Serial cVEMP Testing is Sensitive to Disease Progression in Ménière Patients

Tilburg, Mark J. van; Herrmann, Barbara S.; Guinan, John J.; Rauch, Steven D.

doi:10.1097/mao.0000000000001213

Cited by 12 publications

(8 citation statements)

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“…In particular, the correlation of VEMP amplitudes/AR with clinical symptoms and inner ear ELH deserves special attention. For MD, both the degree of ELH in the affected ear [45,46] and the AR of cVEMP amplitudes increase over time [32,41], which is in line with progressive permanent damage to the sensory epithelia of the labyrinth. Assuming that VM does not result in permanent hair cell damage or neuronal degeneration of the inner ear, we hypothesize that VEMP amplitudes/AR and the degree of ELH would fluctuate over time without progressive deterioration as observed for MD.…”

Section: Discussionmentioning

confidence: 86%

“…To the best of our knowledge, only one study has compared cVEMP recordings between patients with MD and VM at two different points in time. Van Tilburg and coworkers [41] observed an increase in cVEMP amplitude AR after a mean followup period of 2 years in MD patients, while no significant changes were observed in VM patients. Although the results of the present study are very preliminary due to the small sample size, they indicate variable degrees of asymmetry over time (in particular in patient VM 2 with a short disease history), in contrast to the steady increase in AR observed for the two MD patients (Figs.…”

Section: Monitoring Of Vemps In Single Patientsmentioning

confidence: 92%

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Vestibular evoked myogenic potentials in vestibular migraine and Menière’s disease: cVEMPs make the difference

Dlugaiczyk

Dieterich

2020

J Neurol

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Objective Vestibular evoked myogenic potentials (VEMPs) have been suggested as biomarkers in the differential diagnosis of Menière's disease (MD) and vestibular migraine (VM). The aim of this study was to compare the degree of asymmetry for ocular (o) and cervical (c) VEMPs in large cohorts of patients with MD and VM and to follow up the responses. Study design Retrospective study in an interdisciplinary tertiary center for vertigo and balance disorders. Methods cVEMPs to air-conducted sound and oVEMPs to bone-conducted vibration were recorded in 100 patients with VM and unilateral MD, respectively. Outcome parameters were asymmetry ratios (ARs) of oVEMP n10p15 and cVEMP p13n23 amplitudes, and of the respective latencies (mean ± SD). Results The AR of cVEMP p13n23 amplitudes was significantly higher for MD (0.43 ± 0.34) than for VM (0.26 ± 0.24; adjusted p = 0.0002). MD-but not VM-patients displayed a higher AR for cVEMP than for oVEMP amplitudes (MD 0.43 ± 0.34 versus 0.23 ± 0.22, p < 0.0001; VM 0.26 ± 0.14 versus 0.19 ± 0.15, p = 0.11). Monitoring of VEMPs in single patients indicated stable or fluctuating amplitude ARs in VM, while ARs in MD appeared to increase or remain stable over time. No differences were observed for latency ARs between MD and VM. Conclusions These results are in line with (1) a more common saccular than utricular dysfunction in MD and (2) a more permanent loss of otolith function in MD versus VM. The different patterns of o-and cVEMP responses, in particular their longitudinal assessment, might add to the differential diagnosis between MD and VM.

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Section: Discussionmentioning

confidence: 86%

Section: Monitoring Of Vemps In Single Patientsmentioning

confidence: 92%

Vestibular evoked myogenic potentials in vestibular migraine and Menière’s disease: cVEMPs make the difference

Dlugaiczyk

Dieterich

2020

J Neurol

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“…In the current study, well-defined MD patients were compared with healthy controls to investigate how well cVEMP detects saccular dysfunction. Clinically, the ability to detect saccular dysfunction with cVEMPs could potentially be used to identify patients whose symptoms are suggestive, but not diagnostic for MD, as well as to track saccular function over time (38). It appears that different stages of MD may be accompanied by different cVEMP outcomes, with an increase in cVEMP thresholds for patients with more advanced disease (39,40).…”

Section: Discussionmentioning

confidence: 99%

Cervical Vestibular Evoked Myogenic Potentials in Menière's Disease: A Comparison of Response Metrics

