Clinical value of tone burst vestibular evoked myogenic potentials at threshold in acute and stable Ménière's disease

Abstract

Introduction:The objectives of this preliminary, prospective, cohort study were to ascertain the characteristics of vestibular evoked myogenic potentials at threshold levels in two groups of Ménière's disease patients – acute and stable – and to identify whether vestibular evoked myogenic potentials can provide any specific, objective information to distinguish acute from stable Ménière's disease.Subjects and methods:The study was based at a tertiary neuro-otology centre. Twenty adult patients who fulfilled the American Academy of Otolaryngology–Head and Neck Surgery1 criteria for Ménière's disease were divided into two groups: 11 patients with acute Ménière's disease and nine patients with stable Ménière's disease. Eighteen healthy adult volunteers served as controls. All subjects underwent vestibular evoked myogenic potential testing with ipsilateral, short tone burst stimuli at 500 Hz, as well as pure tone audiometry. The patients also underwent caloric testing.Results:Vestibular evoked myogenic potentials were present in all controls, and were present in 65 per cent of patients but absent in 35 per cent. The mean absolute threshold (Tvestibular evoked myogenic potential) ± standard deviation in normal controls was 116 ± 7.7 dBSPL; this did not differ statistically from that in patients, nor did it differ between acute and stable Ménière's disease. The p13/n23 latencies at the threshold levels in the normal, acute and stable groups (mean ± standard deviation) were respectively: 15 ± 2.2 ms/23.0 ± 2.5 ms; 15.7 ± 0.9 ms/23.7 ± 0.9 ms; and 15.3 ± 2.0 ms/24.2 ± 1.9 ms. The mean interaural amplitude difference ratio (IAD) ± standard deviation was significantly higher in the stable group compared with the acute group (0.54 ± 0.33 vs −0.15 ± 0.22; p = 0.007) and with the controls (0.54 ± 0.33 vs 0.1 ± 0.22; p = 0.05).Conclusions:The parameter that best differentiated acute from stable Ménière's disease at threshold was the interaural amplitude difference ratio. Therefore, this parameter may be used to monitor the clinical course of Ménière's disease.

Ocular Vestibular Evoked Myogenic Potentials in Response to Air-Conducted Sound in Ménière's Disease

“…As to the cVEMP, however, a significantly higher threshold in 34 affected Ménière's ears was also found by Rauch et al (15). Osei-Lah et al (17) studied 20 patients with Ménière's disease and did not find a threshold shift in patients.…”

Vestibular evoked myogenic potentials: review

“…A relationship has been demonstrated between increasing inter-aural vestibular evoked myogenic potential amplitude difference (i.e. right ear − left ear/right ear + left ear) and Ménière's disease stage progression 25 , 52 . Other studies have demonstrated an increase or reappearance of vestibular evoked myogenic potential amplitudes following glycerol loading or intravenous furosemide treatment in some patients with Ménière's disease 53 , 54 …”

“…51 Although absent or decreased vestibular evoked myogenic potential responses have been demonstrated in Ménière's disease patients, delays in p13n23 complex latencies have rarely been detected. 25,52 Other studies have demonstrated an increase or reappearance of vestibular evoked myogenic potential amplitudes following glycerol loading or intravenous furosemide treatment in some patients with Ménière's disease. right ear − left ear/right ear + left ear) and Ménière's disease stage progression.…”

Effect of personal music system use on sacculocollic reflex assessed by cervical vestibular-evoked myogenic potential: A preliminary investigation

“…[ 57 58 59 ] The pathologies that affect only the saccule but not the nerve, such as Meniere's disease and BPPV, have been shown to produce normal-like latencies. [ 49 60 ] Since the present study has shown normal-like latencies in both the subgroups (ARML and BRML), the inference from the above studies would suggest the lack of neuronal involvement in the subjects used in the present study. Therefore, it appears that damage caused by music overexposure in the present study was limited to the saccule and there was no impact of it on the inferior vestibular nerve fibers that supply the saccule.…”