Evidence of Large Vestibulo-Ocular Reflex Reduction in Patients With Menière Attacks

Abstract

Objective: To examine the high frequency horizontal vestibular ocular-reflex (hVOR) during acute attacks of vertigo in Menière's disease (MD). Study Design: Retrospective case series and literature review. Setting: Tertiary academic medical center. Patients: Patients with clinical diagnosis of unilateral “definite MD.” Intervention: Review of medical records. Main Outcome Measures: Spontaneous nystagmus and the dynamic hVOR gain change at different stages of an acute episode of MD attack. Results: We studied 10 vertigo attacks during the unique stages of the episode. During the acme stage of the attack, lower hVOR gain was recorded on the affected side (mean 0.48 ± 0.23), which was associated with a paralytic nystagmus (beating away from the affected ear). Additionally, the mean hVOR gain remained significantly (p < 0.05) reduced during each of the other stages of the attack as compared with the unaffected side and a control group. After the attack, mean hVOR gains normalized in the affected ear. Mean hVOR gain of the unaffected ear remained normal during all stages. Conclusion: Vestibular function during an attack of MD is a dynamic process associated with fluctuation of the dynamic (hVOR gain) and static (spontaneous nystagmus) processes, which exist in parallel with the perception of vertigo. Our data support vHIT monitoring during an episode to provide objective and accurate evidence of the ear with active disease. This would be particularly useful for those patients with MD presentations of unreliable hearing or assisting to identify the ear to be treated in the case of bilateral MD.

Enhanced Eye Velocity in Head Impulse Testing—A Possible Indicator of Endolymphatic Hydrops

“…consider that patient selection is an important factor. Some clinics only see patients who are well-advanced in the disease (31,32). Other clinics test patients who are at the very earliest stage of inner ear disease (33), and it may be that the enhanced eye velocity is more salient early in the disease.…”

Ductus Reuniens and Its Possible Role in Menière's Disease

“…direction reverse. Animal experiments and fortuitous nystagmus recordings in the clinic (38)(39)(40)(41)(42)(43)(44)(45) have been used to both support and refute a rupture mechanism. Varying descriptions of initial nystagmus direction and reversals may depend on the phase of attack recorded.…”