Clin Exp Otorhinolaryngol.  2013 Jun;6(2):57-62.

Clinical Value of Vestibular Evoked Myogenic Potential in Assessing the Stage and Predicting the Hearing Results in Meniere's Disease

• Kim MB
• Choi J
• Park GY
• Cho YS
• Hong SH
• Chung WH

Abstract

OBJECTIVES
Our goal was to find the clinical value of cervical vestibular evoked myogenic potential (VEMP) in Meniere's disease (MD) and to evaluate whether the VEMP results can be useful in assessing the stage of MD. Furthermore, we tried to evaluate the clinical effectiveness of VEMP in predicting hearing outcomes.
METHODS
The amplitude, peak latency and interaural amplitude difference (IAD) ratio were obtained using cervical VEMP. The VEMP results of MD were compared with those of normal subjects, and the MD stages were compared with the IAD ratio. Finally, the hearing changes were analyzed according to their VEMP results.
RESULTS
In clinically definite unilateral MD (n=41), the prevalence of cervical VEMP abnormality in the IAD ratio was 34.1%. When compared with normal subjects (n=33), the VEMP profile of MD patients showed a low amplitude and a similar latency. The mean IAD ratio in MD was 23%, which was significantly different from that of normal subjects (P=0.01). As the stage increased, the IAD ratio significantly increased (P=0.09). After stratification by initial hearing level, stage I and II subjects (hearing threshold, 0-40 dB) with an abnormal IAD ratio showed a decrease in hearing over time compared to those with a normal IAD ratio (P=0.08).
CONCLUSION
VEMP parameters have an important clinical role in MD. Especially, the IAD ratio can be used to assess the stage of MD. An abnormal IAD ratio may be used as a predictor of poor hearing outcomes in subjects with early stage MD.

Keyword

Vestibular evoked myogenic potential; Meniere's disease; Stage; Hearing loss; Vertigo

MeSH Terms

Hearing
Hearing Loss
Humans
Meniere Disease
Prevalence
Vertigo

Figure

• 

  Fig. 1 The peak to peak amplitude of vestibular evoked myogenic potential (VEMP): Ménière's disease vs. normal subjects. The mean (±SD) peak to peak P13-N23 amplitude in Ménière's disease was 100.16 (±73.15) µV, which was significantly lower than normal subjects (153.03±89.91 µV; P=0.01).

• 

  Fig. 2 The latency of P13 and N23 potentials: Ménière's disease vs. normal subjects. (A) The P13 in patients with Ménière's disease had a mean±SD of 16.9±2.07 ms, and showed similar latency with normal subjects (16.7±1.47 ms). (B) The N23 in patients with Ménière's had a mean of 26.6±2.51 ms and showed similar latency with normal subjects (26.1±1.93 ms). VEMP, vestibular evoked myogenic potential.

• 

  Fig. 3 The interaural amplitude difference ratio of vestibular evoked myogenic potential (VEMP): Ménière's disease vs. normal subjects. The mean±SD percentage of the interaural amplitude difference ratio in Ménière's disease was 23.55%±38.34%, which showed significantly larger asymmetry compared to normal subjects (-0.16%±15.17%; P=0.01).

• 

  Fig. 4 The staging of Ménière's disease using vestibular evoked myogenic potential (VEMP). (A) The interaural amplitude difference (IAD) ratio in stage I and II Ménière's disease patients was 12.62%±29.77% and this result was similar with normal subjects. But, in patients with stage III and IV Meniere's disease, the IAD ratio was increased (38.98%±44.37%) and was significantly larger than in stage I and II patients (P=0.03). (B) The mean±SD percentage of the IAD ratio was 7.94%±30.86% in stage I, 14.96%±29.95% in stage II and 40.20%±45.53% in stage III (P=0.09).

• 

  Fig. 5 Hearing changes between the initial and last visits in patients (PTAs) with normal and abnormal vestibular evoked myogenic potential (VEMP): stage I and II Ménière's disease. (A) In stage I and II Ménière's disease, PTAs with a normal interaural amplitude difference (IAD) ratio showed minimal hearing aggravation (5.44±16.1dB). (B) The PTAs with an abnormal IAD ratio showed much more hearing aggravation (21.07±22.07 dB).

• 

  Fig. 6 Hearing changes between the initial and last visits in patients (PTAs) with normal and abnormal vestibular evoked myogenic potential (VEMP): stage III and IV Ménière's disease. (A) In stage III and IV Ménière's disease, PTAs with a normal interaural amplitude difference (IAD) ratio showed minimal hearing change (-1.25±11.13 dB). (B) PTAs with an abnormal IAD ratio showed similar hearing change compared to PTAs with a normal IAD ratio (-2.14±11.59 dB).

Reference

1. da Costa SS, de Sousa LC, Piza MR. Meniere's disease: overview, epidemiology, and natural history. Otolaryngol Clin North Am. 2002; 6. 35(3):455–495. PMID: 12486835.

2. Okuno T, Sando I. Localization, frequency, and severity of endolymphatic hydrops and the pathology of the labyrinthine membrane in Menière's disease. Ann Otol Rhinol Laryngol. 1987; Jul-Aug. 96(4):438–445. PMID: 3619290.

