On certain occasions it becomes inportant to evaluate vestibular function in a patient with otitis media. The potential application of the air caloric test in evaluating such patients was examined. Patients with unilateral otitis media before and after surgery were studied to answer certain clinical questions. More questions were raised than answers provided. The preliminary conclusions from this study are:
1. Patients with tympanostomy tubes or small perforation of one ear may show a caloric response in the perforated ear equal to that of the intact ear.
2. Patients with a large tympanic membrane perforation on one side may show hyperactive caloric responses on the perforated side.
3. Patients with a moist ear may show inverted horizontal nystagmus to warm air caloric testing. This applies to patients with a large perforation or mastoidectomy cavity.
4. Patients with a dry open mastoid or fenestration cavity are likely to show a hyperactive caloric response on the side of previous surgery, accompanied by vegetative symptoms. This size of the cavity appears to be less important than the presence of the cavity per se.
5. Patients may be safely tested in the early postoperative period.