Characterizing a Joint Reflection-Distortion OAE Profile in Humans With Endolymphatic Hydrops.

OBJECTIVES: Endolymphatic hydrops (EH), a hallmark of Meniere disease, is an inner-ear disorder where the membranes bounding the scala media are distended outward due to an abnormally increased volume of endolymph. In this study, we characterize the joint-otoacoustic emission (OAE) profile, a results profile including both distortion- and reflection-class emissions from the same ear, in individuals with EH and speculate on its potential utility in clinical assessment and monitoring. DESIGN: Subjects were 16 adults with diagnosed EH and 18 adults with normal hearing (N) matched for age. Both the cubic distortion product (DP) OAE, a distortion-type emission, and the stimulus-frequency (SF) OAE, a reflection-type emission, were measured and analyzed as a joint OAE profile. OAE level, level growth (input/output functions), and phase-gradient delays were measured at frequencies corresponding to the apical half of the human cochlea and compared between groups. RESULTS: Normal hearers and individuals with EH shared some common OAE patterns, such as the reflection emissions being generally higher in level than distortion emissions and showing more linear growth than the more strongly compressed distortion emissions. However, significant differences were noted between the EH and N groups as well. OAE source strength (a metric based on OAE amplitude re: stimulus level) was significantly reduced, as was OAE level, at low frequencies in the EH group. These reductions were more marked for distortion than reflection emissions. Furthermore, two significant changes in the configuration of OAE input/output functions were observed in ears with EH: a steepened growth slope for reflection emissions and an elevated compression knee for distortion emissions. SFOAE phase-gradient delays at 40 dB forward-pressure level were slightly shorter in the group with EH compared with the normal group. CONCLUSIONS: The underlying pathology associated with EH impacts the generation of both emission types, reflection and distortion, as shown by significant group differences in OAE level, growth, and delay. However, hydrops impacts reflection and distortion emissions differently. Most notably, DPOAEs were more reduced by EH than were SFOAEs, suggesting that pathologies associated with the hydropic state do not act identically on the generation of nonlinear distortion at the hair bundle and intracochlear reflection emissions near the peak of the traveling wave. This differential effect underscores the value of applying a joint OAE approach to access both intracochlear generation processes concurrently.

Meniere's disease is a manifestation of migraine.

PURPOSE OF REVIEW: To discuss the theory that Meniere's disease (MD) is a variation of otologic migraine rather than an isolated inner ear condition. RECENT FINDINGS: In contrast to the approximately 12% of the general population suffering from migraine headaches, 51-60% of patients with MD experience migraine headaches. While pathognomonic for MD, endolymphatic hydrops has also been identified in patients with vestibular migraine. Treatment with the integrative neurosensory rehabilitation approach (diet and lifestyle changes, magnesium and riboflavin supplementation, and when needed, prophylactic medication) to treat the underlying migraine process has been highly effective in patients with MD. SUMMARY: MD can be understood as a manifestation of migraine such that patients with MD can be effectively treated with migraine therapies.

Frequency-specific Electrocochleography and Traveling Wave Time as a Clinical Test for Menière's Disease.

INTRODUCTION: Menière's disease is a clinical entity with no definitive objective testing. It has been hypothesized that underlying endolymphatic hydrops stiffens the basilar membrane leading to increased speed of the acoustic stimulus, therefore traveling wave velocity has been proposed as an objective test to aid in the diagnosis. The objective of this study is to compare electrocochleography frequency-specific action potential latency, basilar membrane traveling wave time, and summation to action potential (SP/AP) ratio in Menière's and non-Menière's patients. METHODS: Tympanic electrocochleography was performed with frequency-specific action potential latency time and SP/AP ratio recorded. Patient demographics, symptoms, audiogram data, AAO-HNS classification of Menière's disease, management interventions, and follow-up were recorded. Statistical analysis was performed to compare outcome measures across patient groups, demographics, and clinical data. RESULTS: Ninety-one patients (182 ears) were included. There was a significant difference between a "definite" Menière's diagnosis and an "unlikely" or "probable" diagnosis by an average of 13 dB HL for the pure-tone thresholds at 250 Hz on the affected side (p = 0.006). There was no significant difference in pure-tone thresholds at any other frequency, AP latency at any frequency, or AP/SP ratio between the different Menière's classification groups. CONCLUSIONS: Our study fails to show significance of the traveling wave velocity as an objective test for Menière's disease. A significant correlation was found with low-frequency hearing loss between AAO-HNS Menière's classification groups.

