Short-term hearing fluctuation in Meniere's disease

Ménière's disease (MD) is characterized by fluctuations in labyrinthine function which are well known and objectively established for the auditory symptoms [1,2]. It is also well known that it is disorders of balance, rather than hearing, which are the major symptoms during the early stages of the disease [3]. But to date there have been only a few measurements of the fluctuations in vestibular function around the time of the attack. This has been due to two factors. First, the difficulty of testing early MD patients around the time of their attack, which can have highly variable duration: each attack may last from 10 min to hours [2,3]. Second, the limited range of vestibular tests available and the fact that the usual tests of vestibular function are so demanding that they are not feasible in patients around the time of the attack.However, recently, we published results of a new nondemanding test of otolith function-the n10 of the ocular vestibular-evoked myogenic potential which showed that there are fluctuations in vestibular function, with enhanced dynamic utricular function at the time of the attack compared to quiescence [4]. Here, we wish to address the complementary question as to whether dynamic semicircular canal function fluctuates as auditory and dynamic otolith function does and we present evidence of variations in dynamic semicircular canal function around the time of the MD attack.The development of the video head impulse test (vHIT) has allowed non-demanding objective measures of semicircular canal function [5]. This is a very simple, fast way of measuring dynamic semicircular canal function accurately and has been validated by directly comparing it to simultaneous measures by the ''gold standard'' search coil test [6]. The gain measurements of the two tests are not significantly different and show very high concordance correlations [6]. With vHIT it is possible to test patients very quickly at short intervals and this kind of easily repeatable, high accuracy, minimally demanding test allows the measurement of the sequential changes in semicircular canal function at the time of the attack.The vHIT test involves the clinician delivering brief, passive, high acceleration head impulses of yaw head rotation unpredictably to the right or left through an angle of about 10°-20°while the patient is instructed to keep looking at an earth-fixed target. The patient wears a set of minimal-slip goggles to which is attached a small lightweight high speed video camera to measure eye position and a 3-d sensor to measure head velocity. We used vHIT to measure the yaw VOR response of patients with evidence of early MD, both at quiescence and during an acute attack. Here, we report that the repeated tests at short intervals show that the VOR response changes substantially around the time of an attack (Fig. 1).

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“…These rapid changes in VOR function appear to correspond to some of the rapid changes in auditory function around the time of an attack [1].…”

Section: Dear Sirmentioning

confidence: 97%

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confidence: 99%

Rapid fluctuations in dynamic semicircular canal function in early Ménière’s disease

Manzari

Burgess

MacDougall

et al. 2010

Eur Arch Otorhinolaryngol

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“…3B). This patient complained of fluctuating hearing during vertigo attacks, but hearing impairment could not be documented during our interictal assessment, as is often the case in early Meniere's disease (McNeill et al 2009). This suggests that the transient EVS may be used to assist diagnosis of early Meniere's disease.…”

Section: Discussionmentioning

confidence: 78%

Enhanced Vestibulo-ocular Reflex to Electrical Vestibular Stimulation in Meniere’s Disease

Todd

et al. 2012

JARO

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Meniere's disease is characterized by sporadic episodes of vertigo, nystagmus, fluctuating sensorineural hearing loss, tinnitus and aural pressure. Since Meniere's disease can affect different regions of the vestibular labyrinth, we investigated if electrical vestibular stimulation (EVS) which excites the entire vestibular labyrinth may be useful to reveal patchy endorgan pathology. We recorded three-dimensional electrically evoked vestibulo-ocular reflex (eVOR) to transient EVS using bilateral, bipolar 100-ms current steps at intensities of 0.9, 2.5, 5.0, 7.5 and 10.0 mA with dual-search coils in 12 unilateral Meniere's patients. Their results were compared to 17 normal subjects. Normal eVOR had tonic and phasic spatiotemporal properties best described by the torsional component, which was four times larger than horizontal and vertical components. At EVS onset and offset of 8.9 ms latency, there were phasic eVOR initiation (M = 1,267 °/s(2)) and cessation (M = -1,675 °/s(2)) acceleration pulses, whereas during the constant portion of the EVS, there was a maintained tonic eVOR (M = 9.1 °/s) at 10 mA. However in Meniere's disease, whilst latency of EVS onset and offset was normal at 9.0 ms, phasic eVOR initiation (M = 1,720 °/s(2)) and cessation (M = -2,523 °/s(2)) were enlarged at 10 mA. The initiation profile was a bimodal response, whilst the cessation profile frequently did not return to baseline. The tonic eVOR (M = 20.5 °/s) exhibited a ramped enhancement of about twice normal at 10 mA. Tonic eVOR enhancement was present for EVS >0.9 mA and disproportionately enhanced the torsional, vertical and horizontal components. These eVOR abnormalities may be a diagnostic indicator of Meniere's disease and may explain the vertigo attacks in the presence of declining mechanically evoked vestibular responses.

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“…3, lower trace). According to McNeill et al, a significant proportion of short-term hearing fluctuation in MD had also greatest change at the middle frequencies around 800-3000 Hz, although the low frequencies were the commonest site of fluctuation [70]. Spontaneous fluctuation of deafness should be mediated by the same mechanism underlying the glycerol test.…”

Section: Brief Commentmentioning

confidence: 95%

A possible mechanism of the formation of endolymphatic hydrops and its associated inner ear disorders

Takeda

Takeda²,

Kakigi

2020

Auris Nasus Larynx

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Short-term hearing fluctuation in Meniere's disease

Cited by 14 publications

References 13 publications

Rapid fluctuations in dynamic semicircular canal function in early Ménière’s disease

Rapid fluctuations in dynamic semicircular canal function in early Ménière’s disease

Enhanced Vestibulo-ocular Reflex to Electrical Vestibular Stimulation in Meniere’s Disease

A possible mechanism of the formation of endolymphatic hydrops and its associated inner ear disorders

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