Vertigo patients exhibiting features of vestibular migraine (VM) and Menière's disease (MD) present a difficult diagnostic challenge to the clinician, and the two entities are likely to overlap. The aim of the present study was to investigate the occurrence of endolymphatic hydrops in patients with VM and auditory symptoms. This was an observatory diagnostic study. At an academic interdisciplinary dizziness centre, nineteen consecutive patients with definite or probable VM and auditory symptoms were examined by locally enhanced inner ear MR imaging. MR images were evaluated for the presence of endolymphatic hydrops. Of the 19 included patients, four patients (21 %) demonstrated evidence of cochlear and vestibular endolymphatic hydrops on locally enhanced inner ear MR imaging (three with "definite VM", one with "probable VM"). Locally enhanced inner ear MR imaging may be useful in the diagnostic evaluation of patients with VM and auditory symptoms, as some of these patients have signs of endolymphatic hydrops. Whether these patients suffer from MD only and are misdiagnosed as VM or suffer from both, VM and MD or whether endolymphatic hydrops is a consequence of inner ear damage due to VM are clinically relevant questions that can be evaluated by application of this technique.
A small increase in upward gaze angle caused a considerable augmentation of amplitudes. Controlling the level of gaze when recording oVEMP is thus indispensable to ensure interindividual and intraindividual comparability of oVEMP results.
Ocular vestibular evoked myogenic potentials (oVEMP) are strongly influenced by recording conditions and stimulus parameters. Throughout the published literature, a large variety of stimuli is used for eliciting oVEMP. Our objective was to determine the effects of different rise/fall times and plateau times on oVEMP amplitudes and latencies. 32 healthy subjects were enrolled in the study. 500 Hz air-conducted tone bursts with the parameters rise-plateau-fall time 0-4-0, 4-0-4, 2-2-2 and 2-4-2 ms were used for eliciting oVEMP. For all stimuli, response prevalences were 100 %. The 4-0-4 ms stimulus generated the smallest amplitudes, whereas the 2-2-2 and 0-4-0 ms stimuli achieved the largest amplitudes. n1 and p1 latencies were significantly shorter for the 0-4-0 ms than for the other stimuli, whereas latencies in response to the 4-0-4 ms stimulus were prolonged. Hence, a variety of stimuli is suitable for evoking oVEMP in healthy subjects. We recommend a 2-2-2 ms stimulus for clinical testing of oVEMP elicited by air conducted sound, because it reproducibly generates oVEMP without exposing the ear to unnecessary amounts of acoustic energy.
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