Abstract
Objective: The peak-to-peak amplitude of the p13-n23 wave in cervical vestibular evoked myogenic potential can increase after furosemide administration in patients with Meniere's disease [furosemide-loading VEMP (FVEMP) testing]. The examination is used to test for the presence of endolymphatic hydrops; we investigated factors that may influence the results.Methods: Forty-two subjects (23 males and 19 females, aged 24–70 years) with unilateral definite Meniere's disease who underwent FVEMP testing were retrospectively studied. Possible factors associated with the results of FVEMP testing were studied using logistic regression analysis.Results: Ages, sex, affected side, stage, disease duration, and mean hearing level of pure tone audiometry did not influence the results of FVEMP testing in the univariate analysis (p > 0.05). Number of days since the last vertigo attack [odds ratio (OR): 1.07, p = 0.031] and frequency of vertigo attacks per month (OR: 0.42, p = 0.003) were significantly associated with the results of testing. Multivariate analysis showed that both days since the last vertigo attack < 7 (OR: 0.13, p = 0.04) and frequency of vertigo attacks per month ≥ 2 (OR: 0.06, p = 0.004) were risk factors for negative results on FVEMP testing.Conclusion: This study found that recent and frequent vertigo attacks produced negative findings on FVEMP testing in Meniere's disease. This apparently irrational finding can be explained by the consequences of membranous labyrinth rupture during vertigo attacks, where the altered saccular resonance due to EH cannot be recovered by furosemide administration because of the dissolving dehydration effect that occurs through communication between the endolymphatic and perilymphatic spaces. In addition, the impairment of sensory cells that is caused by endolymph and perilymph mixing upon rupture does not improve upon furosemide administration. FVEMP testing results may provide us with pathophysiological information regarding the membranous labyrinth.
Highlights
The etiology of Meniere’s disease (MD) is known to involve idiopathic endolymphatic hydrops (EHs) based on Yamakawa’s human temporal bone study of 1938 [1]. This pathological finding was only detected in the temporal bone specimen, which had been harvested after death
70 years later, Nakashima et al detected EHs in vivo using gadolinium (Gd)enhanced magnetic resonance imaging (MRI) [2]. This method should develop as a useful tool for the diagnosis of EH; it still can be used in limited institutions because it requires a 3T device
To revise the furosemide-loading VEMP (FVEMP), we studied cervical vestibular evoked myogenic potentials (cVEMP) amplitudes that were stimulated at 250, 500, 700, 1,000, 1,500, and 2,000 Hz and were measured before and after furosemide administration in MD and normal control groups [11]
Summary
Forty-two subjects (23 males and 19 females, aged 24–70 years) with unilateral definite Meniere’s disease who underwent FVEMP testing were retrospectively studied. We selected subjects that were diagnosed with MD based on the criteria set by the Barany Society after the reconfirms of the patient’s medical chart, and used the subjects in this study [14]. They include previous prescription of anti-vertigo drugs or diuretics. The subjects’ ages, sex, affected side, stage, disease duration, period since the last vertigo attack, frequency of vertigo attacks per month, and mean pure tone audiometry (PTA) in lower, middle, and higher frequencies were obtained from clinical charts. Their ages ranged from 24 to 70 (mean: 51.0, SD: 12.4) years
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