3. Schuknecht HF, Gulya AJ. Endolymphatic hydrops: an overview and classification. Ann Otol Rhinol Laryngol Suppl. 1983; Sep-Oct. 106:1–20. PMID: 6414357.

4. Paparella MM. The cause (multifactorial inheritance) and pathogenesis (endolymphatic malabsorption) of Meniere's disease and its symptoms (mechanical and chemical). Acta Otolaryngol. 1985; Mar-Apr. 99(3-4):445–451. PMID: 4013733.

5. Merchant SN, Adams JC, Nadol JB Jr. Pathophysiology of Meniere's syndrome: are symptoms caused by endolymphatic hydrops? Otol Neurotol. 2005; 1. 26(1):74–81. PMID: 15699723.

6. Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere's disease. American Academy of Otolaryngology-Head and Neck Foundation, Inc. Otolaryngol Head Neck Surg. 1995; 9. 113(3):181–185. PMID: 7675476.

7. Enander A, Stahle J. Hearing loss and caloric response in Menière's disease: a comparative study. Acta Otolaryngol. 1969; 1. 67(1):57–68. PMID: 5373617.

8. de Waele C, Huy PT, Diard JP, Freyss G, Vidal PP. Saccular dysfunction in Meniere's disease. Am J Otol. 1999; 3. 20(2):223–232. PMID: 10100527.

9. Igarashi M, O-Uchi T, Isago H, Wright WK. Utricular and saccular volumetry in human temporal bones. Acta Otolaryngol. 1983; Jan-Feb. 95(1-2):75–80. PMID: 6829305.

10. Moon IJ, Park GY, Choi J, Cho YS, Hong SH, Chung WH. Predictive value of electrocochleography for determining hearing outcomes in Ménière's disease. Otol Neurotol. 2012; 2. 33(2):204–210. PMID: 22246386.

11. Colebatch JG, Halmagyi GM, Skuse NF. Myogenic potentials generated by a click-evoked vestibulocollic reflex. J Neurol Neurosurg Psychiatry. 1994; 2. 57(2):190–197. PMID: 8126503.

12. Young YH, Huang TW, Cheng PW. Assessing the stage of Meniere's disease using vestibular evoked myogenic potentials. Arch Otolaryngol Head Neck Surg. 2003; 8. 129(8):815–818. PMID: 12925337.

13. Murofushi T, Matsuzaki M, Takegoshi H. Glycerol affects vestibular evoked myogenic potentials in Meniere's disease. Auris Nasus Larynx. 2001; 8. 28(3):205–208. PMID: 11489361.

14. Rauch SD, Zhou G, Kujawa SG, Guinan JJ, Herrmann BS. Vestibular evoked myogenic potentials show altered tuning in patients with Ménière's disease. Otol Neurotol. 2004; 5. 25(3):333–338. PMID: 15129114.

15. Murofushi T, Shimizu K, Takegoshi H, Cheng PW. Diagnostic value of prolonged latencies in the vestibular evoked myogenic potential. Arch Otolaryngol Head Neck Surg. 2001; 9. 127(9):1069–1072. PMID: 11556854.

16. Ribeiro S, Almeida RR, Caovilla HH, Gananca MM. Vestibular evoked myogenic potentials in affected and asymptomatic ears in unilateral Ménière's disease. Braz J Otorhinolaryngol. 2005; Jan-Feb. 71(1):60–66. PMID: 16446893.

17. Chang CH, Yang TL, Wang CT, Young YH. Measuring neck structures in relation to vestibular evoked myogenic potentials. Clin Neurophysiol. 2007; 5. 118(5):1105–1109. PMID: 17368089.

18. Altmann F, Kornfeld M. Histological studies of Menière's disease. Ann Otol Rhinol Laryngol. 1965; 12. 74(4):915–943. PMID: 5854713.

19. Hallpike CS, Cairns H. Observations on the pathology of Ménière's syndrome: section of otology. Proc R Soc Med. 1938; 9. 31(11):1317–1336. PMID: 19991672.

20. Huppert D, Strupp M, Brandt T. Long-term course of Menière's disease revisited. Acta Otolaryngol. 2010; 6. 130(6):644–651. PMID: 20001444.

21. Green JD Jr, Blum DJ, Harner SG. Longitudinal followup of patients with Menière's disease. Otolaryngol Head Neck Surg. 1991; 6. 104(6):783–788. PMID: 1908968.

22. Katsarkas A. Hearing loss and vestibular dysfunction in Menière's disease. Acta Otolaryngol. 1996; 3. 116(2):185–188. PMID: 8725510.

23. Stahle J, Friberg U, Svedberg A. Long-term progression of Meniére's disease. Acta Otolaryngol Suppl. 1991; 485:78–83. PMID: 1843175.

24. Tokumasu K, Fujino A, Naganuma H, Hoshino I, Arai M. Initial symptoms and retrospective evaluation of prognosis in Menière's disease. Acta Otolaryngol Suppl. 1996; 524:43–49. PMID: 8790762.