Abstract

Purpose
During caloric irritation, the spinning/rotating sensation is predominant. However, there is no report on temporal relationship between the caloric nystagmus and perception.
Method
Consecutive 57 participants underwent bithermal caloric test in dizziness clinic of Chungnam National University Hospital from Feb 2018 to Sep 2018. For vestibular perception, we asked the subject to report feelings of rotation and/or linear sensation during each warm and cold water irrigation period. Besides routine caloric parameters, the duration of nystagmus and vestibular sensation were analyzed.
Results
In most participants, the caloric nystagmus preceded the vestibular sensation (79.6 % in right warm, 83.3% in left warm, 88.5% in right cool, and 84.6% in left cool stimuli). The precedence of perception was observed in 5 normal persons and 15 patients with vestibular migraine (n=4), unilateral vestibulopathy (n=3), and Meniere’s disease (n=2), multiple systemic atrophy (n=2), cerebellar ataxia (n=2), vertebrobasilar insufficiency (n=1) and post-earthquake dizziness (n=1). The mean latency between nystagmus and perception was 11.7s. And the duration of nystagmus was longer than that of perception in all conditions. Non-spinning sensations during caloric test were also observed in some participants (26.8% in right warm, 30.3% in left warm, 29.1% in right cool, and 24.1% in left cool stimuli).
Conclusion
During bithemal alternate caloric test, various vestibular perception and temporal relationship between perception and nystagmus suggests the bithermal caloric stimulation does not reflect only the signal originating from horizontal canal pathway. Further validation study is needed.

• Keywords: caloric test; perception; reflex, vestibulo-ocular;