Batuecas-Caletrio Angel, Montes-Jovellar Lourdes, Boleas-Aguirre Maria Soledad, Perez-Fernandez Nicolas
Department of Otorhinolaryngology, Hospital Universitario de Salamanca, University of Salamanca, Spain.
Acta Otolaryngol. 2009 Dec;129(12):1414-9. doi: 10.3109/00016480902791686.
Three possible results are commonly seen after ice-water caloric irrigation and to correctly interpret them the function of the corresponding vestibular receptor and of normal endolymphatic flow must be taken into account. Bedside vestibular examination helps to interpret discrepant findings.
To review the findings obtained with the ice-water caloric test in patients with dizziness and to compare the results with those of the bedside test.
The study was undertaken in a university hospital, tertiary medical center. The indications to perform the ice-water caloric test were: 1) unilateral canal weakness >90%; 2) a maximum slow phase velocity of nystagmus after hot (44 degrees C) and cold (30 degrees C) caloric stimulation in either ear of <9 degrees s(-1); or 3) in both ears <15 degrees s(-1). After irrigating the ear with ice water, nystagmus was recorded in the face-up and face-down positions. The result of the test was classified as a response (nystagmus beats away from the irrigated ear in the supine position and changes when in prone), a gravity-independent response (nystagmus does not change in direction in the prone position) or no response. The spontaneous and post head-shaking nystagmus, as well as the results of the head-impulse test, were also analyzed. When indicated, a rotatory chair test was performed.
In the 71 patients that displayed unilateral hypofunction, the ice-water test produced a normal response in 24, a gravity-independent response in 31, and no response in 14. In two of these patients a vertical gravity-independent nystagmus response was observed. Bilateral hypofunction was found in 12 patients and the results in the head-impulse test were in agreement with the results in the ice-water test.
冰水冷热试验后通常可见三种可能结果，要正确解读这些结果，必须考虑相应前庭感受器的功能及正常内淋巴液流动情况。床边前庭检查有助于解读不一致的检查结果。
回顾头晕患者冰水冷热试验的检查结果，并将其与床边检查结果进行比较。
本研究在一家大学医院的三级医疗中心进行。进行冰水冷热试验的指征为：1）单侧半规管功能减弱>90%；2）热（44℃）、冷（30℃）刺激后任一耳眼震的最大慢相速度<9°/s；或3）双耳均<15°/s。用冰水冲洗耳朵后，记录仰卧位和俯卧位时的眼震情况。试验结果分为反应性（仰卧位时眼震向远离冲洗耳方向跳动，俯卧位时改变）、重力无关反应性（俯卧位时眼震方向不变）或无反应。还分析了自发性眼震、摇头后眼震以及摇头试验结果。必要时进行转椅试验。
在71例显示单侧功能减退的患者中，冰水试验产生正常反应的有24例，重力无关反应的有31例，无反应的有14例。其中2例患者观察到垂直重力无关性眼震反应。12例患者发现双侧功能减退，摇头试验结果与冰水试验结果一致。
