Towards a new staging of Ménière’s disease: a vestibular approach

Abstract

Ménière's disease (MD) is characterised by intermittent episodes of vertigo, fluctuating sensorineural hearing loss, tinnitus and aural pressure. Histopathologically, endolymphatic hydrops are seen initially in the cochlear duct and saccule, and with progression of the disease subsequent involvement of the utricle and semicircular canals occurs. The aims of this study are: 1) to assess the function of the saccule, utricle and three semicircular canals using cervical vestibular evoked myogenic potential (cVEMP), ocular VEMP (oVEMP) and video head impulse test (vHIT) in Ménière's patients, and 2) to correlate the findings with the different stages of MD. Forty patients diagnosed with unilateral definite MD according to the AAO-HNS (1995) criteria were tested. They were divided into four subgroups according to the stage of MD using the average of 500, 1000, 2000 and 3000 Hz pure tone thresholds of the worst documented audiogram during the 6-month interval before examination. A control group of 40 healthy age-matched adults was equally divided into four corresponding subgroups according to their pure tone average. 500 and 1000 Hz tone burst air conduction cVEMP and oVEMP tests, bithermal caloric test and video HIT for all semicircular canals were recorded for both groups. The results of this study showed that the highest prevalence of abnormalities in Ménière's patients were seen in the PTA (85%), followed by cVEMP (72.5%) and oVEMP (67.5%). Caloric test abnormalities followed with a lower prevalence of 32.5%. The vHIT presented the lowest prevalence of abnormalities with 20% in the lateral canal, 7.5% in the anterior and 5% in the posterior. This pattern of abnormality agrees with the histopathological pattern of hydrops formation in the vestibular system. The findings of the current study suggest that with the advancement in the stage of MD, abnormal cVEMP, oVEMP, caloric and vHIT responses occur following the histopathological evidence of progression of the disease from the saccule up to the semicircular canals. Based on these findings, the authors suggest a new staging scheme for MD. KEY WORDS: Cervical vestibular evoked myogenic potential • Ocular vestibular evoked myogenic potential • Video head impulse test • Ménière's disease • Staging of Ménière's disease RIASSUNTO La malattia di Ménière (MD) è caratterizzata da episodi intermittenti di vertigine, ipoacusia neurosensoriale fluttuante, tinnito e sensazione di ovattamento auricolare. L'idrope endolinfatica è inizialmente osservata a livello istopatologico nel dotto cocleare e nel sacculo, ma con la progressione della malattia anche l'utricolo e i canali semicircolari possono venire interessati. Lo scopo dello studio è duplice: 1) definire la funzione del sacculo, dell'utricolo e dei tre canali semicircolari per mezzo di potenziali evocati vestibolari miogeni cervicali e oculari (cVEMP, oVEMP) e del video-Head Impulse Test (vHIT) nei pazienti affetti da MD; 2) correlare i risultati ottenuti con i diversi stadi di malattia. Quaranta pazienti con diagnosi di MD m...

Evaluation of a large cohort of adult patients with Ménière’s disease: bedside and clinical history

“…Further studies can assess if a dissociation between the 2 tests may be a peculiar characteristic of MD. Moreover, SVIN mainly detect a deficit of the lateral canal function; other tests, ocular and cervical VEMPs, are promising in studying macular function, above all when performed with sounds at different frequencies and studying the tuning curve of responses, thus allowing a mapping of all parts of the inner ear 28,29 . Some weak points in our investigation should be underlined.…”

Quantification of endolymphatic hydrops and its correlation with Meniere’s disease clinical features

“…Previous studies have reported that endolymphatic hydrops is observed most frequently in the cochlea and the saccule, followed by the utricle and semicircular canal. 20 With gadolinium-enhanced inner ear MRI, it is likely that the gadolinium injected into the tympanic cavity cannot evenly distribute to the distal parts of the ear, such as the semicircular canal, thus presenting false-positive endolymphatic hydrops. By contrast, intravenous gadolinium injection has a weaker signal but a more uniform distribution.…”

Advanced Imaging of the Vestibular Endolymphatic Space in Ménière's Disease

“…Recent reports confirm that the otoneurological responses correlate well with the magnetic resonance imaging (MRI) showing that the EH starts from the saccule and then progresses to the SCC ( 6 ).…”