Noij¹,

Herrmann

Guinan

et al. 2019

Otology &Amp; Neurotology

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Objective: The cervical vestibular evoked myogenic potential (cVEMP) has been used to evaluate patients with Meniere's Disease (MD). Studied cVEMP metrics include: amplitude, threshold, frequency tuning and interaural asymmetry ratio (IAR). However, few studies compared these metrics in the same set of MD patients, and methodological differences prevent such a comparison across studies. This study investigates the value of different cVEMP metrics in distinguishing one set of MD patients from age-matched controls. Study design: Prospective study Setting: Tertiary care center Patients: Thirty patients with definite unilateral MD and twenty-three age-matched controls were prospectively included. All underwent cVEMP testing at 500, 750, 1000 and 2000 Hz on each side. Ears were separated into three groups: affected MD, unaffected MD and control. Main outcome measures: Sound level functions were obtained at each frequency, and normalized peak-to-peak amplitude (VEMPn), VEMP inhibition depth (VEMPid), threshold, frequency-tuning ratio and IAR were calculated. For all metrics, the differentiation between MD and control ears was compared using ROC curves. Results: 500 Hz cVEMP threshold, VEMPn and VEMPid were similarly good at distinguishing affected MD ears from healthy ears, with ROC area under the curves (AUCs) of >0.828 and optimal sensitivities and specificities of at least 80% and 70%. Combinations of these three metrics yielded slightly larger AUCs (>0.880). Tuning ratios and IAR were less effective in separating healthy from affected ears with AUCs ranging from 0.529-0.720.

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“…Moreover, cVEMP absence was highly correlated with hearing loss in the other study (43). Further, VEMPs were used to indicate control of vertigo caused by MD (44), and cVEMP was suggested to be implemented to track progression of MD (45). These studies suggested that the test results of vestibular functions might be helpful to identify the progress of MD.…”

Section: Discussionmentioning

confidence: 99%

A New Proposal for Severity Evaluation of Menière's Disease by Using the Evidence From a Comprehensive Battery of Auditory and Vestibular Tests

Huang

Zhou

et al. 2020

Front. Neurol.

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To date, no widely accepted criteria exist to quantify the severity of Menière's disease (MD) by using vestibular tests. This study aimed to compare association of hearing loss and vertigo severity with association of accurate assessments of vestibular function and the vertigo severity. The severity of vertigo was documented by a comprehensive medical history with number of vertigo attacks in the past 6 months and a Dizziness Handicap Inventory (DHI) questionnaire. The involvement of vestibular organs was verified by audio-vestibular tests in 80 definite MD patients. Correlations between DHI scores, number of vertigo attacks in the past 6 months, audio-vestibular function, and the number of involved vestibular end organs were evaluated. We show that there are no significant differences in either severity of vertigo or laboratory results across the degree of hearing loss. Furthermore, the number of involved vestibular end organs was significantly correlated with vestibulo-ocular reflex gain in anterior and posterior canal video head impulse test (vHIT), interaural asymmetry ratio in vestibular-evoked myogenic potentials (VEMPs), and number of vertigo attacks in the past 6 months and DHI score. The vestibulo-ocular reflex gain in the rotatory chair test (RCT) was significantly correlated with the DHI Physical scores and number of involved vestibular end organs at 0.08 Hz. These results indicate that hearing loss is a poor indicator of vertigo severity in MD whereas the number of involved vestibular end organs may serve as an objective measure for MD progress. A battery of vestibular tests targeting different sensor organs is a complementary method for evaluating inner ear deficits and may aid in "grading" the severity of MD.

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Serial cVEMP Testing is Sensitive to Disease Progression in Ménière Patients

Abstract: cVEMP is able to track progression in Ménière's disease over time. Thresholds were the most effective outcome measure to both track progression and to distinguish between MAV and Ménière's patients.

Cited by 12 publications

References 12 publications

Vestibular evoked myogenic potentials in vestibular migraine and Menière’s disease: cVEMPs make the difference

Vestibular evoked myogenic potentials in vestibular migraine and Menière’s disease: cVEMPs make the difference

Cervical Vestibular Evoked Myogenic Potentials in Menière's Disease: A Comparison of Response Metrics

A New Proposal for Severity Evaluation of Menière's Disease by Using the Evidence From a Comprehensive Battery of Auditory and Vestibular Tests

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