BACK TOTOP Browse A-ZSearchBrowse A-ZABCDEFGHIJKLMNOPQRSTUVWXYZ0-9 E-mail FormEmail ResultsName:Email address:Recipients Name:Recipients address:Message: Print-FriendlyBookmarksbookmarks-menuCaloric stimulationCaloric test; Bithermal caloric testing; Cold water calorics; Warm water calorics; Air caloric testingCaloric stimulation is a test that uses differences in temperature to diagnose damage to the acoustic nerve. This is the nerve that is involved in hearing and balance. The test also checks for damage to the brain stem. How the Test is Performed This test stimulates your acoustic nerve by delivering cold or warm water or air into your ear canal. When cold water or air enters your ear and the inner ear changes temperature, it should cause fast, side-to-side eye movements called nystagmus. The test is done in the following way:NystagmusNystagmus is a term to describe uncontrollable movements of the eyes that may be:Side to side (horizontal nystagmus)Up and down (vertical nystagmus)R...Read Article Now Book Mark Article Before the test, your ear, especially the eardrum, will be checked. This is to make sure it is normal. One ear is tested at a time. A small amount of cold water or air is gently delivered into one of your ears. Your eyes should show an involuntary movement called nystagmus. Then they should turn away from that ear and slowly back. If water is used, it is allowed to drain out of the ear canal. Next, a small amount of warm water or air is gently delivered into the same ear. Again, your eyes should show nystagmus. Then they should turn toward that ear and slowly back. Your other ear is tested in the same way.During the test, the health care provider may observe your eyes directly. Most often, this test is done as part of another test called electronystagmography.ElectronystagmographyElectronystagmography is a test that looks at eye movements to see how well nerves in the brain are working. These nerves are:Vestibular nerve (eigh...Read Article Now Book Mark Article How to Prepare for the Test Do not eat a heavy meal before the test. Avoid the following at least 24 hours before the test, because they can affect the results:Alcohol Allergy medicines Caffeine Sedatives Do not stop taking your regular medicines without first talking to your provider. How the Test will Feel You may find the cold water or air in the ear uncomfortable. You may feel your eyes scanning back and forth during nystagmus. You may have vertigo, and sometimes, you may also have nausea. This lasts only a very short time. Vomiting is rare.VertigoDizziness is a term that is often used to describe 2 different symptoms: lightheadedness and vertigo. Lightheadedness is a feeling that you might fai...Read Article Now Book Mark Article Why the Test is Performed This test may be used to find the cause of:Dizziness or vertigo Hearing loss that may be due to certain antibiotics or other drugs It may also be done to look for brain damage in people who are in a coma.ComaDecreased alertness is a state of reduced awareness and is often a serious condition. A coma is the most severe state of decreased alertness from whi...Read Article Now Book Mark Article Normal Results Rapid, side-to-side eye movements should occur when cold or warm water is placed into the ear. The eye movements should be similar on both sides. What Abnormal Results Mean If the rapid, side-to-side eye movements do not occur even after ice cold water is given, there may be damage to the:Nerve of the inner ear Balance sensors of the inner ear Brain Abnormal results may be due to:Poor blood supply to the ear Bleeding (hemorrhage) Blood clot Brain or brain stem damage Cholesteatoma (a type of skin cyst in the middle ear and mastoid bone in the skull) CholesteatomaCholesteatoma is a type of skin cyst that is located in the middle ear and mastoid bone in the skull.Read Article Now Book Mark Article Birth defects of the ear structure or brain Damage to the ear nerves (from infections such as rubella or from medicines) Poisoning Stroke Trauma The test may also be done to diagnose or rule out:Acoustic neuroma (tumor of the acoustic nerve) Acoustic neuromaAn acoustic neuroma is a slow-growing tumor of the nerve that connects the ear to the brain. This nerve is called the vestibular cochlear nerve. It...Read Article Now Book Mark Article Benign positional vertigo (a type of dizziness) Benign positional vertigoBenign positional vertigo is the most common type of vertigo. Vertigo is the feeling that you are spinning or that everything is spinning around you...Read Article Now Book Mark Article Labyrinthitis (irritation and swelling of the inner ear) LabyrinthitisLabyrinthitis is irritation and swelling of the inner ear. It can cause vertigo and hearing loss.Read Article Now Book Mark Article Meniere disease (inner ear disorder that affects balance and hearing)Meniere diseaseMénière disease is an inner ear disorder that affects balance and hearing.Read Article Now Book Mark Article Risks Too much water pressure can injure an already damaged eardrum. This rarely occurs because the amount of water to be used is measured.Water caloric stimulation should not be done if the eardrum is torn (perforated). This is because it can cause an ear infection. It also should not be done during an episode of vertigo because it can make symptoms worse.Ear infectionOtitis is a term for infection or inflammation of the ear.Read Article Now Book Mark Article Open ReferencesReferencesBaloh RW, Jen JC. Hearing and equilibrium. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 400.Kerber KA, Baloh RW. Neuro-otology: diagnosis and management of neuro-otological disorders. