Question
What is the clinical significance of bilateral hyperactive caloric response?
Answer
Caloric responses are identified as hyperactive when the peak slow phase velocities are greater than 80 deg/sec (some laboratories use a lower limit of 60 deg/sec for cool irrigations). True caloric hyperactivity is almost always bilateral and denotes a central vestibular abnormality.
Since the incidence of hyperactive caloric responses in ENG is very low (less than 1 in 1000 ENG tests), the examiner should rule out a few technical problems. The responses are not considered hyperactive if only one or two out of four irrigations is greater than 80 deg/sec. Such a result usually indicates either an artifact that requires repeating the irrigation or presence of strong spontaneous nystagmus that is added to the caloric response. When the responses from only one ear are hyperactive, the patient has two different abnormalities, a peripheral vestibular lesion on the side of the weakness plus a central lesion. The examiner should rule out tympanic membrane perforation on the side of the stronger responses. Air irrigation of a perforated ear sometimes generates very strong responses. Finally, the examiner must make sure the results are not due to overcalibration.
Kamran Barin is the Director of the Balance Disorders Clinic at the Ohio State University, Department of Otolaryngology. He has taught national, international, and graduate level courses in vestibular function testing since 1983.
Kamran Barin, PhD
Director of Balance Disorders Clinic at the Ohio State University Medical Center and Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Department of Speech and Hearing Science, and Biomedical Engineering Program
Kamran Barin, Ph.D. is the Director of Balance Disorders Clinic at the Ohio State University Medical Center and Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Department of Speech and Hearing Science, and Biomedical Engineering Program. He received his Master’s and Doctorate degrees in Electrical/Biomedical Engineering from the Ohio State University. He has taught national and international courses and seminars in different areas of vestibular assessment and rehabilitation. Kamran Barin is a consultant to Otometrics and provides courses and other educational material to the company
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