Utility of the Frequency Tuning Measure of oVEMP in Differentiating Meniere's Disease from BPPV.

Abstract

Utility of frequency tuning of ocular vestibular evoked myogenic potential (oVEMP) for evaluation of utricular function in individuals with Meniere's disease is a recent development. However, there is dearth of studies regarding its utility in differential diagnosis of Meniere's disease from other vestibular pathologies. The present study aimed at investigating the feasibility of frequency tuning of oVEMP in discriminating Meniere's disease from benign paroxysmal positional vertigo (BPPV). Static group comparison. oVEMPs were acquired from 36 individuals, each with unilateral Meniere's disease and unilateral BPPV. Thirty-six age- and gender-matched healthy individuals formed comparison group for each of the two clinical groups. Contralateral oVEMPs were recorded from both ears of all the participants. The responses pertaining to octave and mid-octave frequencies from 250 to 4000 Hz, one frequency presented at a time, were recorded from infra-orbital electrodes (noninverting placed 1 cm below the lower eyelid and inverting 2 cm below the inverting on the cheek) with forehead as ground. Starting intensity was 125 dB peSPL with subsequent reductions in 10-dB steps to arrive at threshold. The stimuli were delivered to the ear at a rate of 5.1 Hz. The frequency corresponding to the largest peak-to-peak amplitude, best threshold, and/or largest peak-to-peak amplitude at thresholds was considered as the tuning frequency. Proportions of ears with frequency tuning at a particular frequency were compared between the groups. The frequency tuning at 1000 Hz was found to exist in a significantly higher proportion of affected ears with Meniere's disease than the comparison group as well as ears with BPPV (p < 0.05). Using a criterion point of frequency tuning at 875 Hz, the sensitivity and specificity for identifying Meniere's disease was found to be 68% and 100%, respectively. The shift in frequency tuning is an efficient parameter for not only discriminating Meniere's disease from healthy individuals but also distinguishing it from BPPV. Therefore, frequency tuning is recommended as a test parameter of oVEMP for identification of Meniere's disease.