Objective methods to measure vestibular evoked myogenic potential response saccular tuning curves.

Objective: To detect cervical vestibular evoked myogenic potential (cVEMP) responses using objective statistical approaches and to apply this approach to estimate saccular frequency-tuning curves in volunteers and Ménière's disease (MD) patients. Design: Estimates of cVEMP threshold were carried out by 3 expert raters at 500 Hz and compared to objective threshold estimates (using Hotelling's T2 [HT2] and Fsp). Saccular tuning curves were objectively estimated. Study sample: Objective and subjective estimates of cVEMP response thresholds were compared for 13 normal hearing adults. Objective measurement of saccular tuning curves was explored in 20 healthy adults and 15 patients with MD. Results: Significant variability was seen between subjective estimates of cVEMP thresholds. Objective analysis with the HT2 test was more sensitive than 2 of 3 experts in detecting responses. The measurement time of cVEMP was considerably reduced with the HT2 test. Objective saccular tuning curves in volunteers showed strongest responses at 500 Hz. A flatter tuning curve was seen for MD patients. Conclusions: There is significant variability in subjective estimations of cVEMP thresholds. Objective analysis methods are more sensitive than subjective analysis, can detect responses rapidly and have potential to reduce variability in threshold estimates, hence they appear well suited to measure cVEMP tuning curves.

Inter-frequency amplitude ratio of oVEMP for differentiating Meniere's disease from BPPV: clinical validation using a double-blind approach.

OBJECTIVE: The study aimed at examining the usefulness of inter-frequency amplitude ratio (IFAR) of ocular vestibular evoked myogenic potential (oVEMP) in identifying Meniere's disease (MD) and differentiating it from benign paroxysmal positional vertigo (BPPV). DESIGN: A case-control design was used with a double blind approach. Phase 1 included 70 healthy individuals and 36 individuals each with MD and BPPV and Phase 2 included 20 individuals each with MD and BPPV. The age range of the participants in both phases was 15-50 years. All participants underwent oVEMP testing using 500 and 1000 Hz tone bursts and IFAR was obtained. RESULTS: The results in phase 1 revealed significantly higher IFARs in Meniere's disease than BPPV and healthy individuals (p < 0.001). An optimum criterion point of IFAR ≥1.11 for diagnosing MD was found which yielded 80% sensitivity and 98% specificity. The results in phase 2 demonstrated 85% correct identification of MD and 95% correct rejection of BPPV as non-MD. CONCLUSIONS: IFAR of oVEMP appears highly sensitive and specific parameter for identifying MD and a clinically valid tool for differentiating MD from BPPV.

Characterizing the Age and Stimulus Frequency Interaction for Ocular Vestibular-Evoked Myogenic Potentials.

OBJECTIVES: The normal process of aging is mostly associated with global decline in almost all sensory aspects of the human body. While aging affects the 500-Hz tone burst-evoked ocular vestibular-evoked myogenic potentials (oVEMPs) by reducing the amplitudes and prolonging the latencies, its interaction with oVEMP responses at other frequencies has not been studied. Therefore, the present study aimed at investigating the impact of advancing age on the frequency tuning of oVEMP. DESIGN: Using a cross-sectional research design, oVEMPs were recorded for tone burst frequencies of 250, 500, 750, 1000, 1500, and 2000 Hz from 270 healthy individuals divided into six age groups (10-20, 20-30, 30-40, 40-50, 50-60, and >60 years). RESULTS: The results revealed significantly lower response rates and amplitudes in age groups above 50 years of age than all the other groups at nearly all the frequencies (p < 0.05). Further, the frequency tuning was obtained at 500 or 750 Hz in majority of individuals below 60 years of age and at ≥1000 Hz in most of the individuals above 60 years of age (p < 0.05). Thus, there was a significant shift in frequency tuning of oVEMP from 500 or 750 Hz in the younger and the middle-aged adults to ≥1000 Hz in older adults, especially above 60 years of age. CONCLUSIONS: The results of the study showed significantly higher prevalence of frequency tuning at 1000 Hz in older adults above 60 years of age. Because the shift in frequency tuning to ≥1000 Hz is frequently used for identification of Meniere's disease, it is suggested that age-related correction be used for the diagnosis of Meniere's disease when using frequency tuning of oVEMP.

