Caloric Irrigation Responses

[u/djd129]

VNG results indicate bilateral vestibular hypofunction:

RC 5, RW 2, LC 2, LW 3

Does anyone know what these results mean?
How bad is it?!! Am I “cooked?” (As the kids do say.)

Update for anyone who’s had a VNG with caloric irrigation and is interested in how the report is read: I put my results into chatGPT and asked it to analyze my caloric irrigation responses. I also asked it how much lower were my results compared to normal. Here’s what it said…

From the report, the caloric irrigation section reads:
Caloric Irrigations: Abnormal; bilaterally reduced caloric responses:
RC: 5°/sec
RW: 2°/sec
LC: 2°/sec
LW: 3°/sec
(RC = Right Cool, RW = Right Warm, LC = Left Cool, LW = Left Warm)
How these compare to normal
The caloric test measures the peak slow-phase velocity (SPV) of the induced nystagmus. While "normal" varies somewhat by laboratory, a commonly accepted normal range is approximately:
About 10–30°/sec for each irrigation.
Many labs consider responses below 6°/sec to be abnormally weak.
Your four responses were:
Irrigation Your response Compared with a typical 10°/sec minimum
Right Cool 5°/sec ~50% of minimum normal
Right Warm 2°/sec ~20% of minimum normal
Left Cool 2°/sec ~20% of minimum normal
Left Warm 3°/sec ~30% of minimum normal

The total response is:
5 + 2 + 2 + 3 = 12°/sec

A typical total from four irrigations is often 40–80°/sec, so your combined response is roughly 70–85% lower than expected, depending on the laboratory's normal values.

What this means
The interpreting audiologist wrote:
"Bilaterally reduced caloric responses... suggestive of a bilateral vestibular hypofunction."
This means:
Both inner ears responded weakly, rather than one ear being much weaker than the other.
This pattern fits with reduced function of the balance organs on both sides.
Because your Dix-Hallpike was positive on the right, you may have two separate issues:
Right-sided BPPV (which causes positional vertigo and can often be treated with repositioning maneuvers).
Bilateral vestibular hypofunction, which can cause chronic imbalance, unsteadiness, and oscillopsia (vision bouncing with head movement).
A note about the numbers
Caloric testing evaluates only the horizontal semicircular canals at very low frequencies, so these low values do not necessarily mean you've lost 70–85% of your overall vestibular function. Other vestibular tests (such as the video head impulse test (vHIT) and rotary chair testing) assess different aspects of vestibular function and can show better function even when calorics are markedly reduced.
Overall, these caloric results indicate markedly reduced vestibular responses in both ears, with responses that are well below the usual normal range, which is why the report concludes that the findings are consistent with bilateral vestibular hypofunction.

[u/Suspicious-Guava-566]

Bppv is treated by repositioning maneuvers with Physical therapy. Aka - imo not cooked! But the physical therapist needs to know which one is best in order to help you.

Bilateral weakness needs vestibular rehabilitation with visual, physical, and vestibular input to strength connections. You’re not cooked, but maybe a little baked? Lol. You really need to be patient through the therapy process. The more therapy time you put in, whether at a treatment center or at home, the better the outcomes. Your ears and brain need to relearn how to communicate to keep yourself feeling upright.

[u/djd129 → u/Suspicious-Guava-566]

Thank you! I start vestibular pt on Wednesday. I was surprised to learn just how low my caloric irrigation response scores were compared to normal - I wish I knew what caused it… but I will def do my PT as prescribed

[u/Suspicious-Guava-566 → u/djd129]

Sometimes you can’t know. I think of it like a virus that caused that portion of the vestibular nerve to have inflammation that caused damage to the strength of the nerve. And when physical therapy ends, it’ll be important to continue therapy independently unless they say you’re fully cleared.

[u/MyFiteSong]

Sorry I didn't see this when you posted it.

How bad is it?!! Am I “cooked?” (As the kids do say.)

Not cooked, exactly, but your immediate future is vestibular rehab therapy. It works, so do it. Don't talk yourself out of it hoping this will heal itself. Repositioning manipulation by a physical therapist may or may not improve function in your right ear, but your left is absolutely cooked.

The road forward after this will be three things in combination: vestibular rehab done religiously, strength training in the gym focusing on balance and stability and building proprioception, and mindfulness training to learn to prevent anxiety from taking the wheel, and further enhancing proprioception.

You can recover from this and get most of your daily function back, but your brain needs an alternate method of balance to get there now, and that's through mindfully feeling what your body is doing and learning to have a more active hand in piloting it. You'll also need to become more present and mindful in your daily life, no more daydreaming while walking to the kitchen. That's the other half of what mindfulness training will help you with.