Abstract
ObjectiveVestibular evoked myogenic potentials (VEMPs) have been suggested as biomarkers in the differential diagnosis of Menière’s disease (MD) and vestibular migraine (VM). The aim of this study was to compare the degree of asymmetry for ocular (o) and cervical (c) VEMPs in large cohorts of patients with MD and VM and to follow up the responses.Study designRetrospective study in an interdisciplinary tertiary center for vertigo and balance disorders.MethodscVEMPs to air-conducted sound and oVEMPs to bone-conducted vibration were recorded in 100 patients with VM and unilateral MD, respectively. Outcome parameters were asymmetry ratios (ARs) of oVEMP n10p15 and cVEMP p13n23 amplitudes, and of the respective latencies (mean ± SD).ResultsThe AR of cVEMP p13n23 amplitudes was significantly higher for MD (0.43 ± 0.34) than for VM (0.26 ± 0.24; adjusted p = 0.0002). MD—but not VM—patients displayed a higher AR for cVEMP than for oVEMP amplitudes (MD 0.43 ± 0.34 versus 0.23 ± 0.22, p < 0.0001; VM 0.26 ± 0.14 versus 0.19 ± 0.15, p = 0.11). Monitoring of VEMPs in single patients indicated stable or fluctuating amplitude ARs in VM, while ARs in MD appeared to increase or remain stable over time. No differences were observed for latency ARs between MD and VM.ConclusionsThese results are in line with (1) a more common saccular than utricular dysfunction in MD and (2) a more permanent loss of otolith function in MD versus VM. The different patterns of o- and cVEMP responses, in particular their longitudinal assessment, might add to the differential diagnosis between MD and VM.
Highlights
Vestibular evoked myogenic potentials (VEMPs) are shortlatency, mainly otolith-driven vestibular reflexes elicited by air-conducted sound (ACS), bone-conducted vibration (BCV), or galvanic vestibular stimulation and recorded from the inferior oblique eye muscle or the sternocleidomastoid muscle
The current diagnostic criteria for Menière’s disease (MD) and vestibular migraine (VM) developed by the Classification Committee of the Bárány Society are mainly based on patients’ history and symptoms
MD is defined by at least two recurrent vertigo attacks lasting 20 min to 12 h, audiometrically documented low- to middlefrequency sensorineural hearing loss related to the vertigo attacks, and fluctuating aural symptoms in the affected ear [5]
Summary
Vestibular evoked myogenic potentials (VEMPs) are shortlatency, mainly otolith-driven vestibular reflexes elicited by air-conducted sound (ACS), bone-conducted vibration (BCV), or galvanic vestibular stimulation and recorded from the inferior oblique eye muscle (ocular or oVEMPs) or the sternocleidomastoid muscle (cervical or cVEMPs). The current diagnostic criteria for MD and VM developed by the Classification Committee of the Bárány Society are mainly based on patients’ history and symptoms. The diagnostic criteria for VM include at least five vertigo attacks between 5 min and 72 h, accompanied by at least one migraine symptom (i.e., visual aura, migraine-type headache, photo-/phonophobia) in at least 50% of the attacks and/or a positive history of migraine [8]. A combination of central (e.g., a reciprocal connection between the trigeminal and vestibular nuclei, abnormal neurotransmitter modulation in the brainstem) and peripheral pathophysiology (e.g., neurogenic inflammation of the inner ear mediated by projections of the trigeminovascular system to the labyrinthine artery) most likely explains the various clinical presentations of this multi-facetted disorder [9, 10]
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.
