Importance of simultaneous binaural bithermal caloric testing. (Guest Editorial).

In September I was part of the faculty in the Balance Workshop under the auspices of the ANS in Denver. My presentation was on caloric and positional nystagmus. As one would assume, I spent time showing the advantage of the sensitivity of simultaneous binaural bithermal (SBB) over that of alternate binaural bithermal (ABB) caloric testing. The attendees' critiques of the workshop included a note about the amount of time spent in discussing the SBB. I was shocked by this comment, since in my practice I see a number of patients who have been evaluated previously by electronystagmography with ABB alone, who have been told there was nothing wrong with them. It is quite clear that the large number of cases of "psychogenic" vertigo or dizziness that appears in the medical literature arises from this line of thinking.

The last three VESTIBULOGY CLINICS published in EAR, NOSE & THROAT JOURNAL (Jan-Mar 2002) presented caloric findings in patients with vestibular disorders. Some are confirmed by the ABB results. Thoughtful analysis should allow a logical conclusion of the value of the positive results of the SBB when the ABB and positional testing are negative.

I would again point out, if there is no abnormality found on positional and ABB caloric testing, the evaluation is incomplete without the SBB!