The aim of this retrospective review was to determine the clinical value of simultaneous binaural bithermal caloric testing (SBT) versus alternate binaural bithermal caloric testing (ABB) in the setting of a tertiary care neurotology clinic. Charts of 131 adults who had presented with otologic complaints and had undergone both SBT and ABB examinations were included in the study. The main outcome measure was the identification of peripheral hypofunction. One hundred two patients had a normal ABB caloric examination; 86 of those 102 patients (84.3%) had normal ABB examinations but abnormal SBT results. We conclude that SBT is a more sensitive measure of peripheral pathology than the traditional ABB examination. If peripheral pathology is suspected but not confirmed by ABB, SBT appears useful for detecting mildly reduced vestibular response.