Utilisation of multi-frequency VEMPs improves diagnostic accuracy for Meniere's disease.

To determine whether vestibular evoked myogenic potential (VEMP) measurements that combine the VEMP 500/1000 Hz frequency tuning ratio and the inter-aural asymmetry ratio can reliably detect unilateral Meniere's disease ears as compared to healthy controls. Forty-two consecutive patients with certain unilateral Meniere's disease (as confirmed using a locally enhanced inner ear MRI (LEIM)) were assessed. Cervical vestibular evoked myogenic potentials (cVEMP) and ocular vestibular evoked myogenic potentials (oVEMP) were recorded at 500 and 1000 Hz. The VEMP amplitudes, asymmetry ratios, and the 500/1000 Hz amplitude ratios were compared with those of 21 age-matched healthy controls. A multi-frequency VEMPs score that combined: (1) the cVEMP 500/1000 Hz amplitude ratio, (2) the oVEMP 500/1000 Hz amplitude ratio, (3) the 500 Hz cVEMP asymmetry ratio, (4) the 1000 Hz cVEMP asymmetry ratio, produced a ROC curve with an area under the curve (AUC) of 0.814. The inclusion of audiology data further improved the result to 0.906. This score can be used to discriminate with a good degree of clinical accuracy between Meniere's ears (unilateral) and those of healthy controls. Multi-frequency VEMP analysis offers a simple, cost-effective solution to the diagnostic difficulties presented by Meniere's disease.

Diagnostic value of vestibular-evoked myogenic potentials in Ménière's disease and vestibular migraine.

Overlaps can be seen between vestibular migraine (VM) Ménière's Disease (MD) and diagnosis is difficult if hearing is normal. We aimed to investigate the sacculo-collic pathway in VM patients, MD patients, and healthy controls to define the diagnostic role of cervical VEMP (cVEMP). VEMP testing in response to 500 Hz and 1000 Hz air-conducted tone burst (TB) stimulation was studied prospectively in 22 subjects with definite VM (according to Bárány nomenclature), 30 subjects with unilateral definite MD, and 18 volunteers matched healthy controls. In VM subjects, response rate, p13 and n23 latencies were similar to healthy controls, but peak-to-peak amplitudes were bilaterally reduced at 500 Hz TBs (p= 0.005). cVEMP differentiated MD patients from VM and healthy controls with asymmetrically reduced amplitudes on affected ears with low response rates at 500 Hz TBs, and alteration of frequency dependent responses at 500 and 1000 Hz TBs. These findings suggest that cVEMP can be used as a diagnostic test to differentiate MD from VM. On the other hand, VEMP responses are symmetrically reduced on both sides in VM patients, suggesting that otolith organs might be affected by migraine-induced ischemia.

Abnormal fast fluctuations of electrocochleography and otoacoustic emissions in Menière's disease.

The responses of cochlear hair cells to sound stimuli depend on the resting position of their stereocilia bundles, which is sensitive to the chemical and mechanical environment. Cochlear hydrops, a hallmark of Menière's disease (MD), which is likely to come with disruption of this environment, results in hearing symptoms and electrophysiological signs, such as excessive changes in the cochlear summating potential (SP) and in the postural shifts of distortion-product otoacoustic emissions (DPOAEs). Here, SP from the basal part of the cochlea and DPOAEs from the apical part of the cochlea were recorded concomitantly in 73 patients with a definite MD, near an attack (n = 40) or between attacks with no clinical symptoms (n = 33), to compare their sensitivities to posture and evaluate their stability. The phase of the 2f1-f2 DPOAEs was monitored during body tilt, with stimuli f1 = 1 kHz and f2 = 1.2 kHz at 72 dB SPL. Extratympanic electrocochleography was performed in response to 95-dBnHL clicks. The normal limits of the DPOAE phase shift with body tilt, [-18°, +38°], and of the SP to action-potential (AP) ratio, <0.40, were exceeded in 75% and 60% of patients, respectively, near an attack. In these patients, but not in the asymptomatic ones, both tests reveal fluctuating cochlear responses from one data sample to the next. They emphasize how hydrops hinders normal hair-cell operation and may generate fast fluctuations in inner-ear functioning. If these fluctuations also occur on shorter time scales, it might explain the imperfect diagnostic sensitivity of SP and DPOAE tests, as averaging procedures would tend to level out transient fluctuations characteristic of hydrops.

