Comparing the sensitivity and specificity of cervical vestibular-evoked myogenic potentials and electrocochleography in the diagnosis of Ménière’s disease

Abstract

Objective: To compare the sensitivity and specificity of objective cervical vestibular-evoked myogenic potential (cVEMP) tuning curves and electrocochleography (ECochG) for the diagnosis of M eni ere's disease (MD). Design: Sensitivity and specificity were calculated from 95% normative ranges of 500 Hz cVEMP threshold and ECochG SP/AP amplitude ratios. Measures: Extra-tympanic ECochG testing to 90 dB nHL clicks and cVEMP threshold tuning curves (250-1000 Hz). Study sample: We tested 15 patients (30 ears) diagnosed with definite bilateral MD based on the clinical criteria proposed by the American Academy of Otolaryngology Head and Neck surgery, 1995 (assumed gold standard) and 20 controls. Results: 500 Hz cVEMP threshold was the most promising parameter to differentiate MD ears from controls. cVEMP and ECochG showed high specificity (83.3 and 100%, respectively) and low to moderate sensitivity (22.2 and 71.4%) for long term MD. ECochG sensitivity increased to 89% during a symptomatic period, compared to 33% for cVEMP. However, ECochG can be difficult to schedule during symptomatic periods. Sensitivity of cVEMP for the diagnosis of MD appears limited. Conclusions: ECochG has higher sensitivity than cVEMP in the diagnosis of M eni ere's patients, but the ECochG SP/AP amplitude ratio measure is not perfect for the diagnosis of MD.

Physiology, clinical evidence and diagnostic relevance of sound-induced and vibration-induced vestibular stimulation

“…In contrast to patients with vestibular migraine, Menie `re's disease patients frequently display a shift in frequency tuning from 500 to 1000 Hz for oVEMPs and cVEMPs [74][75][76]. The issue of age-matched controls is of paramount importance in studying VEMPs in Menie `re's disease, as an increase of VEMP best frequency is also observed for normal controls above the age of 60 [77,78]. Vestibular migraine patients typically show abnormal oVEMPs with preserved cVEMPs [79].…”