Meniere's Disease: Insights from a Caloric Test Experience

Similar to Meniere's disease, and underwent the caloric test?

I experienced dizziness in September of last year, and it recurred in February of this year.
Currently, I have daily dizziness (feeling like I'm swaying on a bus), with intermittent severe and mild episodes, and sometimes tinnitus.
I have a feeling of fullness and pressure in my left ear, which also experiences numbness that extends to the entire left side of my face, the left side of my neck, and the left side of my chest.
I visited an ENT specialist at a medical center, who suggested that my condition resembles Meniere's disease.
To investigate further, they performed a caloric test, where cold or warm air was introduced into my ear.
During the test, the audiologist was chatting with a colleague while conducting the test.
I experienced dizziness more quickly when cold or warm air was applied to my right ear, but it took much longer for dizziness to occur in my left ear—so long that the audiologist left the room for about 10 minutes while the air continued to blow into my left ear.
After the audiologist returned, they indicated that the left ear needed to be retested.
By that time, I was already feeling extremely dizzy, yet I was compelled to undergo the retest.
During the retest, the audiologist was distracted, using their phone and eating snacks.
After the tests were completed, I waited a week for the report, and the doctor informed me that the results were normal and that I had no illness.
The doctor suggested I consult other specialists, such as a neurologist.
I requested the test data to seek a second opinion at another hospital, but the doctor only provided a certificate stating "Caloric test: normal." When I asked for a report with the actual data, the doctor replied that it was specialized content and would not be useful for others.
My questions are: 1.
If I experience dizziness more slowly when cold or warm air is applied to my left ear, does that mean I truly have no illness? 2.
Under what circumstances in a caloric test would it be considered abnormal? 3.
Is it normal for the doctor to only provide a certificate stating "Caloric test: normal" without giving the final test data?

123, 20~29 year old female. Ask Date: 2014/07/28

Dr. Zheng Jueyi reply Otolaryngology

Hello,
1.
A slower response does not necessarily indicate a problem, as the test primarily compares the differences between both sides.
If the differences remain within the normal range, it may still be considered normal.

2.
The caloric test generally assesses for the presence of unilateral canal paresis.
This can be calculated using a specific formula.
If one side shows a weaker response, it may suggest a peripheral issue.
However, if there are other concerns, it may lean towards a central issue.
In cases of central problems, further examination may be necessary, or a detailed evaluation by a neurologist may be required.

Wishing you health and safety,
Dr.
Jue-Yi Cheng
Director, Department of Otolaryngology
Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2014/07/28

More Info

Meniere's disease is a complex inner ear disorder characterized by episodes of vertigo, tinnitus (ringing in the ears), a feeling of fullness or pressure in the ear, and fluctuating hearing loss. Your experience with dizziness and the caloric test raises several important points regarding the diagnosis and management of Meniere's disease.

1. Understanding the Caloric Test: The caloric test is a part of vestibular testing that evaluates the function of the vestibular system, which is crucial for balance. During this test, warm or cold water or air is introduced into the ear canal, which stimulates the vestibular system. The expected response is a specific pattern of eye movements (nystagmus) that indicates how well the vestibular system is functioning. In individuals with Meniere's disease, the response may be abnormal, often showing a reduced or absent response on the affected side.
2. Your Symptoms and Test Results: You mentioned that your left ear responded more slowly to the caloric stimulation compared to your right ear. This could suggest some dysfunction in the vestibular system on the left side, which is consistent with Meniere's disease. However, the normal report from the physician indicates that the test did not show significant abnormalities according to the standard criteria. It's important to note that the interpretation of these tests can vary, and sometimes subtle dysfunctions may not be captured in a standard report.

3. Diagnosis of Meniere's Disease: The diagnosis of Meniere's disease is typically based on a combination of clinical history, symptoms, and test results. The classic symptoms include recurrent episodes of vertigo lasting 20 minutes to several hours, fluctuating hearing loss, tinnitus, and aural fullness. If the caloric test is normal, it does not completely rule out Meniere's disease, especially if you have a strong clinical history of the symptoms.
4. Communication with Your Physician: It is concerning that you were not provided with detailed data from the caloric test. While the physician may have deemed the results normal, having access to the specific data could help you understand your condition better and facilitate discussions with other specialists. If you feel that your concerns are not being adequately addressed, it may be beneficial to seek a second opinion from another ENT specialist or a neurologist who specializes in vestibular disorders.

5. Next Steps: Given your ongoing symptoms, it may be worthwhile to explore further evaluations, such as MRI scans to rule out other potential causes of your symptoms, including vestibular schwannoma or other central nervous system issues. Additionally, lifestyle modifications, dietary changes (such as reducing salt intake), and medications may help manage Meniere's disease symptoms.

In conclusion, while the caloric test results were reported as normal, your symptoms and the slower response in your left ear warrant further investigation. It is essential to advocate for your health by seeking comprehensive evaluations and ensuring clear communication with your healthcare providers. If necessary, do not hesitate to pursue additional opinions or tests to get to the root of your symptoms.

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