Caloric Machine

varioair vestibular caloric machine

Here at Attuned Vitality, our Functional Neurologist offers many different treatment modalities. One such modality is the caloric machine. The caloric machine can both test and treat the vestibular organ by means of air. Its extremely precise temperature and airflow control ensures that the transferred air remains constant throughout the duration of the therapy.

But how does the caloric machine work?

There are a few things that you need to know before understanding how the caloric machine works.

  • While people commonly associate the term calorie with food, a calorie is fundamentally a unit of heat. Therefore, a caloric machine is a machine capable of regulating temperature. Our caloric machine, the Atmos Varioair 3, can produce both warm and cool air depending on the therapeutic needs of the patient.
  • The vestibular system refers to the area in you ear that is responsible for your sense of balance. Hence, damage to your vestibular system can result in dizziness, vertigo, and other balance problems. Examples of injuries are concussions, Parkinson’s disease, BPPV, POTS, Meniere’s disease, and orthostatic hypotension.

The warm air that emits from the caloric machine influences the fluid in the vestibular system, resulting in subtle movements of the eyes called nystagmus. As a clinical tool, the presence of any abnormalities in the eyes can indicate damage to the brain and the vestibular system. Hence, this allows the healthcare practitioner to diagnose and evaluate different forms of dizziness and vertigo.

Dizziness is a common complaint in both outpatient and inpatient settings. Caloric testing serves as a valuable clinical tool for evaluating dizziness, enabling the assessment and quantification of individual vestibular system functionality. By utilizing the vestibulo-ocular reflex (VOR), caloric testing helps identify unilateral peripheral deficits as potential causes of the patient’s symptoms. Additionally, due to its reliance on an intact brainstem, this testing method can also evaluate brainstem function, particularly in comatose patients. The following outlines the indications, contraindications, techniques, and clinical relevance of caloric testing.


  • Hearing Loss Caused by Antibiotic Use
  • Vertigo (Dizziness)
  • Brain Damage in Comatose Individuals


Before conducting caloric testing, the health care provider ensures the normalcy of the ear, especially the eardrum.


  1. The testing is conducted on one ear at a time.
  2. Warm air goes into the ear canal, causing an involuntary eye movement called nystagmus.
  3. The process is repeated for the other ear.

Clinical Relevance:

Caloric stimulation offers the advantage of precise and reproducible results due to adjustable stimulus duration and temperatures ranging from 20°C to 47°C. It finds utility in various medical settings, including ENT outpatient departments, diagnostics rooms, and medical practices. This compact device facilitates thermal testing of the vestibular organ without requiring a water connection.

Therapeutic Treatment:

If the Functional Neurologist determines that your therapeutic plan should involve the caloric machine, you can expect the following process to take place:

  • Inserting warm air into the ear canals.
  • Monitoring eye activity throughout the session to determine optimal sets and durations.
  • Administering mild discomfort, potentially leading to brief vertigo and nausea. At this point, we will terminate therapy.
  • Progressing from 3 to 15-second durations depending on patient response.
  • Using VOG goggles for real-time monitoring of eye movements in darkness.
  • Combining other therapeutic modalities if necessary, such as class I laser, carotid massage, head movements, and breathing exercises.
  • Performing the test in a seated position throughout.

In summary:

Caloric testing offers a non-invasive method to assess vestibular function, potentially aiding in managing conditions related to balance, hearing, and brainstem function.

If you have any questions, please make an appointment with Dr. Funk. Be sure to follow us on Facebook to stay up to date on our business.

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