title: Triple test as predictive screen for unilateral weakness on caloric testing in routine practice.
abstract: OBJECTIVE
  To investigate in vertigo patients in routine practice to what extent a rapid and straightforward triple bedside test (spontaneous nystagmus, head-shaking nystagmus, and the head impulse test) can predict a normal result on caloric testing.
  
  
  METHODS
  Prospective, single-blind, diagnostic study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  151 patients (78 male and 73 female subjects; mean age, 52.5 +/- 16.4 yr) presenting with acute or recent symptoms of vertigo.
  
  
  METHODS
  Diagnostic evaluation.
  
  
  METHODS
  The negative predictive value (NPV) of the triple test in relation to a normal caloric test response.
  
  
  RESULTS
  In unilateral weakness (UW) on caloric testing (UW, >=25%), the triple test had sensitivity of 63.6%, specificity of 85.4%, a positive predictive value (PPV) of 71.4%, and an NPV of 80.4%. In other words, 80.4% of patients with a negative triple test also had a normal response on caloric testing. In pronounced canal paresis (UW, >=50%), the triple test had sensitivity of 81.8%, specificity of 81.4%, a PPV of 55.1%, and an NPV of 94.1%. Significant differences were found between 2 subgroups assessed by examiners with differing levels of experience (p < 0.05).
  
  
  CONCLUSIONS
  The triple test represents a good screening tool that quickly and reliably excludes unilateral weakness and in particular pronounced canal paresis on caloric testing.
authors: Department of Otorhinolaryngology, University of Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, Germany. christian.rohrmeier@ukr.de
authors: Christian
authors: C
authors: Rohrmeier
authors: Otto
authors: O
authors: Richter
authors: Michael
authors: M
authors: Schneider
authors: Kornelia
authors: K
authors: Wirsching
authors: Isabella
authors: I
authors: Fiedler
authors: Frank
authors: F
authors: Haubner
authors: Jürgen
authors: J
authors: Strutz
authors: Thomas S
authors: TS
authors: Kühnel
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D002150:Caloric Tests / Q000379:methods*; D005260:Female; D019416:Head Movements / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods; D009759:Nystagmus, Pathologic / Q000175:diagnosis; D010036:Otolaryngology / Q000379:methods*; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D014717:Vertigo / Q000175:diagnosis*; D015837:Vestibular Diseases / Q000175:diagnosis; D014724:Vestibular Function Tests