A closer look at subjective caloric sensations: Is there more to vertigo than spinning?

J Vestib Res. 2018;27(5-6):271-277. doi: 10.3233/VES-170624.

Abstract

Background: There is a prevailing opinion that spinning sensations signify a peripheral vestibular pathology while non-spinning sensations are not of vestibular origin.

Objectives: 1) Characterize the subjective sensations reported by patients during caloric testing. 2) Assess if the sensation was correlated with the peak slow phase velocity (SPV).

Methods: Retrospective chart review at a Canadian adult tertiary-quaternary care balance centre for patients undergoing diagnostic caloric testing between December 2014 and September 2015.

Results: Of 163 patients included, 122 had normal calorics and 41 demonstrated unilateral weakness. Spinning/rotatory movements were the most commonly reported sensations (55-70%). No sensation was reported among 10-20% of patients. Other non-rotatory sensations were reported 20-25% of the time. Both lack of sensation and other sensations were more likely to be correlated with SPVs that were significantly lower than those associated with spinning/rotating sensations. However, 18% of patients with normal calorics and robust SPVs with warm irrigation still reported non-spinning sensations.

Conclusions: During caloric irrigation, subjective sensations other than spinning and rotating are reported 20-25% of the time and these tend to be associated with lower peak SPV. Non-spinning vertigo is not uncommon as a subjective description of vestibular sensation even in normal patients with strong SPVs.

Keywords: Caloric tests; dizziness; vertigo; vestibular diseases; vestibular function tests.

MeSH terms

  • Caloric Tests
  • Female
  • Humans
  • Male
  • Middle Aged
  • Postural Balance / physiology
  • Retrospective Studies
  • Rotation*
  • Sensation
  • Vertigo / diagnosis
  • Vertigo / physiopathology*
  • Vestibular Diseases / diagnosis
  • Vestibular Diseases / physiopathology*
  • Vestibule, Labyrinth / physiopathology*