Monothermal Caloric Screening to Improve Healthcare Value

Thatcher, Aaron L.; Beckerman, Margot L.; Telian, Steven A.; King, W. M.

doi:10.1097/aud.0000000000000262

Cited by 13 publications

(7 citation statements)

References 17 publications

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“…On the other hand, it has to be as reliable as a BCT, with high sensitivity and acceptable specificity for use as a screening test in specialized neurotology clinics. The DP results of BCT were not included in the study, as it requires four irrigations to be calculated, it does not represent asymmetry, such as UW, and it could deviate to either side without the presence of HSN [ 10 , 11 , 12 , 13 , 15 , 16 ]. Previous studies using water caloric tests have shown that the sensitivity of the MWST is higher than that of the MCST, and the specificity is nearly similar [ 5 , 7 , 8 , 11 , 12 , 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…HSN is a failure factor that decreases the sensitivity and specificity of MCT [ 11 , 12 , 18 , 19 , 20 , 21 ]. A positive HSN of >4°/s in the VNG is considered an indication of BCT [ 5 , 6 , 13 ]. Other studies found the presence of HSN regardless of its velocity, which is an indication of BCT [ 11 , 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Many authors have proven that MCT is an invalid screening test because of the high false negative predictive value reaching 29% [ 7 , 8 , 9 ] and high false positive predictive value ranging from 48% to 78% [ 9 , 10 ]. On the other hand, many authors found that MCT is a valid test with warm water irrigation after excluding the failure criteria [ 11 , 12 ] that could increase the false negative rate; therefore, it needs to be completed by a BCT; these failure criteria are: (1) IAD lower than 15%; (2) SPEV less than 8°/s for each warm irrigation [ 13 ]; (3) horizontal spontaneous nystagmus (HSN) of 4°/s or higher [ 5 , 12 , 13 ]. Different study group sizes, different failure criteria for pathologic BCT, variations in test procedures, and stimulus types will result in conflicting results and different conclusions.…”

Section: Introductionmentioning

confidence: 99%

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Reliability of Monothermal Caloric Test as Screening Test of Vestibular System

Alhabib

Saliba

2022

JCM

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This retrospective study completed at a tertiary care center aimed to assess the monothermal caloric test (MCT) as a screening test, using the bithermal caloric test (BCT) as a reference. Additionally, it attempts to measure the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a fixed inter-auricular difference (IAD) value for both cold and warm stimuli using water irrigation. Medical records of 259 patients referred for vestibular symptoms who underwent BCT with water irrigation were reviewed. Patients with bilateral vestibular weakness and caloric tests using air irrigation were excluded. BCT showed 40.9% unilateral weakness. Two formulas were used to determine the monothermal caloric asymmetry (MCA-1 and MCA-2). The measurement of agreement Kappa between the two formulas in comparison with BCT revealed moderate agreement at 0.54 and 0.53 for hot and cold stimulation, respectively. The monothermal warm stimulating test (MWST) using MCA-2 showed better results, with a sensitivity of 80%, specificity of 91%, PPV of 83.1%, and NPV of 89.2%. Thirty-four patients had horizontal spontaneous nystagmus (HSN) with a mean velocity of 2.25°/s. These patients showed better sensitivity but lower specificity after adjustment of HSN using the MCA-2 formula at warm temperatures. Therefore, they should complete the caloric test with cold irrigation to perform the BCT. MCT is efficient as a screening test if the warm stimulus is used with the MCA-2 formula fixed at 25%. If present, HSNs should be adjusted. Negative IAD (normal) in the absence or presence of adjusted HSN or slow-phase eye velocity ≤ 6°/s at each right and left warm stimulation should be accomplished by the BCT.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reliability of Monothermal Caloric Test as Screening Test of Vestibular System

Alhabib

Saliba

2022

JCM

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“…To minimize the burden for the patient, the warm caloric test was not performed in this study. It should be noted, however, that the added value of combined cold and warm (i.e., bithermal) caloric tests is still under debate ( 26 – 29 ).…”