MRI Inner Ear Imaging and Tone Burst Electrocochleography in the Diagnosis of Ménière's Disease.

OBJECTIVE: To compare the sensitivity of gadolinium MRI inner imaging with tone burst electrocochleography (EcochG) for diagnosing endolymphatic hydrops. STUDY DESIGN: A prospective study on patients who were to have an MRI scan to exclude retrocochlear pathology. SETTING: Tertiary care center. PATIENTS: One hundred and two patients: 57 patients with Possible, Probable, or Definite Ménière's Disease, 25 with asymmetrical hearing loss, 18 with sudden sensorineural hearing loss, and 2 with unilateral tinnitus had additional MRI inner ear imaging and click and tone burst stimulus EcochG testing. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURE: To compare the sensitivity of the two techniques. RESULTS: In 30 patients with symptom-based Definite Ménière's Disease, tone burst EcochG was positive in 25 (83%) and the click EcochG was positive in 9/30 (30%), and gadolinium MRI imaging diagnosed hydrops in 14 (47%). A positive result for either MRI imaging or tone burst EcochG was seen in 26 patients (87%). In 14 subjects with symptom-based Probable Ménière's Disease, 10 (71%) had either a positive EcochG or MRI. In 13 with Possible Ménière's Disease, four (31%) had a positive EcochG or MRI. CONCLUSION: This study confirms the greatly enhanced diagnostic sensitivity of tone burst EcochG over click response in diagnosing endolymphatic hydrops in Ménière's disease. Even though adequate MRI imaging was achieved in 90%, tone burst EcochG was a more sensitive test.

Diagnostic value of frequency-associated vestibular-evoked myogenic potential responses in Ménière's disease.

Thirty subjects with unilateral Ménière's disease (MD) and 18 age-matched controls underwent cervical (cVEMP) and ocular vestibular-evoked myogenic potential (oVEMP) testing using bilateral air-conducted stimulation (ACS) with stimulus frequencies of 500 and 1,000 Hz. The aim of this study is to determine the diagnostic value of frequency-associated responses in MD using oVEMP and cVEMP following 500- and 1,000-Hz ACS. In healthy controls and unaffected ears, responses to 500 Hz were found better than 1,000-Hz ACS in both oVEMP and cVEMP, while ears with MD responded to 1,000-Hz ACS better than to 500-Hz ACS in oVEMP. In cVEMP tests, affected ears responded to 500-Hz and 1,000-Hz ACS equally. Amplitude ratios of 1,000/500 Hz in both oVEMP and cVEMP were successful in differing affected ears from unaffected ears and healthy controls. This study showed frequency alteration of oVEMP and cVEMP can be used as a diagnostic test battery in MD.

Systematic review and meta-analysis of Meniett therapy for Meniere's disease.

