Caloric testing
A balance test that gently warms and cools each ear in turn to check how well each inner ear's balance organ is working.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It checks how well each inner ear's balance organ works, and is especially good at spotting a weaker side.
- It only tests part of the balance system at low speeds, so a normal result does not rule out every cause of dizziness.
- It briefly brings on dizziness and sometimes nausea; this passes, but it is sensible to arrange a lift home.
- Many balance medicines have to be stopped for about 48 hours beforehand, or the result can be misleading.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Shows whether one inner ear's balance organ is weaker than the other, which can explain certain types of dizziness.
It is the wrong first step for sudden vertigo with stroke-like features (such as new weakness, slurred speech or a severe headache), which needs urgent...
You feel dizzy for a minute or two with each irrigation. The clinician records your eye movements and gives you rest in between.
A clear explanation of what your result means alongside your symptoms, not in isolation.
You feel dizzy for a minute or two with each irrigation. The clinician records your eye movements and gives you...
You may feel off-balance, tired or slightly sick. You rest in the department until you feel steady enough to leave.
Some people feel a little unsteady or washed out. It is sensible not to drive if you feel this way, and to take it...
The clinician may give an idea on the day, but the formal interpretation and report usually go to the doctor who...
What is caloric testing?
Caloric testing is a balance test that checks how well the balance organ in each inner ear is working. The audiologist or specialist runs warm and then cool water (or sometimes air) into each ear canal for a short time. This gently stimulates the inner ear and makes your eyes flick in a particular way (called nystagmus). Special goggles or sensors record these eye movements.
It is usually part of a wider set of balance tests called videonystagmography (VNG). Each ear is tested separately, so the test can show whether one ear's balance organ is weaker than the other. This is often the most useful thing it tells your clinician.
Caloric testing has been used for a very long time and is still a key way to pick up a weak balance organ on one side. But it mainly tests one part of the inner ear (the horizontal canal) at low speeds, so it does not check everything. It is one piece of the puzzle, used alongside your history, examination and sometimes other tests.
The test is safe, but it deliberately brings on dizziness for a short time, and some people feel sick. Your clinician will warn you, and most people settle within minutes to a short while.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Caloric testing vs video head impulse test (vHIT)
| Feature | Caloric test | vHIT |
|---|---|---|
| What it checks | Horizontal canal at low speeds | All semicircular canals at fast head speeds |
| How it feels | Briefly dizzy, sometimes sick | Quick head turns, usually well tolerated |
| Each ear separately | Yes | Yes, each canal |
| Time | Longer | Shorter |
The two tests look at the balance system in different ways and are often used together rather than instead of each other.
Preparing for your test
- Ask which medicines to stop: many balance and anti-sickness medicines (for example prochlorperazine, betahistine, some antihistamines and sedatives) usually need to be stopped for about 48 hours, or the result can be unreliable — but never stop a medicine without checking first.
- Avoid alcohol and caffeine for about 48 hours beforehand, as advised by the clinic.
- Do not wear eye make-up, as it stops the goggles recording your eye movements properly.
- Eat lightly beforehand; a very full or empty stomach can make nausea worse.
- Tell the clinic if you have heart problems, epilepsy, neck or back problems, or cannot lie flat.
- Bring your glasses or contact lens details and a list of your medicines.
- Arrange for someone to take you home, as it is not advisable to drive straight afterwards if you feel off-balance.
What happens
You will usually sit or lie on a couch and wear goggles or have small sensors near your eyes to record their movements. The clinician first checks your ear canals and eardrums.
Warm and then cool water (or air) is run into one ear at a time for a short period. As each ear is stimulated, you will feel a spinning or dizzy sensation for a minute or two while your eyes are recorded. The clinician may ask you to do simple mental tasks, like naming things, to keep you alert so the response shows clearly.
There is a rest between each irrigation to let the dizziness settle. All four irrigations (warm and cool, each ear) take roughly half an hour to an hour in total. Afterwards you rest until you feel steady enough to leave.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- It is the wrong first step for sudden vertigo with stroke-like features (such as new weakness, slurred speech or a severe headache), which needs urgent assessment, not an outpatient balance test.
- It may be unhelpful or need adapting if you cannot stay alert, cannot lie still, or cannot stop dizziness-suppressing medicines.
