Which of the following is not true of caloric test?
**Core Concept**
The caloric test is a vestibular function test that assesses the lateral semicircular canal's response to thermal stimulation, inducing nystagmus in the direction of the fast phase. It evaluates the horizontal semicircular canal's function in the presence of cold or warm water. This test is crucial in diagnosing vestibular disorders, such as benign paroxysmal positional vertigo (BPPV), labyrinthitis, or Meniere's disease.
**Why the Correct Answer is Right**
The caloric test is indeed inconclusive in the case of canal paresis. Canal paresis refers to a condition where there is a reduced or absent response of the lateral semicircular canal to caloric stimulation. This is often due to a peripheral vestibular disorder, such as a vestibular neuronitis or a labyrinthitis, which impairs the function of the vestibular nerve. As a result, the expected nystagmus response is either absent or reduced, making the test inconclusive. The vestibular system's response to caloric stimulation involves the stimulation of the hair cells in the lateral semicircular canal, which then send signals to the vestibular nerve and eventually to the brain.
**Why Each Wrong Option is Incorrect**
**Option A:** Induction of nystagmus by thermal stimulation is a true statement. The caloric test works by generating a temperature gradient in the external auditory canal, which then affects the lateral semicircular canal's fluid temperature, inducing a nystagmus response.
**Option B:** Normally, cold water indeed induces nystagmus to the opposite side, and warm water induces nystagmus to the same side. This is because the cold water causes the endolymph in the lateral semicircular canal to become denser, while warm water causes it to become less dense, leading to the stimulation of the hair cells and the generation of nystagmus in the opposite direction.
**Option D:** "None" is incorrect because option C is indeed not true of the caloric test.
**Clinical Pearl / High-Yield Fact**
It is essential to remember that the caloric test should be used in conjunction with other vestibular function tests, such as the electronystagmography (ENG) or the video head impulse test (vHIT), to obtain a comprehensive assessment of vestibular function. This is because the caloric test may be inconclusive in cases of canal paresis or other vestibular disorders.
**β Correct Answer: C. In canal paresis, the test is inconclusive**