Abnormal Cervical Vestibular-Evoked Myogenic Potentials Predict Evolution of Isolated Recurrent Vertigo into Meniere’s Disease

Abstract

IntroductionVestibular-evoked myogenic potentials (VEMPs) can be abnormal in patients with idiopathic recurrent spontaneous vertigo. We aimed to determine whether abnormal cervical vestibular-evoked myogenic potentials (cVEMPs) can predict evolution of isolated recurrent vertigo into Meniere’s disease (MD).MethodsWe had followed up 146 patients with isolated recurrent vertigo and an evaluation of cVEMPs for 0–142 months [median = 6, interquartile range (IQR) = 0–29] at the Dizziness Clinic of Seoul National University Bundang Hospital from June 2003 to May 2014. We defined the variables associated with a progression into MD and calculated cumulative progression rates.ResultsAmong the 94 patients with recurrent vertigo and abnormal cVEMPs, 18 (18/94, 19%) showed an evolution into MD while only 2 of the 50 (4%) patients with normal cVEMPs evolved into MD during the follow-up (p = 0.01). The interval between onset of vertigo and development of cochlear symptoms ranged from 1 month to 13.6 years (median = 3 years, IQR = 0.5–4.5 years). Overall, pure tone audiometry (PTA) threshold at 0.25 kHz [hazard ratio (HR) = 1.1, 95% confidence interval (CI) = 1.0–1.2] and abnormalities of cVEMPs (HR = 5.6, 95% CI = 1.3–25.5) were found to be significantly associated with a later conversion into MD. The cumulative progression rate was 12% (95% CI = 5–18) at 1 year, 18% (8–26) at 2 years, and 22% (11–32) at 3 years.ConclusionAbnormal cVEMPs may be an indicator for evolution of isolated recurrent vertigo into MD. Patients with isolated recurrent vertigo may be better managed conforming to MD when cVEMPs are abnormal.

Vestibular-Evoked Myogenic Potential Testing in Vestibular Localization and Diagnosis

“…A recent retrospective study of patients with isolated recurrent vertigo (i.e., without any aural or headache symptoms) found that 94 of 146 patients had abnormal cVEMPs on initial testing and 19% of these went on to develop MD and experience cochlear symptoms, compared with only 4% of patients with normal cVEMPs. 37 Interestingly, the smaller VEMP did not always indicate the affected ear, suggesting that the cVEMPs were in fact augmented in many of these ears in the very early stages of disease. 37 This confirms earlier reports of enlarged cVEMPs in the affected ear in patients with early MD, 36 and is presumably due to temporary changes in the resonance of the system leading to an increase in sound transmission to the saccule.…”

“…37 Interestingly, the smaller VEMP did not always indicate the affected ear, suggesting that the cVEMPs were in fact augmented in many of these ears in the very early stages of disease. 37 This confirms earlier reports of enlarged cVEMPs in the affected ear in patients with early MD, 36 and is presumably due to temporary changes in the resonance of the system leading to an increase in sound transmission to the saccule. A study by Manzari et al demonstrated that similar fluctuations may also occur within a single attack of MD.…”

“…Taking an extra 5 to 10 minutes to perform an AC oVEMP can differentiate response enlargement from absence, and in doing so, prevent unwarranted stapedectomy. Rarely, enlarged AC VEMP amplitudes are recorded in MD, [36][37][38] and low thresholds and/or enlarged amplitudes have been reported in other third-mobile window syndromes, such as large vestibular aqueduct syndrome [39][40][41] and posterior canal dehiscence. 42,43 Ménière's Disease…”

Parameters of Off-Vertical Axis Rotation in Unilateral and Bilateral Vestibulopathy and Their Correlation with Vestibular Evoked Myogenic Potentials

“…Air-conduction cVEMP tests using 500 Hz tone burst stimuli with an intensity of 105 dB nHL through calibrated headphone, and bone-conduction oVEMP tests using tapping stimuli with the peak amplitude of 85 dB FL were performed in all patients with UVH or BVP to identify correlations with the OVAR results. Each test has been described in detail previously [ 9 , 10 ]. In brief, for the cVEMP test, we placed the subjects on a bed in a supine position, raised their head to approximately 30° from the horizontal, and rotated it contralaterally.…”

Bilateral Vestibulopathy in Superficial Siderosis

“…To compare the normalized p1 – n1 amplitudes of the cVEMP between the sides, the interaural difference ratio of the normalized amplitudes (IAD, %) was also calculated as [(AR – AL) / (AR + AL) × 100], where AR and AL are the normalized p1-n1 amplitude on the right and left sides, respectively. Both the p1 and n1 peak latencies were also calculated ( 32 ). In this study, we defined normal range of cVEMP when the IAD ratio was less than 22.5%.…”