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Caloric Test for Dizziness - What to Expect

Updated on July 30, 2017
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I suffer from dizziness due to unilateral vestibular hypofunction. In this article, I explain how caloric testing assisted in diagnosis.

If you have a suspected inner ear problem that affects your balance and makes you dizzy, caloric testing can help provide a more definitive diagnosis. So, what does the test involve?

In this article, I will provide an overview of how this test works, and will also share my own experience with the procedure. In doing so, I hope to educate others about what to expect.

A patient undergoing caloric testing
A patient undergoing caloric testing | Source

What is a caloric test?

The test is used to see how the horizontal, semi-circular canal of the inner ear reacts. It can only establish function of this part of the inner ear. In simple terms, first warm water, and then cool water, is flushed into the outer ear. (Some test facilities use air instead of water.) The different temperatures cause changes within a healthy inner ear, due to convection. This results in a sensation of vertigo, and involuntary rapid eye movement, called nystagmus. The patient wears monitors, known as Frenzell goggles, to record eye movement. Results can later be studied. Sometimes, instead of goggles, electrodes are places on the face for this recording.

If the inner ear is damaged by a virus, trauma, or circulation problems, results reflect this. Recovery can then be helped by treatment with vestibular rehabilitation therapy. For more scientific information about the test, please see Dr. Timothy Hain's description (Dr. Hain, known as the "Dizzy Doctor," is a professor emeritus at Northwestern University Medical School).

In the following video, medical students observe a colleague having the caloric test to follow his eye movement.

Nystagmus induced by caloric testing

My experience of the caloric test

I'd been having balance problems for a long time, and was finally being sent for tests. When my appointment arrived, it came with instructions to avoid medication and alcohol for 48 hours prior to testing. This is to ensure nothing interferes with the results. The letter also advised having someone with you, and not driving yourself, as the test is likely to make you dizzy.

I've always had a thing about water in my ears - absolutely hate it, so this was not something I was looking forward to. If the water trickled down my neck, I'd have to grit my teeth and concentrate on not leaping off the couch.

Before the caloric test, which was part of a series of testing, my eardrums were checked to make sure there were no perforations or infection. Next, I was fitted with Frenzell goggles, then lay down on the couch. The technician, a friendly lady, placed a small dish behind my right ear. She said my ears were a perfect fit for the dish, which luckily meant no water splashing around.

Water was squirted into the ear, while my eye movements were being recorded. It's important to keep your eyes open if you're wearing the goggles. I had a weird tingling sensation down my leg as the water went in, and did feel the room start to spin. The technician shone a torch into my ear to ensure it looked pink, meaning the warm water had reached deep into the ear.

Once the room stopped spinning for me, the technician moved to the left ear. The process was repeated. It didn't seem to have as much effect, again my ear was checked for pinkness. Although I was dizzy, I did feel more relaxed about the proccess once it was underway. The sensation of having water poured into my ears wasn't nearly as unpleasant as expected.

Now came the cool water. The right side test made the room spin incredibly. Again, my leg tingled. I clung on to the couch. The technician asked if I was nauseous - fortunately not. Another wait until things settled, then the left ear was tested. Very little response. The lady re-did the test in case the water hadn't hit the right points, with the same outcome.

I was freed from the monster goggles and allowed to sit up. Boy, the room spun. The technician said I could go, but actually, I couldn't. Every time my feet touched the floor, it felt like the ground was being whipped away from under me. It took several minutes sitting very still before I dared stand up, and was helped back to the waiting room.

Dizzy!
Dizzy! | Source

Following the caloric test

The next couple of days were a bit lousy; my challenged balance system protested. I was dizzy and tired. This can happen to me anyway, but it did seem the testing had been a strain. Things gradually settled down.

A month later, at the next hospital appointment, results had been studied. It showed a 40% loss of balance function on the left side. I was offered vestibular rehabilitation therapy, (VRT,) to aid recovery, and given an explanation of how a faulty balance system impacts on other parts of life. It was a relief to be offered treatment.

It can be difficult to diagnose balance problems. I found it helpful to finally have an explanation, and know I hadn't been imagining things. So, the testing was worthwhile. I wouldn't volunteer for another go, but neither would I run a mile.

If you are advised to have this test, think of the long term benefits, possible rehab treatment, and try not to worry too much. It's a safe procedure, and can be useful for diagnosis.

We all need balance in life.
We all need balance in life. | Source

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      Rita 5 weeks ago

      I went once and never again. I was so dizzy I thought I was on an LSD trip never again the good thing is they didn't find anything wrong

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      innerspin 19 months ago from uk

      Hi Trish, good on you for carrying on with the test even though you felt unwell. Hopefully the results will make it worthwhile. I don't personally know anyone who had this reaction, but have read it affects some people this way. It seems you are one of the chosen few. At least that's behind you now.

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      Trish 19 months ago

      Hi,

      Thanks for your information. I came across this blog after I had this test done. Just had it done yesterday. The hot water in both my left and right ear did bring about my vertigo, but it quickly subsided. But, when the cold water was introduced to my left ear, even the technician said that my eyes were moving around like crazy. I had never felt vertigo like that in my life. I got extremely nauseous and I had to sit up for 15 minutes to allow for the nausea to subside. I finally mustered enough courage to go through with my right ear. I lay back down and allowed her to put the water in my ear. The room immediately started to spin and I vomited. I sat up straight but couldn't move for 30 minutes. I went home, took a gravol and slept it off...for 15 hours. Has anyone else experienced vomiting? In my research it states that vomiting is rare after a caloric test.