Section: Methodsmentioning

confidence: 99%

The Reliance on Vestibular Information During Standing Balance Control Decreases With Severity of Vestibular Dysfunction

et al. 2018

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The vestibular system is involved in gaze stabilization and standing balance control. However, it is unclear whether vestibular dysfunction affects both processes to a similar extent. Therefore, the objective of this study was to determine how the reliance on vestibular information during standing balance control is related to gaze stabilization deficits in patients with vestibular dysfunction. Eleven patients with vestibular dysfunction and twelve healthy subjects were included. Gaze stabilization deficits were established by spontaneous nystagmus examination, caloric test, rotational chair test, and head impulse test. Standing balance control was assessed by measuring the body sway (BS) responses to continuous support surface rotations of 0.5° and 1.0° peak-to-peak while subjects had their eyes closed. A balance control model was fitted on the measured BS responses to estimate balance control parameters, including the vestibular weight, which represents the reliance on vestibular information. Using multivariate analysis of variance, balance parameters were compared between patients with vestibular dysfunction and healthy subjects. Robust regression was used to investigate correlations between gaze stabilization and the vestibular weight. Our results showed that the vestibular weight was smaller in patients with vestibular dysfunction than in healthy subjects (F = 7.67, p = 0.011). The vestibular weight during 0.5° peak-to-peak support surface rotations decreased with increasing spontaneous nystagmus eye velocity (ρ = −0.82, p < 0.001). In addition, the vestibular weight during 0.5° and 1.0° peak-to-peak support surface rotations decreased with increasing ocular response bias during rotational chair testing (ρ = −0.72, p = 0.02 and ρ = −0.67, p = 0.04, respectively). These findings suggest that the reliance on vestibular information during standing balance control decreases with the severity of vestibular dysfunction. We conclude that particular gaze stabilization tests may be used to predict the effect of vestibular dysfunction on standing balance control.

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“…When each ear is stimulated separately, a left-right asymmetry >20–30% in peak slow-phase eye velocity is considered evidence of a vestibular deficit (1). While the caloric test is relatively inexpensive (3), it does have limitations. Firstly, it only assesses lateral canal function (4).…”

Section: Introductionmentioning

confidence: 99%

Comparing Ocular Responses to Caloric Irrigation and Electrical Vestibular Stimulation in Vestibular Schwannoma

et al. 2019

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Electrical Vestibular Stimulation (EVS) is a non-invasive technique for activating the vestibular-ocular reflex, evoking mainly a torsional eye movement response. We have previously demonstrated that this response can be used to detect vestibular asymmetry in patients with vestibular schwannoma (VS). Here we perform a direct comparison of EVS with caloric irrigation in this patient group. We studied 30 patients with unilateral VS, alongside an equal number of aged-matched healthy control subjects. EVS current was delivered to the mastoid process in a monaural configuration using a sinusoidal stimulus (2 Hz; ± 2 mA; 10 s), with an electrode placed over the spinous C7 process. Evoked eye movements were recorded from the right eye in darkness using an infra-red sensitive camera while the subject sat relaxed with their head on a chinrest. Ocular torsion was subsequently tracked off-line using iris striations. Each subject separately underwent water caloric irrigation, in accordance with the British Society of Audiology guidelines. For the caloric test, eye movement was recorded in the yaw axis using electro-oculography. For both EVS and calorics, inter-aural response asymmetry was calculated to determine the extent of canal paresis. Both tests revealed impaired vestibular function in the ipsilesional ear of VS patients, with a mean asymmetry ratio of 15 ± 17% and 18 ± 16% for EVS and calorics, respectively. Overall, the caloric test results discriminated controls from patients slightly more effectively than EVS (Cohen's D effect size = 1.44 vs. 1.19). Importantly, there was a significant moderate correlation between the AR values produced by EVS and calorics (r = 0.53, p < 0.01), and no significant difference between mean AR estimates. When questioned, ≥85% of participants subjectively preferred the EVS experience, in terms of comfort. Moreover, it took ~15 min to complete, vs. ~1 h for caloric. These results confirm that the results of the EVS test broadly agree with those of caloric irrigation, in terms of detecting vestibular asymmetry. Furthermore, they suggest a higher degree of convenience and patient comfort.

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Monothermal Caloric Screening to Improve Healthcare Value

Abstract: Warm monothermal caloric screening can reduce time and cost of vestibular testing while nearly matching the diagnostic accuracy of bithermal testing.

Cited by 13 publications

References 17 publications

Reliability of Monothermal Caloric Test as Screening Test of Vestibular System

Reliability of Monothermal Caloric Test as Screening Test of Vestibular System

The Reliance on Vestibular Information During Standing Balance Control Decreases With Severity of Vestibular Dysfunction

Comparing Ocular Responses to Caloric Irrigation and Electrical Vestibular Stimulation in Vestibular Schwannoma

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