Caloric stimulation and video-head impulse testing in Ménière’s disease and vestibular migraine

Abstract

Conclusion: Both the bithermal caloric test and the video-head impulse test (vHIT) were more often abnormal in Ménière’s disease (MD) than in vestibular migraine (VM). Horizontal vestibulo-ocular reflex (hVOR) evaluation with caloric test (low-frequency test) was significantly more often abnormal than vHIT (high-frequency test). Therefore, both tests can be used in a complementary way for frequency-selective testing of peripheral vestibular function. Objectives: To compare the results of caloric testing and vHIT in MD and VM and to determine which test is more sensitive to uncover peripheral vestibular hypofunction. Methods: Patients with MD (n=30) or VM (n=23) were examined with the caloric test and vHIT. The parameters analyzed were the canal paresis factor for the caloric test and the hVOR gain on both sides in vHIT. Results: The caloric test was abnormal in 67% of patients with MD and in 22% with VM (p=0.002), while the vHIT showed an hVOR deficit in 37% in MD and 9% in VM (p=0.025). In all, 28% of patients with an abnormal caloric test had a normal vHIT, whereas 6% of those with an abnormal vHIT had a normal caloric test. The sensitivity of vHIT compared with caloric testing was 55% for MD and 40% for VM. Neither the caloric test nor vHIT could detect significant differences between early (<5 years) or advanced stages (>5 years) of MD or VM.

Keywords::

• Caloric test
• vertigo
• dizziness
• Ménière
• vestibular migraine
• video-head impulse test

Acknowledgments

The authors thank Ralf Helbig for technical assistance and Dipl.-Ing. Andreas Blödow for editing the figures.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.