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Dissociation between caloric and head impulse testing in patients with congenital abnormalities of the semicircular canals

  • B Shaw (a1) and R S Raghavan (a1)

Abstract

Background

Dissociation between caloric and head impulse test results in patients with vestibular disorders has been well documented since the introduction of video head impulse testing. Prior to the introduction of video head impulse testing, vestibular diagnostic services relied mainly on caloric testing, and it is now known that the caloric testing shows more positive results than video head impulse testing. A dissipation model was proposed to explain this dissociation.

Case reports

This paper presents two cases in which caloric testing indicated an absent or significantly reduced response on the horizontal semicircular canal plane but video head impulse testing showed near-normal or normal vestibulo-ocular reflex gain on the same plane.

Conclusion

This report supports the dissipation theory and questions the functional relevance of canal paresis values calculated from caloric test results.

Copyright

Corresponding author

Author for correspondence: Dr R Srinivasa Raghavan, Department of ENT, Royal Surrey Hospital, Guildford, Surrey, GU2 7XX, UK E-mail: rsr@doctors.org.uk

Footnotes

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Dr R S Raghavan takes responsibility for the integrity of the content of the paper

A report of case one was presented at the British Association of Audiovestibular Physicians Annual Conference, 16–17 March 2017, Chesham, UK.

Footnotes

References

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1McGarvie, LA, Curthoys, IS, MacDougall, HG, Halmagyi, GM. What does the dissociation between the results of video head impulse versus caloric testing reveal about the vestibular dysfunction in Ménière's disease? Acta Otolaryngol 2015;135:859–65
2Maire, R, Van Melle, G. Vestibulo-ocular reflex characteristics in patients with unilateral Meniere's disease. Otol Neurotol 2008;29:693–8
3Furman, JM, Kamerer, DB. Rotational responses in patients with bilateral caloric reduction. Acta Otolaryngol 1989;108:355–61
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5McCaslin, DL, Jacobson, GP, Bennett, ML, Gruenwald, JM, Green, AP. Predictive properties of the video head impulse test: measures of caloric symmetry and self-report dizziness handicap. Ear Hear 2014;35:E18591
6McGarvie, LA, Curthoys, IS, MacDougall, HG, Halmagyi, GM. What does the head impulse test versus caloric dissociation reveal about vestibular dysfunction in Ménière's disease? Ann N Y Acad Sci 2015;1343:5862
7Valli, P, Buizza, A, Botta, L, Zucca, G, Ghezzi, L, Valli, S. Convection, buoyancy or endolymph expansion: what is the actual mechanism responsible for the caloric response of semicircular canals? J Vestib Res 2002;12:155–65
8Gentine, A, Eichhorn, JL, Kopp, C, Conraux, C. Modelling the action of caloric stimulation of the vestibule. I. The hydrostatic model. Acta Otolaryngol 1990;110:328–33
9Grieser, B, McGarvie, L, Kleiser, L, Manzari, L, Obrist, D, Curthoys, I. Numerical investigations of the effects of endolymphatic hydrops on the VOR response. J Vestib Res 2014;24:219
10Choi, JE, Kim, YK, Cho, YS, Lee, K, Park, HW, Yoon, SH et al. Morphological correlation between caloric tests and vestibular hydrous in Ménière's disease using intravenous Gd enhanced inner ear MRI. PLoS One 2017;12:e0188301
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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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