The cold caloric vestibular test may give false negative or false positive responses. In order to obtain meaningful results, the ear should be irrigated with icecold water for at least ten seconds with the patient in the supine position; then the patient should be turned to the prone position once the nystagmus starts. The nystagmus should change direction if the labyrinth is active. The patient is then returned to supine position, and again the nystagmus should change direction. The nystagmus should be recorded by electronystagmography.
This test can reveal the presence of canal paresis or inactive labyrinth, but does not show directional preponderance and, therefore, cannot replace the bithermal examination when this conclusion is of importance in the diagnosis.