title: Three new strategies to improve the accuracy of monothermal caloric screening testing.
abstract: OBJECTIVE
  The objective was to find a way to estimate the value of inter-ear difference (IED) through monothermal caloric screening testing (MCST) that can be used at any laboratory, controlling and minimising the resulting error.
  
  
  METHODS
  We retrospectively included in this study 2304 patients from our department to whom a videonystagmography with caloric testing was performed between 2003 and 2011. The IED was calculated in 3 different ways: Using the values of the 4 caloric stimulations (bithermal form) and using only the 2 same-temperature values (warm monothermal and cool monothermal forms). We studied 3 strategies to improve the accuracy of MCST: Analysis of variables that could impair the prediction, delimitation of a grey area of insufficient prediction and location of a maximum utility cut-off point.
  
  
  RESULTS
  Correcting Jongkees' formula with the value for spontaneous nystagmus makes it possible to include subjects with spontaneous nystagmus or nystagmus inversion. Establishing 2 cut-off points to classify the subjects avoids approximately 38% of bithermal stimulations performed with a sensitivity and specificity of 95%. Maximum utility was obtained diagnosing as healthy those subjects with IED values lesser than or equal to 16% in warm MCST when the pathological IED was set as greater than 20%.
  
  
  CONCLUSIONS
  New statistical tools help clinicians to make decisions that affect their patients based on the results of MCST.
authors.affiliation: Servicio de Otorrinolaringología, Hospital Universitario Virgen del Rocío , Sevilla, España. Electronic address: emiliodominguezorl@gmail.com.
authors.forename: Emilio
authors.initials: E
authors.lastname: Domínguez-Durán
authors.affiliation: Servicio de Otorrinolaringología, Hospital Universitario Virgen del Rocío , Sevilla, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gandul-Merchán
authors.affiliation: Servicio de Otorrinolaringología, Hospital Universitario Virgen del Rocío , Sevilla, España.
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Tato-Gómez
authors.affiliation: Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Sevilla, España.
authors.forename: Juan Ramón
authors.initials: JR
authors.lastname: Lacalle-Remigio
authors.affiliation: Servicio de Otorrinolaringología, Hospital Universitario Virgen del Rocío , Sevilla, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Abrante-Jiménez
authors.affiliation: Servicio de Otorrinolaringología, Hospital Universitario Virgen del Rocío , Sevilla, España.
authors.forename: Francisco
authors.initials: F
authors.lastname: Esteban-Ortega
mesh_terms: D002150:Caloric Tests; D006801:Humans
keywords: Caloric tests: Videonystagmography; Health resources; Monothermal; Monotérmico; Pruebas calóricas; Recursos de salud; Videonistagmografía