Vestibulo-ocular reflex tests may reflect unilateral Ménière disease progression

Abstract

Vestibular disorders can manifest several patterns of horizontal vestibulo-ocular reflex (VOR) impairment, which can be detected by caloric test and video head impulse test (vHIT). Several studies have examined the patterns of caloric-vHIT response in Ménière disease (MD). The purpose of this study was to investigate the diversity of caloric-vHIT response and its related factors in unilateral MD patients. We also explore the possibility of assessing the progression of unilateral MD by using the horizontal VOR tests. Ninety-eight patients with unilateral MD were enrolled and underwent a battery of audio-vestibular evaluations, including the pure tone audiogram, caloric test, and horizontal vHIT. Some patients received the electrocochleography and glycerol test. The combined results of caloric test and horizontal vHIT were categorized qualitatively into 4 patterns: Pattern I: normal caloric and vHIT responses; Pattern II: abnormal caloric and normal vHIT responses; Pattern III: normal caloric and abnormal vHIT response; and Pattern IV: abnormal caloric and vHIT responses. The abnormal caloric results were semi-quantitatively subdivided into sub-patterns as mild, moderate, and severe abnormality. The associations between these patterns/sub-patterns and related factors were analyzed. Pattern I was found in 35 cases (35.7%), Pattern II in 57 (58.2%), and Pattern IV in 6 (6.1%). No patient had Pattern III. No significant differences were found between the patterns/sub-pattern distribution and age, electrocochleography, and glycerol test results. Disease duration was not associated with the pattern distribution, while remained a relation with sub-pattern distribution. The pattern/sub-pattern distribution varied significantly across MD stages. The proportion of pattern II or pattern IV increased with the stage of unilateral MD. MD can manifest several patterns of horizontal VOR impairment, of which the impaired caloric response with normal vHIT is the most common pattern. With the progression of unilateral MD, the caloric-vHIT pattern tends to shift, which may reflect the deterioration of endolymphatic hydrops and vestibular hair cells impairments.

Anatomical variation of inner ear may be a predisposing factor for unilateral Ménière’s disease rather than for ipsilateral delayed endolymphatic hydrops

“…Similarly, Mateijsen et alalso found no relationship between MRI-PP distance and duration of disease in the MD patients [5]. In patients with MD, the results of EcochG and glycerol test can be used as traditional audiological indicators for ELH, and the caloric response is correlated with the severity of vestibular ELH (as demonstrated by gadoliniumenhanced MRI of the inner ear) [48], suggesting that caloric response may serve as a vestibular indicator for ELH [49]. These audio-vestibular variables may reflect the severity of MD indirectly and were not correlated with the radiological anatomical variations.…”

Comparison between audio-vestibular findings and contrast-enhanced MRI of inner ear in patients with unilateral Ménière’s disease

“…As for evaluating function of semicircular canal (SCC), the instrumental tests mainly include the caloric test and vHIT. It has been reported that MD patients tend to have a dissociated pattern of caloric-vHIT response ( McCaslin et al, 2015 ; Rubin et al, 2018 ; Zhou et al, 2020 ; Hannigan et al, 2021 ). The exact mechanism underlying this caloric-vHIT dissociation remains to be determined.…”

Dissociation between video head impulse test and caloric test: a marker of menière's disease? – A systematic review and meta-analysis

“…Nine 2 , 10 , 11 , 12 , 13 , 14 , 17 , 18 , 19 of the 12 articles analyzed showed caloric tests were performed with water (6 of the them at temperatures of 30 °C and 44 °C), 2 , 10 , 11 , 12 , 13 , 17 , 18 while in three of the studies air (at temperatures of 24 °C and 50 °C) 15 , 16 , 20 was used as a stimulus to perform the same test, which is equivalent when performed at these temperatures. 21 In 11 articles, labyrinthine predominance was used as a criterion for altering the caloric test, which varied between the values of ≥22% and ≥30%.…”