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Dizziness is a common complaint in both ambulatory and inpatient settings. Caloric testing is a valuable clinical tool for evaluating patients with dizziness. It independently assesses and quantifies the functional status of the vestibular system of each inner ear. By stimulating the vestibulo-ocular reflex, caloric testing can reveal unilateral peripheral vestibular deficits that may underlie the patient’s symptoms. As the vestibulo-ocular reflex requires an intact brainstem, caloric testing can also assess brainstem function in comatose patients. This activity describes the indications, contraindications, techniques, and clinical relevance of caloric testing. Objectives: Identify appropriate indications and contraindications for caloric testing in patients with dizziness or vestibular disorders. Apply proper techniques for caloric testing, including using warm air in patients with contraindications to water methods. Select alternate methods of caloric testing in patients with contraindications to water as a testing medium. Implement interprofessional team strategies for improving care coordination and communication to enhance care delivery for patients with dizziness. Access free multiple choice questions on this topic.

Caloric testing is a valuable clinical tool for evaluating patients with dizziness. It independently assesses and quantifies the functional status of the vestibular system of each inner ear. By eliciting the vestibulo-ocular reflex, caloric testing can reveal unilateral peripheral vestibular deficits that may underlie the patient’s symptoms.[1] The vestibulo-ocular reflex requires an intact functional brainstem. This reflex allows for eye fixation on a stationary target while the head is in motion, keeping the target object in the center of the visual field and maintaining the line of sight.[2] As described below, caloric testing manipulates the vestibulo-ocular reflex to assess the integrity of the lateral semicircular canals and their afferent nerves. Abnormalities in caloric testing are documented in individuals with unilateral hearing loss and can serve as an ancillary test.[3]

The adverse effects of caloric testing are generally mild and temporary. Some patients may experience a feeling of fullness or pressure in the ear and a slight increase in dizziness or vertigo. These symptoms typically subside within a few minutes of test completion. In rare cases, some patients experience more severe adverse effects such as vertigo, nausea, or vomiting. Long-term sequelae are not commonly associated with caloric testing.[1]

Caloric testing to assess vestibular dysfunction is typically performed by the practitioner as a bedside test, though additional assistance from nursing staff may be needed to ensure proper execution. In addition, if electro-oculography or video-oculography is used, expertise and specialized training in handling this equipment are essential, and input from a trained audiologist may be required. Caloric testing with warm air is suitable for patients with chronic suppurative otitis media and perforations of the tympanic membrane. This method requires less preparation and fewer personnel, potentially reducing complications compared to testing with water.[4]