OBJECTIVES/HYPOTHESIS: To perform a systematic review and meta-analysis of micropressure treatment for Meniere's disease (MD). DATA SOURCES: Medline, Ovid, Web of Science, and Cochrane Library search of the literature from January 1996 to December 2012. REVIEW METHODS: Systematic literature review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria required definitive diagnosis of unilateral MD, treatment with Meniett device, vertigo control results, and hearing results before and after treatment. Randomized controlled trials and other types of case-control studies were included. Improvements in vertigo, American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) functional score, and pure tone average (PTA) were assessed. Funnel plots were used to detect bias and Q test was used to assess for heterogeneity. Random effects model was used for meta-analysis. T test was used to assess for significance. RESULTS: Of 113 abstracts screened, 18 studies met criteria for review and 12 were used for meta-analysis. Eight studies reported hearing evaluation and the improvement in PTA after Meniett treatment was significant (P = 0.0085). Data could not be combined for AAO-HNS functional score due to heterogeneity. However, there was a trend toward improvement. Of six studies reporting frequency of vertigo, Meniett treatment significantly reduced frequency of vertigo (P = < .0001). LIMITATIONS: Much of the data used in the analysis was derived from retrospective or level 4 studies. The average follow-up was only 5 months, and there were low number of patients in the treatment and control groups. CONCLUSION: The Meniett device is a safe, nondestructive treatment for patients' refractory to medical therapy for MD.

Improvement in symptoms and cochlear flow with pycnogenol in patients with Meniere's disease and tinnitus.

AIM: The aim of this supplement registry was to evaluate the efficacy of the Pycnogenol® in improving cochlear flow and symptoms in a 6-month follow-up for patients with Meniere's disease (MD), tinnitus and cochlear hypoperfusion. METHODS: Main signs/symptoms were considered: Spontaneous vertigo, positional vertigo, hearing loss, tinnitus, pressure in the ear, unsteady gait, associated clinical problems, alterations in daily life. All subjects were managed with the best available management (BM); one group used the supplement Pycnogenol (150 mg/day). Cochlear flow and tinnitus were also evaluated. Out of 120 patients incuded in the registry, 55 used Pycnogenol and 52 (controls) were managed only with BM. RESULTS: There was a more significant improvement in all registry items at 3 and 6 months in the Pycnogenol group (P<0.05). The number of lost working days was lower in the Pycnogenol group. At 3 months, 45.4% of subjects using Pycnogenol were completely asymptomatic in comparison with 23.07% of controls. At 6 months 87.3% of the Pycnogenol subjects were asymptomatic compared with 34.6% of controls. Cochlear flow velocity was significantly better (higher flow, higher diastolic component) in the Pycnogenol group (P<0.05). The subjective tinnitus scale decreased in both groups (P<0.05); the decrease was more significant in Pycnogenol subjects (P<0.05) at 3 and 6 months. CONCLUSION: Symptoms of Meniere's disease, flow at cochlear level and tinnitus improved in Pycnogenol subjects in comparison with best management.

The diagnostic value of vestibular evoked myogenic potentials in patients with Meniere's disease.

OBJECTIVE: To estimate the sensitivity and specificity of vestibular evoked myogenic potentials (VEMPs) in comparison with caloric test in diagnosing Meniere's disease (MD) among patients with dizziness. METHODS: Data were retrospectively collected from 1,170 consecutive patients who underwent vestibular tests. Among them, 114 patients were diagnosed as having unilateral definite MD. VEMPs in response to clicks and short tone burst stimulation as well as caloric tests were performed. The sensitivity and specificity of each test were evaluated. The results of each test were compared with hearing level and staging of MD. RESULTS: The sensitivity and specificity of VEMPs were 50.0% and 48.9%, while those of the caloric test were 37.7% and 51.2%, respectively. There was no significant difference in hearing level between patients appropriately or inappropriately identified by VEMPs, whereas there was a significant difference in those of the caloric test. Combined use of VEMP and caloric test increased the sensitivity to 65.8%. CONCLUSION: Although the sensitivity and specificity of VEMPs in diagnosing MD were not high, they were comparable to those of caloric test. VEMPs as well as caloric testing may give additional information as part of a diagnostic test battery for detecting vestibular abnormalities in MD.

Tenotomy of the stapedius and tensor tympani muscles reduces subjective dizziness handicap in definite Meniere's disease.