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      innerspin 3 years ago from uk

      Hi Laura, sorry to hear you've been having such trouble. I'd say see your doctor for advice on this, I'm not medically trained but have had dizzy problems for years. It doesn't sound right that you experienced pain during the test.

      Do you have any history of migraine? That can involve neck pain, nausea and dizziness. Try looking up migraine associated vertigo. Some doctors tell you migraines don't last more than 72 hours but I know from personal experience the effects can drag on longer.

      Many people with dizziness do have neck pain, nausea and headaches as a result. It can be difficult to know which came first.

      I hope you get the test results soon, and some form of therapy if needed.

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      Laura 3 years ago

      Hi I had this test done 10 days ago using the warm and cold air method. All 4 tests sent me dizzy to some degree but my right side warm air test was the worst with excrutiating pain (I honestly thought my eardrum was going to burst). My main concern is I am still having really bad dizzy spells every day since the testing. Feeling nauseous, have terrible neck pain and had a headache every day too. Is this normal and if so how long does it take for these side effects to go as these are all symptoms I did not have like this before my test.

      Thanks for your help

      Laura

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      innerspin 3 years ago from uk

      Hi Carle, sorry to hear you had such an unpleasant experience. Only you can decide if you're willing to be tested again, with the help of your doctor. I would suggest it's worth trying to overcome your anxiety in any case. Relaxation CDs, meditation and yoga can be helpful.

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      Carle 3 years ago

      Hi

      had this test done about 16 years ago and I swore I would never ever have it again.!!! It felt like torture .!!

      currently they're asking me to do it again.... I am so scared. Just thinking about the test brings so much anxiety to me. I wonder if it's worth it?

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      Christine 3 years ago

      Thanks for the article! I had this test done today. Ugh, it was awful. My right ear caused vertigo but the left ear caused severe vertigo unlike anything I've ever experienced. I've had pressure and pain in my right ear so maybe there is some damage there. I find out on Friday. Anyway, I'm glad to see it's normal to feel out of it for at least the rest of the day. My technician said I would feel better within an hour, but I don't. I'm more dizzy than normal right now (no vertigo though) and really tired. Thanks for sharing your experience! (I'm in VT right now and hope it helps)

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      innerspin 3 years ago from uk

      Hi Sam, sorry you're having problems, hopefully the test will shed some light on your condition. I'm lucky in that I have no hearing loss or tinnitus, in fact I have very good hearing. I know quite a few other folk with balance problems, some also have hearing difficulty but by no means all do. Let's hope yours isn't affected on that side. Yes, it does become easier to cope over time.

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      Sam 3 years ago

      Hi, thanks for writing this up. I've recently had this test done, and they found no reaction whatsoever from my right ear. I have an appointment tomorrow to discuss the results, and I am very nervous. I have been completely deaf in my left ear all my life, and have only been experiencing vertigo, dizziness etc. for the past year. They're concerned that with me, I may lose my hearing in my right ear as well... Have you experienced any hearing loss, or just balance issues? Hope it's getting easier to cope.

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      innerspin 3 years ago from uk

      Hi gilda, I do still have problems but not as bad as before. Many people recover completely. The nerve damage doesn't repair itself, but the brain becomes used to dealing with things differently.

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      gilda 3 years ago

      hi do you still deal with balance issue does it ever go away

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      innerspin 4 years ago from uk

      Hi CAM8N, sorry to hear you're having problems. I hope things settle down. Vestibular rehabilitation therapy - VRT - was a mixed bag for me. The first set did improve things after a while. The second set stirred things up too much and set me back. I was instructed to ease off and use the first set again. Overall, I think it did help in some ways.

      I went back to the balance clinic several months afterwards and saw a different therapist. He gave slightly different advice and was really helpful, suggesting the wii fit balance board. I built up time on it gradually, and found that a real help.

      There are so many causes of vertigo, it can be hard to pin down. I hope you get some answers from the test. At least it's behind you now. Take care.

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      CAM8N 4 years ago

      Has your vestibular rehabilitation therapy been helping at all? I'm going through a bout of vertigo at the moment and had the test today. I t made me very Dizzy. Hoping I feel better soon, feel worn out after that test. Hope things are better for you.

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      innerspin 4 years ago from uk

      Hi, Anne. I'm no expert, but it seems the less you react, the more chance there is that that side has damage. You may have a problem on your left side. Maybe you find that you walk into things more on that side? When you get the results, you should be told if any exercises can help. Best of luck with recovery.

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      Anne 4 years ago

      I had this test done. They tried warm air first in each ear but IT never got dizzy. Then he tried the cold water and IT got very dizzy. I got dizzy when it was done in both ears but more dizzy in my right ear. Any idea what that might mean? I don't have my results yet.

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      innerspin 4 years ago from uk

      RTalloni, thanks for your comment, I hope your relative's doing well. I found it very helpful to have a diagnosis from this test. I know some people who've refused to have it done, as they're worried about the side effects, which seems a shame.

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      RTalloni 4 years ago from the short journey

      So interesting to read about this because a relative had a similar test recently due to head trauma from an accident. His experience was somewhat different at the clinic he used (more tests/different responses) and diagnosis/treatment came more quickly, but the point is that neurologists only offered more symptom/pain medication w/ more appointments to monitor his condition. They did not refer him to this testing/treatment. It's good to see posts that inform people of possibilities for help that typical docs may not suggest. So glad you have found some help!