- Water irrigation is avoided with a perforated eardrum, ear infection or grommets; air may be used instead.
- On its own it cannot diagnose BPPV, which is assessed with positioning tests such as the Dix-Hallpike.
Delay or rearrange if…
- You have an active ear infection or discharge.
- You have recently started or cannot safely stop a balance or anti-sickness medicine that would mask the result.
- You are acutely unwell, vomiting or unable to sit through the test.
- Your symptoms are rapidly worsening or you have new neurological symptoms that need urgent assessment first.
Alternatives to discuss
- Video head impulse test (vHIT), which checks the canals at faster head speeds and is usually better tolerated.
- Vestibular evoked myogenic potentials (VEMP), which check different (otolith) parts of the inner ear.
- Positioning tests such as the Dix-Hallpike if BPPV is suspected.
- Clinical assessment and observation alone if symptoms are mild or settling, sometimes with a hearing test.
- Imaging if a central (brain-related) cause is suspected.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Shows whether one inner ear's balance organ is weaker than the other, which can explain certain types of dizziness.
- Tests each ear separately, which many other balance checks cannot do as clearly.
- Helps tell apart different causes of long-standing or unexplained dizziness.
- Can support a diagnosis such as a weak balance organ on one side after an inner-ear illness.
- Helps plan treatment, including whether balance retraining (vestibular rehabilitation) is likely to help.
Risks & complications
- A spinning or dizzy feeling during and shortly after each irrigation
- Feeling sick (nausea)
- A sense of fullness or mild discomfort in the ear
- Feeling tired or off-balance for a while afterwards
- Being sick (vomiting), usually only if you are prone to motion sickness
- A result that is unclear and needs repeating or another test
- Temporary worsening of existing dizziness for the rest of the day
- Reaction to ear wax being disturbed or, with water, irritation if the eardrum is not intact (air is used instead in that case)
The main thing to expect is short-lived dizziness and possibly nausea — this is the test working, not something going wrong. The bigger limitation is that a normal caloric test does not rule out every cause of dizziness, because it only checks part of the balance system at low speeds. Ask what the result would change and whether other tests are needed.
Published figures to discuss
Caloric testing is a low-risk test, so meaningful complication rates are not the main issue. What varies is how well it picks up problems and how comfortable it is. It only tests the horizontal canal at low frequencies, can be uncomfortable, and is affected by alertness and by medicines that suppress dizziness, so results must be read in context. Exact accuracy figures vary widely by the condition being looked for, so none are given here.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Dizziness, nausea or vomiting during the test | Common and expected | Caloric testing deliberately stimulates the balance organ, so temporary vertigo is part of the test. | Caloric Testing — StatPearls (NCBI)ncbi.nlm.nih.govSource-linked context |
| Inaccurate result from ear disease or technique | Recognised limitation | Wax, perforation, infection, previous ear surgery, poor irrigation or alertness can affect results. | Caloric Testing — StatPearls (NCBI)ncbi.nlm.nih.govSource-linked context |
| Result localises weakness but not the whole diagnosis | Core limitation | Caloric weakness must be interpreted with symptoms, examination, audiology and other vestibular tests. | Caloric Testing — StatPearls (NCBI)ncbi.nlm.nih.govSource-linked context |
| Delayed recovery after provoked vertigo | Uncommon | Most dizziness settles quickly, but people should avoid driving immediately if they still feel unsteady. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery, but the test deliberately brings on dizziness, so you may feel unsteady or tired for a while afterwards. Most people are back to normal within hours.
- Feeling dizzy or spinning briefly during the test
- Mild nausea or tiredness afterwards
- A short period of feeling off-balance
- No lasting symptoms from the test itself for most people
Aftercare
- Rest until the dizziness settles before you leave the department.
- Do not drive until you feel completely steady; ideally have someone take you home.
- Drink some water and have a light snack if you feel washed out.
- Restart any balance medicines you stopped only as your clinician advised.
- Take it easy for the rest of the day if you feel unsteady.
- Note any questions about your symptoms to ask when you get your results.