CONCLUSION: Tenotomy is a promising surgical alternative with a high reduction in dizziness handicap in the short and long term. OBJECTIVES: To investigate the immediate and the long-term effect of tenotomy of the stapedius and tensor tympani muscles on subjective dizziness as measured by the Dizziness Handicap Inventory (DHI). METHODS: A retrospective follow-up study of 42 patients with definite, unilateral Meniere's disease (19 males, 23 females, average age = 58.1 ± 14.1 years) had undergone tenotomy under general anesthesia through an endaural approach. Pre- and postoperative DHI values were compared for all patients, with postoperative follow-up ranging from 6 months to 9 years. Additionally, results were divided into three postoperative subgroups (A = 0-3 years, B = 3-6 years, C = 6-9 years). RESULTS: A statistically significant reduction of 48 DHI points, from a median preoperative DHI = 52 to DHI = 4 postoperatively, was noted (p < 0. 001). In all, 40/42 patients reported a reduction of dizziness handicap, while in 33/42 the difference was > 12 points. A statistically significant reduction of DHI scores was noted (A = 60, B = 34, C = 33) in all subgroups. It was also noted that the higher the preoperative DHI score, the greater the subjective success of the surgery.

Clinical use of vestibular evoked myogenic potentials in the evaluation of patients with air-bone gaps.

OBJECTIVE: To determine the value of vestibular evoked myogenic potential (VEMP) test in clinical evaluation of air-bone gaps. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: A total of 120 patients underwent VEMP testing during clinical investigation of significant air-bone gaps in their audiograms. INTERVENTION(S): Otologic examination and surgeries, high-resolution computerized tomography (CT), air and bone audiometry, tympanometry, acoustic reflex, and VEMP test. MAIN OUTCOME MEASURE(S): Imaging studies demonstrating structural anomalies in the temporal bone. Audiologic outcomes of air-bone gaps and VEMP thresholds. Surgical findings confirming imaging results. RESULTS: Middle ear pathologies, such as otosclerosis and chronic otitis media, were identified in 50 patients, and all of them had absent VEMP responses elicited by air-conduction stimuli. Moreover, 13 of them had successful middle ear surgeries with closures of the air-bone gaps. Abnormally low VEMP thresholds were found in 71 of 73 ears with inner ear anomalies, such as semicircular canal dehiscence and enlarged vestibular aqueduct. Seven patients with superior semicircular canal dehiscence underwent plugging procedure via middle fossa approach, and VEMP thresholds became normalized after the surgery in 3 of them. VEMP test failed to provide accurate diagnosis in only 3 cases. CONCLUSION: Air-bone gaps may be a result of various otologic pathologies, and the VEMP test is useful during clinical evaluation, better than tympanometry and acoustic reflexes. To avoid unnecessary middle ear surgery for air-bone gaps with unknown or unsure cause, VEMP test should be used in the differential diagnosis before an expensive imaging study.

Furosemide-loading vestibular evoked myogenic potential testing can suggest developing bilateral involvement of unilateral Meniere's disease.

CONCLUSIONS: Patients with positive results of furosemide-loading vestibular evoked myogenic potential (F-VEMP) testing in the unaffected ears of unilateral Meniere's disease have a high incidence of developing bilateral lesions. OBJECTIVE: To clarify the meaning of positive results of F-VEMP testing of the unaffected ear of patients with unilateral Meniere's disease. METHODS: Twenty-five patients with unilateral Meniere's disease were investigated in this study. The positive group consisted of 6 patients with positive results of F-VEMP testing in the contralateral ear and the negative group consisted of 19 patients with negative results. The incidence of contralateral involvement was compared in both groups by the Kaplan-Meier method. RESULTS: Contralateral involvement was seen in three cases (50%) in the positive group after 2, 12, and 26 months and in three cases (16%) in the negative group after 27, 56, and 78 months. The positive group had a higher incidence of contralateral involvement than the negative group (p = 0.0017, according to a log-rank test).

On the differential diagnosis of Ménière's disease using low-frequency acoustic biasing of the 2f1-f2 DPOAE.

