The McGill Physiology Virtual Lab

Biological Signals Acquisition

EOG tests > Caloric testing
 

Pathological modification of nystagmus patterns is an important clinical aid to the diagnosis of lesions to the vestibular system.

  As you have seen, vestibular nystagmus can be elicited by rotating a subject in a swivel chair. In the clinic, the vestibular nystagmus may also be elicited using a caloric stimulus. This procedure is referred to as caloric testing. The test takes advantage of the fact that the sensory organ of the inner ear, which senses horizontal head motion, bulges laterally towards the middle ear space.
 
In the caloric test, the sensory organ on one side of the head is locally cooled (or warmed) by pouring cool (or warm) water into the external auditory meatus. By tilting the head back to the proper angle, a warm water stimulus will cause convection currents in the fluid filled vestibular end organ resulting in neural excitation of the central vestibular pathways.
Using warm water in the right ear, an ocular nystagmus is evoked in which the slow phase is towards the left side, and conversely the fast phase is towards the right. Cold water will have the opposite effect. (Note: the sensors on the right and left sides of the head are normally excited by rightward and leftward head motion respectively). The patterns of nystagmus evoked by this artificial stimulus provide important clinical clues regarding the integrity of both peripheral and central vestibular function. An important advantage of this type of caloric testing over rotational testing is that the peripheral vestibular apparatus on each side of the head can be examined independently.

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Adapted from Brookler KH, in Lee KJ, Stewart C, eds. Ambulatory surgery and office procedures in head and neck surgery. Philadelphia: Grune & Stratton,1986.

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