Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes 4 tests), with recording
CPT4 code
Name of the Procedure:
Caloric Vestibular Test
Common Names: Caloric Test, Caloric Stimulation Test
Summary
The caloric vestibular test involves irrigating each ear with warm and cool water (or air) to evaluate the function of the vestibular system in the inner ear. This test measures how well the brain can detect and respond to balance and head motion signals from the ear.
Purpose
The caloric vestibular test assesses the function of the vestibular (balance) portion of the inner ear. It is used to diagnose causes of dizziness, vertigo, or balance problems by providing information on whether one ear is more sensitive or less responsive than the other.
Indications
- Dizziness or vertigo
- Balance problems
- Suspected vestibular system disorders
- Unexplained falls
- Investigating the cause of nystagmus (rapid, involuntary eye movement)
Preparation
- Do not eat or drink anything for a few hours before the test.
- Avoid consuming caffeine, alcohol, and certain medications (as directed by your healthcare provider) that could affect the results.
- Inform your healthcare professional if you have earwax buildup, an ear infection, or ear surgery history.
Procedure Description
- The patient is seated or lying down in a comfortable position.
- Cool and warm water (or air) is sequentially irrigated into each ear canal.
- The temperature difference stimulates the inner ear, causing nystagmus (eye movement), which is recorded and analyzed.
- The test is conducted in four phases: warm water in the right ear, warm water in the left ear, cool water in the right ear, and cool water in the left ear.
- Each irrigation lasts about 30 seconds, and eye movements are recorded using special goggles.
Duration
The procedure typically takes about 30 to 45 minutes.
Setting
The caloric vestibular test is usually performed in an outpatient clinic, an audiologist’s office, or a hospital setting.
Personnel
- Audiologist
- Otorhinolaryngologist (ENT specialist)
- Trained healthcare professional
Risks and Complications
- Dizziness or vertigo during and shortly after the test
- Nausea or vomiting
- Discomfort or temporary hearing changes
- Rare risk of ear canal irritation or infection
Benefits
- Identification of vestibular disorders
- Aids in diagnosing the cause of dizziness or balance issues
- Helps in planning appropriate treatment or management strategies
Recovery
- Patients may feel dizzy or lightheaded for a short period after the test.
- Resting for a few minutes post-test is recommended.
- Patients can typically resume normal activities soon after the procedure.
- Follow-up appointments may be scheduled to discuss test results and treatment plans.
Alternatives
- Electronystagmography (ENG)
- Rotary chair test
- Vestibular evoked myogenic potentials (VEMP)
- MRI or CT scanning for structural assessment
Each alternative has its own set of benefits and limitations. For instance, ENG offers a more comprehensive analysis of eye movements, while MRI scans can provide detailed images of inner ear structures but lack specific functional testing capabilities.
Patient Experience
During the test, the patient may experience a sensation of spinning (vertigo) and may feel dizzy or nauseous. The healthcare provider will ensure patient comfort, and measures will be taken to manage distress. Dizziness typically subsides quickly following the procedure. Pain management is usually not required, but reassuring communication and patient care play a crucial role in comfort.