We have cyclically suppressed the 2f1-f2 distortion product otoacoustic emission (DPOAE) with low-frequency tones (17-97 Hz) as a way of differentially diagnosing the endolymphatic hydrops assumed to be associated with Ménière's syndrome. Round-window electrocochleography (ECochG) was performed in subjects with sensorineural hearing loss (SNHL) on the day of DPOAE testing, and from which the amplitude of the summating potential (SP) was measured, to support the diagnosis of Ménière's syndrome based on symptoms. To summarize and compare the cyclic patterns of DPOAE modulation in these groups we have used the simplest model of DPOAE generation and modulation, by assuming that the DPOAEs were generated by a 1st-order Boltzmann nonlinearity so that the magnitude of the 2f1-f2 DPOAE resembled the 3rd derivative of the Boltzmann function. We have also assumed that the modulation of the DPOAEs by the low-frequency tones was simply due to a sinusoidal change in the operating point on the Boltzmann nonlinearity. We have found the cyclic DPOAE modulation to be different in subjects with Ménière's syndrome (n = 16) when compared to the patterns in normal subjects (n = 16) and in other control subjects with non-Ménière's SNHL and/or vestibular disorders (n = 13). The DPOAEs of normal and non-Ménière's ears were suppressed more during negative ear canal pressure than during positive ear canal pressure. By contrast, DPOAE modulation in Ménière's ears with abnormal ECochG was greatest during positive ear canal pressures. This test may provide a tool for diagnosing Ménière's in the early stages, and might be used to investigate the pathological mechanism underlying the hearing symptoms of this syndrome.

Ocular vestibular evoked myogenic potentials in response to air-conducted sound in Ménière's disease.

BACKGROUND: Currently, Ménière's disease is predominantly diagnosed through clinical criteria. Additional standard vestibular testing, such as nystagmography, can show variable responses. In the last decade, the cervical vestibular evoked myogenic potential (VEMP) has shown to be of additive value in diagnosing Ménière's disease. In this study, the results of the ocular VEMP (oVEMP) in response to air-conducted sound will be discussed. OBJECTIVES: To evaluate possible changes of the oVEMP in a large group (n = 37) of patients with Ménière's disease. MATERIAL AND METHODS: In 55 subjects without Ménière's disease and 37 patients with Ménière's disease, oVEMPs in response to air-conducted sound stimulation (tone-burst, 500 Hz; maximum stimulus level, 120 dB sound pressure level) were studied. Recording was performed in upgaze with surface electrodes underneath both eyes. The burden of the test was scored by all subjects on a visual analogue scale. RESULTS: In patients with Ménière's disease the response rates are lower, the oVEMP amplitudes are smaller, and thresholds are higher than in subjects without Ménière's disease. This effect is observed in both ears of patients with Ménière's disease. The affected ear is more altered than the clinically unaffected ear. CONCLUSION: The air-conducted oVEMP can be a relevant addition to the current diagnostic workup of patients with possible Ménière's disease. A lower response rate, smaller amplitude, and higher threshold of the oVEMP indicate the pathologic disease in this population.

[Air conducted ocular VEMP: II. First clinical investigations]. / Luftleitungsinduzierte oculäre VEMP: II. Erste klinische Untersuchungen.

BACKGROUND: Vestibular-evoked myogenic potentials (VEMP) are widely used to assess vestibular function. Air conducted (AC) cervical VEMP (cVEMP) reflect sacculus and inferior vestibular nerve function. Ocular VEMP (oVEMP) however has been hardly examined up to now. In recent studies it has been assumed that AC oVEMP probably reflects superior vestibular nerve function. The aim of this pilot study was to evaluate clinical application of the AC oVEMP. MATERIAL AND METHODS: AC oVEMP were recorded in patients with peripheral vestibular disorders (n=21). In addition thermal irritation and head impulse test were performed and AC cVEMP were recorded. For intense AC-sound stimulation tone bursts (500 Hz) with 100 dB nHL were used. RESULTS: In peripheral vestibular disorders AC oVEMP and AC cVEMP could be classified into: • type 1 (inferior vestibular neuritis) with loss of AC oVEMP but normal AC cVEMP, • type 2, probable type of superior vestibular neuritis, showing present AC cVEMP but loss of AC oVEMP, • type 3, probable complete vestibular neuritis, without AC oVEMP and AC cVEMP. CONCLUSIONS: AC oVEMP may be used as an appropriate test for clinical investigation in patients with vestibular disorders. AC oVEMP is an additional, essential test for assessing otolith function beside AC cVEMP. Further vestibular test are necessary for precise clinical interpretation.