Cervical Vestibular Evoked Myogenic Potentials in Menière's Disease: A Comparison of Response Metrics

Noij, Kimberley S.; Herrmann, Barbara S.; Guinan, John J.; Rauch, Steven D.

doi:10.1097/mao.0000000000002092

Cited by 13 publications

(11 citation statements)

References 47 publications

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“…The abnormal response to different frequencies and the normalized p13–n23 amplitude and VEMP inhibition depth have been considered a good marker of Ménière`s disease for the detection of suspected asymptomatic hydrops in the saccule [ 5 ]. This finding has also been obtained to a lesser degree in the unaffected ear of a small group of patients with unilateral MD [ 6 ].…”

Section: Introductionsupporting

confidence: 66%

Endolymphatic hydrops in the unaffected ear of patients with unilateral Ménière’s disease

Guajardo

Suárez-Vega

Domínguez

et al. 2022

Eur Arch Otorhinolaryngol

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Purpose Current studies show that frequency tuning modification is a good marker for the detection of endolymphatic hydrops (EH) employing magnetic resonance imaging (MRI) in patients with Ménière’s disease (MD). The purpose of the present study is to analyze the auditory and vestibular function with audiometric and vestibular-evoked myogenic potentials (VEMP) responses, respectively, in both the affected and unaffected ears of patients with unilateral MD using MRI as diagnostic support for the degree of EH. Methods We retrospectively reviewed the medical records of 76 consecutive patients with unilateral definite MD (age 55 (28–75); 39 women, 37 men). MRI was used through intravenous gadolinium administration, audiometry, and VEMPs. Functional tests were performed up to a week after the MRI. All were followed up one year after imaging utilizing clinical, auditory, and vestibular testing to rule out bilateral involvement. Results In the unaffected ear, the mean pure-tone average is normal even in cases with hydrops and, for a similar severity of hydrops is significantly lower than in the affected ear. Significant differences for the amplitude of the response at 0.5 kHz, at 1 kHz between the affected and unaffected ears were found to be lower in the affected ears. The relative amplitude ratio (1 Kz–0.5 kHz) was significantly lower in the affected ear and in the case of the oVEMP response depends on the degree of EH. The response in the unaffected ear was not modified by the presence or the degree of hydrops. Conclusion In the unaffected ear, hydrops is not associated with hearing deterioration. For a similar degree of hydrops, hearing loss is significantly greater in the affected ear. The endolymphatic hydrops in the vestibule induces a frequency bias in the VEMP response only in the affected ear and not in the unaffected ear. Because of these findings we consider that hydrops does not represent an active disorder in the unaffected ear.

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Section: Introductionsupporting

confidence: 66%

Endolymphatic hydrops in the unaffected ear of patients with unilateral Ménière’s disease

Guajardo

Suárez-Vega

Domínguez

et al. 2022

Eur Arch Otorhinolaryngol

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“…In case of implantation of otolith structures, cVEMP and oVEMP responses should be absent bilaterally. Although the otolith system can probably have a gradual decline in function and does not work as an “on-off” system [ 52 ], VEMPS are not currently clinically suited to detect subtle changes in otolith function or define “minimal residual otolith function”. It was decided therefore that otolith implantation should only be performed in patients with bilaterally absent VEMP responses and not take into account other parameters, e.g.…”

Section: Commentsmentioning

confidence: 99%

The vestibular implant: Opinion statement on implantation criteria for research1

Berg

Ramos²,

Rompaey

et al. 2020

VES

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This opinion statement proposes a set of candidacy criteria for vestibular implantation of adult patients with bilateral vestibulopathy (BVP) in a research setting. The criteria include disabling chronic symptoms like postural imbalance, unsteadiness of gait and/or head movement-induced oscillopsia, combined with objective signs of reduced or absent vestibular function in both ears. These signs include abnormal test results recorded during head impulses (video head impulse test or scleral coil technique), bithermal caloric testing and rotatory chair testing (sinusoidal stimulation of 0.1 Hz). Vestibular implant (VI) implantation criteria are not the same as diagnostic criteria for bilateral vestibulopathy. The major difference between VI-implantation criteria and the approved diagnostic criteria for BVP are that all included vestibular tests of semicircular canal function (head impulse test, caloric test, and rotatory chair test) need to show significant impairments of vestibular function in the implantation criteria. For this, a two-step paradigm was developed. First, at least one of the vestibular tests needs to fulfill stringent criteria, close to those for BVP. If this is applicable, then the other vestibular tests have to fulfill a second set of criteria which are less stringent than the original criteria for BVP. If the VI-implantation is intended to excite the utricle and/or saccule (otolith stimulation), responses to cervical and ocular vestibular evoked myogenic potentials must be absent in addition to the above mentioned abnormalities of semicircular canal function. Finally, requirements for safe and potentially effective stimulation should be met, including implanting patients with BVP of peripheral origin only, and assessing possible medical and psychiatric contraindications.

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“…(2017) studied 42 patients with certain unilateral MD and 21 healthy controls and reported that multi-frequency VEMPs analysis offers a simple and cost-effective method to address the diagnostic difficulties presented by MD. Noij et al. (2019) showed that the cervical VEMPs metrics most useful in distinguishing definite MD patients from healthy controls are VEMPs threshold, VEMPs -normalized peak-to-peak amplitude, and VEMPs inhibition depth.…”

Section: Discussionmentioning

confidence: 99%

Identification of early-stage Meniere’s disease as a cause of unilateral tinnitus

Alsarhan

2021

Journal of Otology

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Introduction Meniere’s disease (MD) is characterized by episodic symptoms, including vertigo, hearing loss, and tinnitus. Objectives in this study, cases of unilateral tinnitus were investigated for MD. Method Twenty-two patients who presented with chronic unilateral tinnitus on puretone audiograms showing an average threshold better than 25 dB HL and thresholds in the lower frequencies worse than those in the higher frequencies by more than 10 dB were suspected to have early-stage MD and underwent electrocochleography (ECochG). Patients showing ECochG findings conclusive for MD were compared to a control group of patients presenting with chronic unilateral tinnitus on pure-tone audiograms showing an average threshold better than 25 dB and thresholds in the higher frequencies worse than those in the lower frequencies by more than 10 dB. Results Eighteen of the 22 patients included in this study showed elevated summating potential amplitude to action potential amplitude ratios in ECochG (suggestive of endolymphatic hydrops due to MD) and were followed up for 2 months; 14 of them experienced at least two attacks of vertigo or unsteadiness. In contrast, only one patient in the control group reported two or more attacks of vertigo or unsteadiness in the 2 month observation period. The incidence of this finding in the two groups was significantly different. Conclusion Patients with early-stage MD can present with only unilateral tinnitus. Thus, the addition of “pure-tone audiograms showing lower-frequency thresholds worse than higher-frequency thresholds” to the probable MD category in the globally. agreed diagnostic criteria for MD, may be useful.

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Cervical Vestibular Evoked Myogenic Potentials in Menière's Disease: A Comparison of Response Metrics

Cited by 13 publications

References 47 publications

Endolymphatic hydrops in the unaffected ear of patients with unilateral Ménière’s disease

Endolymphatic hydrops in the unaffected ear of patients with unilateral Ménière’s disease

The vestibular implant: Opinion statement on implantation criteria for research1

Identification of early-stage Meniere’s disease as a cause of unilateral tinnitus

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