92537 Caloric vestibular test with recording, bilateral; bithermal (ie, one warm and one cool irrigation in each ear for a total of four irrigations)

Name of the Procedure:

Caloric Vestibular Test with Recording, Bilateral; Bithermal (i.e., one warm and one cool irrigation in each ear for a total of four irrigations)

Summary

The Caloric Vestibular Test is a diagnostic procedure used to evaluate the function of the inner ear and its connection to the brain. This test involves irrigating each ear twice, once with warm water and once with cool water, to stimulate the inner ear and assess how well it sends signals to the brain.

Purpose

The purpose of the Caloric Vestibular Test is to diagnose potential disorders of the vestibular system, which is responsible for balance and spatial orientation. The test aims to identify any abnormalities or dysfunctions in the inner ear that may contribute to dizziness, vertigo, or balance issues.

Indications

• Symptoms of dizziness, vertigo, or imbalance
• Suspected vestibular disorders such as vestibular neuritis or Meniere's disease
• Unexplained hearing loss
• Pre-operative assessment for ear surgery
• Monitoring progression of known vestibular conditions

Preparation

• Patients may be instructed to avoid caffeine, alcohol, and certain medications (e.g., sedatives, tranquilizers) for 24 hours before the test.
• Typically, no fasting is required.
• Patients may be advised to wear comfortable clothing and bring a friend or family member for support, as dizziness may occur post-test.

Procedure Description

1. The patient is seated or lies down on an examination table.
2. Each ear is irrigated, first with warm water and then with cool water, in separate sessions. Each irrigation lasts for about 30 seconds.
3. Eye movements (nystagmus) are recorded using special goggles or electrodes; this data helps evaluate the function of the vestibular system.
4. The procedure is repeated for the other ear, resulting in a total of four irrigations.

Duration

The entire procedure typically takes about 45 minutes to 1 hour.

Setting

The test is usually performed in a specialized outpatient clinic or hospital setting equipped with the necessary diagnostic tools.

Personnel

Usually conducted by an audiologist or an otolaryngologist (ENT specialist). A nurse or medical assistant may also be present.

Risks and Complications

• Common: Mild to moderate dizziness or vertigo during and shortly after the procedure.
• Rare: Nausea or vomiting, ear discomfort, temporary hearing changes.
• Very rare: Ear infection or injury to the ear canal.

Benefits

• Provides valuable diagnostic information about the function of the vestibular system.
• Helps in planning appropriate treatment or management for balance disorders.
• Non-invasive with minimal discomfort.

Recovery

• Post-procedure, patients may feel dizzy for a short period.
• It is advisable to rest for a few minutes after the test.
• Patients should avoid driving or operating heavy machinery for the rest of the day.
• Follow-up appointments may be scheduled to discuss results and treatment plans.

Alternatives

• Rotational chair testing or video head impulse testing (vHIT)
• Pros: Other tests may be less discomforting.
• Cons: May not provide the same detailed information as the Caloric Vestibular Test.

Patient Experience

Patients might experience a sensation of spinning or dizziness during and shortly after the irrigations. This is a normal response and subsides quickly. Comfortable setting and reassurance from healthcare personnel help in managing any discomfort experienced during the test.