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The minimal ice water caloric test compared with established vestibular caloric test procedures
pp. 215 - 224
Frank Schmäl, Björn Lübben, Kerstin Weiberg, Wolfgang Stoll

Caloric testing of the vestibular labyrinth is usually performed by classical caloric test procedures (CCTP) using water warmed to 30°C and 44°C. Ice water irrigation (4°C) is usually not performed, although it might be useful as a bedside test. To verify the validity of the Minimal Ice Water Caloric Test (MIWCT), comparative video-oculographic investigations were performed in 22 healthy subjects using ice water (0.5 ml, 1.0 ml, 2 ml), CCTP, and cold air (27°C). Frequency, amplitude, slow phase velocity (SPV), the onset, and the duration of nystagmus were documented. After addition of three ice cubes, the temperature of conventional tap water (16°C) fell within 13 min to 4°C. In pessimum position the subjects demonstrated no nystagmus response. Compared to CCTP, MIWCT was associated with a significantly later onset of nystagmus and a significant prolongation of the nystagmus reaction. In contrast to air stimulation (27°C), a significant Spearman's correlation was noted between MIWCT (1 and 2 ml) and established CCTP in respect of essential nystagmus parameters (frequency, amplitude and SPV). Furthermore, MIWCT (0.5 and 1 ml) showed a higher sensitivity and specificity with regard to the detection of canal paresis based on Jongkees' formula compared to stimulation with air 27°C. Thus, MIWCT appears to be a suitable procedure for bedside investigation of vestibular function outside the vestibular laboratory, e.g. in a hospital ward, where bedridden patients with vertigo occasionally require vestibular testing.