- Confirmed which medicines to pause and for how long
- Avoided alcohol and caffeine as advised
- Came without eye make-up
- Ate something light beforehand
- Arranged a lift home
- Cleared the rest of the day in case you feel unsteady
⚠ Get urgent help if…
- A sudden, severe or 'worst ever' headache, especially with dizziness
- Slurred speech, drooping face, or weakness or numbness in an arm or leg
- Double vision or loss of vision
- Fainting, chest pain or a very irregular pulse
- Dizziness that is severe and unrelenting rather than settling after the test
- New deafness in one ear with the dizziness
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A normal result suggests both inner ear balance organs respond similarly. A weaker response on one side suggests that ear's balance organ is underactive, which can fit with certain inner-ear problems. The result is read alongside your symptoms and other tests, not on its own.
A normal caloric test does not prove your balance system is entirely fine, because it checks only part of it at low speeds. Equally, a weak side does not always cause ongoing symptoms, because the brain often learns to compensate. Your clinician will explain what your particular result means for you.
The result reflects how your balance organs are working around the time of the test. If your symptoms change, get worse or new symptoms appear, the test may need repeating, or a different test may be more useful. A single normal test does not guarantee you will not develop balance problems in future.
Related tests, treatments or support
Caloric testing is usually done as part of videonystagmography and is often paired with a video head impulse test and sometimes vestibular evoked myogenic potentials, because each looks at the balance system in a different way. A hearing test is frequently done at the same visit.
Follow-up & long-term care
Your results are usually sent to the doctor who referred you, who then explains what they mean and discusses any treatment, such as balance retraining, further tests or referral. Ask when and how you will get your results, and who to contact if your symptoms change in the meantime.
Repeat, follow-on and what comes next
- The test sometimes needs repeating if a medicine, drowsiness or technical factors made the result unreliable.
- An inconclusive or borderline result may lead to a different balance test rather than a repeat.
- A normal result with ongoing symptoms often prompts further assessment rather than reassurance alone.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear explanation of what your result means alongside your symptoms, not in isolation.
- A named route to ask questions and to report if symptoms change or worsen.
- A sensible plan if the result is normal but symptoms continue, including further tests or balance retraining.
- Advice on resting and not driving until you feel steady after the test.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether caloric testing is done alone or as part of a fuller videonystagmography session
- Whether other balance tests (vHIT, VEMP) and a hearing test are done at the same visit
- The seniority of the audiologist or specialist running and interpreting the test
- Whether a written report and a follow-up consultation to explain results are included
- The clinic or hospital facility fees
- Whether further tests or scans are recommended afterwards
- Exactly which balance tests are included in the price
- Whether interpretation and a written report are included
- Whether a consultation to explain the results is included or charged separately
- What happens, and what it costs, if the test is inconclusive and needs repeating
- Whether any recommended follow-up tests are quoted
- The clinic's cancellation and rescheduling policy
On the NHS? Balance testing including caloric testing is widely available on the NHS when clinically indicated; private testing may be chosen for faster access, choice of provider or a second opinion.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being warned that the test deliberately brings on dizziness and sometimes nausea.
- Not being told which medicines to stop, leading to a misleading result.
- Being given a 'normal' result as full reassurance without explaining what the test cannot check.
- No clear plan for who explains the result and what happens next.
Marketing red flags
- Claims that one balance test can find the cause of all dizziness.
- Selling a long panel of balance tests without explaining why each is needed.
- Promising a diagnosis from the test alone, without history and examination.
- Downplaying that results depend on stopping certain medicines and staying alert.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What are you hoping this test will show in my case?
- What will the result change about my diagnosis or treatment?
- Which of my medicines should I stop, and for how long?
- What happens if the result is normal, abnormal or unclear?
- Will I need other balance tests as well, and why?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Does caloric testing hurt?
Will I be able to drive home?
Why do I have to stop my dizziness medicine first?
Is it available on the NHS?
What if my result is normal but I still feel dizzy?
Can I eat before the test?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Dizziness NICE CKS — Vertigo James Paget University Hospitals NHS — Vestibular assessment (preparation) Newcastle Hospitals NHS — Vestibular (balance) assessment Caloric Testing — StatPearls (NCBI) British Society of Audiology — practice guidance and recommended procedures
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Video head impulse test (vHIT) · Vestibular evoked myogenic potentials (VEMP) · Dix-Hallpike test for BPPV · Vestibular rehabilitation therapy · Acoustic reflex testing