Cervical VEMP tuning changes by Meniere's disease stages

Abstract

Objective To determine if changes in cervical vestibular‐evoked myogenic potential (cVEMP) testing reflect the different stages of cochlea‐saccular hydrops in Meniere's disease (MD). Methods This is a case‐control retrospective series. Forty‐seven patients with unilateral MD by American Academy of Otolaryngology–Head and Neck Surgery diagnostic and staging criteria, and 30 with non‐MD vertigo as control. Meniere patients were further classified based on symptoms at the time of testing as active or stable. Subsequently, patients underwent cVEMP testing by tone‐burst stimuli at 500 and 1,000 Hz. The main outcome measure was to compare the cVEMP 1,000 and 500 Hz amplitude ratio in ears with MD and non‐MD vertigo, and in active versus stable MD. Results The cVEMP 1,000/500 Hz amplitude ratio was higher in Meniere's ears (mean = 1.14 μV, SD = 0.25) than in non‐Meniere's ears (mean = 0.96 μV, SD = 0.2) (Student's t test, P = .001), and higher in active (mean = 1.22 μV, SD = 0.25) than in stable MD (mean = 1.00 μV, SD = 0.18) (P = .0035). The diagnostic value of cVEMP 1,000/500 Hz amplitude ratio to differentiate MD versus non‐MD vertigo was evaluated with a receiver‐operating characteristics (ROC) curve and the area under the curve (AUC) was 0.716 (95% confidence interval [CI] [0.591, 0.829]). The ideal cutoff point was 0.9435 with sensitivity and specificity values of 83% and 53%, respectively. The sensitivity and specificity values for this test to differentiate active versus stable MD were 68% and 81%, respectively, with AUC 0.746 (95% CI [0.607, 0.885]) and cutoff value of 1.048. In all ears, the 1,000/500 Hz amplitude ratio increased by a decrease of the 500 Hz amplitude with increasing age. Conclusion The cVEMP 1,000/500 Hz amplitude ratio is elevated in ears with MD but not in those with non‐MD vertigo. After corrected by age, this ratio is higher in active but not in stable MD, probably reflecting dynamic changes in saccular membrane motion mechanics in hydrops, and may be a useful marker of disease progression and the effect of therapy. Level of Evidence IV

Altered mapping of sound frequency to cochlear place in ears with endolymphatic hydrops provide insight into the pitch anomaly of diplacusis

“…Vestibular sensitivity to motion depends on an end organ’s ratio of mass to stiffness, which sets the resonant frequency. Increased endolymph can be expected to push on vestibular end organs and increase their effective stiffness, which increases the resonant frequency of the saccule as shown by vestibular evoked myogenic potentials 24 – 27 . The vestibular central nervous system (CNS) has a great capacity to adapt to changes in the peripheral end organs, but over a period of days.…”

Hearing and Vestibular Testing in Menière’s Disease

“…For pointing this problem, the tuning curve method suggested. In this method, amplitude of 500 Hz VEMP compared with that of 1000 Hz in the same ear [33]. The ratio decreased in MD patients (i.e., flattening of the tuning curve occurs because in hydropic Hearing and Vestibular Testing in Menière's Disease DOI: http://dx.doi.org/10.5772/intechopen.107945 ear, endolymphatic tuning shifts to 100 Hz).…”

“…The ratio decreased in MD patients (i.e., flattening of the tuning curve occurs because in hydropic Hearing and Vestibular Testing in Menière's Disease DOI: http://dx.doi.org/10.5772/intechopen.107945 ear, endolymphatic tuning shifts to 100 Hz). They showed that this ratio could be a marker for MD progression because the ratio is high during acute phase and is normal during intermediate stable phase [33]. Of course, the ambiguity is whether we are going to use the test to determine the disorder or to use the test to grade the disorder we already know.…”

Dissociation between Caloric and Video Head Impulse Tests in Dizziness Clinics

“…Because of the fluctuating nature of the disease and unpredictable pattern of audiovestibular damage, only audiometry demonstrating low- to medium-frequency sensorineural hearing loss is considered a diagnostic criterion for definitive MD [ 20 ]. Significant efforts have been made to understand why these patients have vertigo attacks, and numerous studies have been published with regards to vHIT, Cal, electrocochleography and vestibular evoked myogenic potentials in these patients, both during attacks and between attacks [ 22 , 23 , 24 , 25 ].…”