vestib Res 2025 : 9574271251336143. Doi: 10.1177/09574271251336143.

21. Striteska M, Skoloudik L, Valis M et al. Estimated Vestibulogram (EVEST) for Effective Vestibular Assessment. Biomed Res Int 2021; 2021 : 8845943. Doi: 10.1155/2021/8845943.

22. Kozynkina-Marchenko K. Multifrekvenční testování pacientů po akutním izolovaném vestibulárním deficitu. Otorinolaryngol Foniatr 2024; 73 (2): 71–80. Doi: 10.48095/ccorl 202471.

23. Strupp M, Kim JS, Murofushi T et al. Bilateral vestibulopathy: Diagnostic criteria Consensus document of the Classification Committee of the Barany Society. J Vestib Res 2017; 27 (4): 177–189. Doi: 10.3233/VES-170619.

24. Spector M. Electronystagmographic findings in central nervous system disease. Ann Otol Rhinol Laryngol 1975; 84 (3 Pt 1): 374–378. Doi: 10.1177/000348947508400315.

Prohlášení o střetu zájmu

Autor práce prohlašuje, že v souvislosti s tématem, vznikem a publikací tohoto článku není ve střetu zájmů a vznik ani publikace článku nebyly podpořeny žádnou farmaceutickou firmou. Toto prohlášení se týká i všech spoluautorů.

Grantová podpora

Tento výstup vznikl v rámci programu Cooperatio, vědní oblasti Surg.

Přijato k recenzi: 17. 5. 2025

Přijato k tisku: 4. 7. 2025

MUDr. Maja Stříteská, Ph.D.

Klinika otorinolaryngologie a chirurgie hlavy a krku

FN Hradec Králové

Sokolská 581

500 05 Hradec Králové

mstriteska@seznam.cz