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 22.AllVideoImagesTog Tests for Caloric stimulation Caloric stimulationRelated Information Dizziness(Symptoms)Anemia(Condition)Decreased alertness(Symptoms)Rubella(Condition)Atherosclerosis(Condition)Cholesteatoma(Condition)Benign ear cyst or tumor(Condition)Acoustic neuroma(Condition)Benign positional vertigo(Condition)Labyrinthitis(Condition)Anemia - InDepth(In-Depth)Brain tumors - primary - InDepth(In-Depth) Review Date: 1/23/2023 Reviewed By: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School of Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. 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Caloric stimulationCaloric test; Bithermal caloric testing; Cold water calorics; Warm water calorics; Air caloric testingCaloric stimulation is a test that uses differences in temperature to diagnose damage to the acoustic nerve. This is the nerve that is involved in hearing and balance. The test also checks for damage to the brain stem. How the Test is Performed This test stimulates your acoustic nerve by delivering cold or warm water or air into your ear canal. When cold water or air enters your ear and the inner ear changes temperature, it should cause fast, side-to-side eye movements called nystagmus. The test is done in the following way:NystagmusNystagmus is a term to describe uncontrollable movements of the eyes that may be:Side to side (horizontal nystagmus)Up and down (vertical nystagmus)R...Read Article Now Book Mark Article Before the test, your ear, especially the eardrum, will be checked. This is to make sure it is normal. One ear is tested at a time. A small amount of cold water or air is gently delivered into one of your ears. Your eyes should show an involuntary movement called nystagmus. Then they should turn away from that ear and slowly back. If water is used, it is allowed to drain out of the ear canal. Next, a small amount of warm water or air is gently delivered into the same ear. Again, your eyes should show nystagmus. Then they should turn toward that ear and slowly back. Your other ear is tested in the same way.During the test, the health care provider may observe your eyes directly. Most often, this test is done as part of another test called electronystagmography.ElectronystagmographyElectronystagmography is a test that looks at eye movements to see how well nerves in the brain are working. These nerves are:Vestibular nerve (eigh...Read Article Now Book Mark Article How to Prepare for the Test Do not eat a heavy meal before the test. Avoid the following at least 24 hours before the test, because they can affect the results:Alcohol Allergy medicines Caffeine Sedatives Do not stop taking your regular medicines without first talking to your provider. How the Test will Feel You may find the cold water or air in the ear uncomfortable. You may feel your eyes scanning back and forth during nystagmus. You may have vertigo, and sometimes, you may also have nausea. This lasts only a very short time. Vomiting is rare.VertigoDizziness is a term that is often used to describe 2 different symptoms: lightheadedness and vertigo. Lightheadedness is a feeling that you might fai...Read Article Now Book Mark Article Why the Test is Performed This test may be used to find the cause of:Dizziness or vertigo Hearing loss that may be due to certain antibiotics or other drugs It may also be done to look for brain damage in people who are in a coma.ComaDecreased alertness is a state of reduced awareness and is often a serious condition. A coma is the most severe state of decreased alertness from whi...Read Article Now Book Mark Article Normal Results Rapid, side-to-side eye movements should occur when cold or warm water is placed into the ear. The eye movements should be similar on both sides. What Abnormal Results Mean If the rapid, side-to-side eye movements do not occur even after ice cold water is given, there may be damage to the:Nerve of the inner ear Balance sensors of the inner ear Brain Abnormal results may be due to:Poor blood supply to the ear Bleeding (hemorrhage) Blood clot Brain or brain stem damage Cholesteatoma (a type of skin cyst in the middle ear and mastoid bone in the skull) CholesteatomaCholesteatoma is a type of skin cyst that is located in the middle ear and mastoid bone in the skull.Read Article Now Book Mark Article Birth defects of the ear structure or brain Damage to the ear nerves (from infections such as rubella or from medicines) Poisoning Stroke Trauma The test may also be done to diagnose or rule out:Acoustic neuroma (tumor of the acoustic nerve) Acoustic neuromaAn acoustic neuroma is a slow-growing tumor of the nerve that connects the ear to the brain. This nerve is called the vestibular cochlear nerve. It...Read Article Now Book Mark Article Benign positional vertigo (a type of dizziness) Benign positional vertigoBenign positional vertigo is the most common type of vertigo. Vertigo is the feeling that you are spinning or that everything is spinning around you...Read Article Now Book Mark Article Labyrinthitis (irritation and swelling of the inner ear) LabyrinthitisLabyrinthitis is irritation and swelling of the inner ear. It can cause vertigo and hearing loss.Read Article Now Book Mark Article Meniere disease (inner ear disorder that affects balance and hearing)Meniere diseaseMénière disease is an inner ear disorder that affects balance and hearing.Read Article Now Book Mark Article Risks Too much water pressure can injure an already damaged eardrum. This rarely occurs because the amount of water to be used is measured.Water caloric stimulation should not be done if the eardrum is torn (perforated). This is because it can cause an ear infection. It also should not be done during an episode of vertigo because it can make symptoms worse.Ear infectionOtitis is a term for infection or inflammation of the ear.Read Article Now Book Mark Article Open ReferencesReferencesBaloh RW, Jen JC. Hearing and equilibrium. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 400.Kerber KA, Baloh RW. Neuro-otology: diagnosis and management of neuro-otological disorders. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 22.
