title: Hot or cold? Is monothermal caloric testing useful and cost-effective?
abstract: OBJECTIVE
  Videonystagmography (VNG) is used widely in the assessment of balance dysfunction. The full test battery can be time-consuming and can induce patient discomfort. The purpose of this study was to examine the value of monothermal caloric testing in predicting unilateral caloric weakness, as well as abnormal VNG vestibular and nonvestibular eye movement, while considering the time and reimbursement associated with these tests.
  
  
  METHODS
  In a retrospective review of 645 patients who completed a comprehensive VNG test battery with bithermal caloric testing, we calculated the specificity, sensitivity, and predictive values of monothermal caloric testing in relation to bithermal caloric results and noncaloric VNG results.
  
  
  RESULTS
  With unilateral vestibular weakness (UVW) defined as a 25% interear difference, warm-air monothermal caloric testing yielded a sensitivity of 87% and a negative predictive value of 90% for predicting UVW. With a 10% UVW definition, the warm-air caloric testing sensitivity increased to 95% and the negative predictive value to 92%. Warm-air monothermal caloric testing had a positive predictive value of 85% and a negative predictive value of 18% for predicting noncaloric VNG findings; cold-air monothermal and bithermal testing displayed similar results.
  
  
  CONCLUSIONS
  Isolated monothermal testing is a sensitive screening tool for detecting UVW, but is not adequate for predicting noncaloric VNG results.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Bush
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Bingcang
authors.forename: Edward T
authors.initials: ET
authors.lastname: Chang
authors.forename: Brandon
authors.initials: B
authors.lastname: Fornwalt
authors.forename: Christopher
authors.initials: C
authors.lastname: Rayle
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Gal
authors.forename: Raleigh O
authors.initials: RO
authors.lastname: Jones
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Shinn
mesh_terms: D000465:Algorithms; D002150:Caloric Tests / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D006801:Humans; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015837:Vestibular Diseases / Q000175:diagnosis*; D014741:Video Recording