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Oculovestibular TestingAka: Cold Calorics

Technique
1. Patient supine with head at 30 degrees elevation
  1. Isolates input of horizontal semicircular canals
2. Instill 10-20 ml iced saline into auditory canal
  1. Use 20 cc syringe
  2. Use butterfly tubing with needle cut off
  3. Cools mastoid bone and alters endolymphatic flow
  4. Stimulates vestibular nuclei as if head turned
    1. rapidly to opposite side
Interpretation
1. Nystagmus both eyes slow toward cold, fast to midline
  1. Not comatose
2. Both eyes tonically deviate toward cold water
  1. Coma with intact brainstem
3. No eye movement
  1. Brainstem injury
4. Movement only of eye on side of stimulus
  1. Internuclear ophthalmoplegia
  2. Suggests brainstem structural lesion

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/10/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.