Three New Strategies to Improve the Accuracy of Monothermal Caloric Screening Testing

Publication date: March–April 2016
Source:Acta Otorrinolaringologica (English Edition), Volume 67, Issue 2
Author(s): Emilio Domínguez-Durán, Antonio Gandul-Merchán, José Ignacio Tato-Gómez, Juan Ramón Lacalle-Remigio, Antonio Abrante-Jiménez, Francisco Esteban-Ortega
ObjectiveThe 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.MethodsWe 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.ResultsCorrecting 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%.ConclusionNew statistical tools help clinicians to make decisions that affect their patients based on the results of MCST.



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