Unilateral Meniere's Disease Research Articles

Vestibular Migraine Patients Show Lack of Habituation in Auditory Middle Latency Responses to Repetitive Stimuli: Comparison With Meniere's Disease Patients

Objectives: To compare habituation in auditory middle latency response (AMLR) to repetitive stimuli of vestibular migraine (VM) patients with Meniere's disease (MD) patients and healthy controls (HC) and to assess usefulness of AMLR for diagnosis of VM.Subjects: Thirteen unilateral definite MD patients (2 men, 11 women, mean age 50.6), 13 definite VM patients (3 men, 10 women, mean age 45.5), and 8 HC subjects (2 men, 6 women, mean age 37.1) were enrolled.Methods: The electrodes were placed on the vertex and the spinal process of the fifth cervical vertebra. Binaural click stimulation (0.1 ms, 70 dBnHL) was presented. A total of 800 responses were averaged. Averaged responses were divided into four sets (S1 to S4) according to the temporal order. No, Po, Na, and Pa were identified, and amplitudes and latencies were measured.Results: Concerning latencies, HC subjects showed a tendency of shorter latencies. However, there was no clear effect of repetitive stimulation. Concerning No-Po amplitudes, no significant differences were observed. Raw amplitudes of Na-Pa showed statistically significant differences in S1 and S2 among the groups (p < 0.01 one-way ANOVA). Differences were shown in MD vs. VM and HC vs. VM in S1 (smaller in VM) (p < 0.01 Bonferroni's test) and in MD vs. VM in S2 (smaller in VM) (p < 0.01 Bonferroni test). Relative amplitudes of Na-Pa to S1 showed statistically significant differences in S4 (p < 0.01 one-way ANOVA). Differences were shown in MD vs. VM and HC vs. VM (larger in VM) (p < 0.01 Bonferroni's test). Differences of Na-Pa amplitudes in S2 to S4 from Na-Pa amplitude in S1 were significant in S4 of VM patients (Dunnett's test).Conclusions: VM patients showed lack of habituation (potentiation) of Na-Pa amplitude in AMLR to repetitive stimuli while MD patients and HC subjects showed habituation. Observation of lack of habituation has high diagnostic accuracy for differential diagnosis of VM from MD.

Long-term outcomes of triple semicircular canal plugging for the treatment of intractable Meniere's disease: A single center experience of 361 cases.

Meniere's disease is a common chronic inner ear disease. Because the definitive pathogenesis is still unknown, there is currently no cure for this disorder. Semicircular canal plugging (SCP), first used to treat patients with intractable benign paroxysmal positional vertigo, has since been applied to patients with intractable peripheral vertigo. This study was aimed to explore the long-term efficacy of triple semicircular canal plugging (TSCP) in the treatment of intractable Meniere's disease (MD) so as to provide a new method in the framework of treatment with MD. Three hundred and sixty-one unilateral MD patients, who were treated with TSCP in our hospital between Dec. 2010 and Sep. 2016, were recruited in this study for retrospective analysis. Vertigo control and auditory function were monitored during a period of two-year follow-up. Seventy three patients who were subjected to intratympanic gentamicin were selected as a control group. Pure tone audiometry, caloric test, vestibular evoked myogenic potential (VEMP) were performed in two-year follow-up. The total control rate of vertigo in TSCP group was 97.8% (353/361) in the two-year follow-up, with complete control rate of 80.3% (290/361) and substantial control rate of 17.5% (63/361). The rate of hearing loss was 26.3% (95/361). The total control rate of vertigo in intratympanic gentamicin group was 83.6% (61/73), with complete control rate of 63.0% (46/73) and substantial control rate of 20.5% (15/73). The rate of hearing loss was 24.7% (18/73). The vertigo control rate of TSCP was significantly higher than that of chemical labyrinthectomy(χ2 = 24.798, p < 0.05). There was no significant difference of hearing loss rate between two groups. (χ2 = 0.087, p > 0.05). Triple semicircular canal plugging (TSCP), which can reduce vertiginous symptoms in patients with intractable Meniere's disease (MD), represents an effective therapy for this disorder. It might become a new important method in the framework of treatment with MD.

Prediction of Unilateral Meniere's Disease Attack Using Inner Ear Test Battery.

In the clinical setting, a variety of inner ear test results are obtained from patients with unilateral Meniere's disease (MD). In this study, the authors use inner ear test results as parameters to illustrate the relationship between inner ear function and vertigo attack frequency. We retrospectively enrolled 50 unilateral MD patients. In addition to clinical symptoms, the results of pure-tone audiometry and caloric, acoustic cervical vestibular-evoked myogenic potential (cVEMP), galvanic cVEMP, vibratory ocular VEMP (oVEMP), and galvanic oVEMP tests were collected via chart review. The multiple linear regression method was used to examine which independent variables have a statistically significant influence on vertigo attacks. In affected ears, the abnormal rate of the caloric, acoustic cVEMP, galvanic cVEMP, vibratory oVEMP, and galvanic oVEMP tests was 74%, 76%, 48%, 34%, and 30%, respectively. According to the regression model, the abnormal galvanic cVEMP response and abnormal galvanic oVEMP response had significantly negative correlations with the frequency of vertigo attacks after logarithmic transformation. A predictive model for disease attack frequency using significant parameters and their regression coefficients was proposed: (Equation is included in full-text article.) CONCLUSIONS:: Using the proposed model with galvanic VEMP, clinicians could develop better strategies to manage vertigo attacks in patients with MD.

The Relationship Between Tests of Hearing and Vestibular Function and the Duration of Symptoms in Patients With Unilateral Ménière's Disease

PurposeMénière's disease (MD) is a constellation of otologic symptoms that includes aural fullness, tinnitus, hearing loss, and episodic vertigo. Even though the criteria for diagnosing the disorder was set forth in 1972, the causes are still not well understood. The purpose of this study was to describe the relationships between tests of hearing and vestibular function and length of time patients diagnosed with unilateral MD have experienced symptoms.MethodThe charts of 254 patients with definite unilateral MD from the Mayo Clinic database were retrospectively reviewed. In order to be included, patients must have reported active MD diagnosis within the previous 5 years. Main outcome measures were results for audiometry, cervical vestibular evoked myogenic potentials, ocular vestibular evoked myogenic potentials, caloric test findings, video head impulse test, and sinusoidal harmonic acceleration.ResultsResults indicate there is a significant effect of the duration of MD symptoms reported by the patient and findings on some tests of hearing and vestibular function. Specifically, pure-tone average, caloric paresis, and rotational chair phase were all positively correlated with duration of symptoms. Rotational chair gain was found to have an inverse relationship with time. We did not find that video head impulse test gain or certain vestibular evoked myogenic potential measures were significantly correlated with the reported duration of patient symptoms.ConclusionsOur results suggest that, although the duration of symptoms reported by the patient does correlate with a number of vestibular and hearing tests, the relationships are relatively weak. The number of attacks and severity of symptoms should be investigated to determine if they are better predictors of laboratory testing results in the patient with MD.

Head-Shaking Nystagmus in the Early Stage of Unilateral Meniere's Disease.

The aim of the present study was to evaluate the ability of head-shaking nystagmus (HSNy), evoked after the resolution of a vertigo spell, to predict an imminent crisis in the early stage of Meniere's disease (MD). A total of 20 patients in the early stage of MD were included in the study. The head-shaking test (HST) was performed twice, during the first visit within 24 h of vertigo spell (T0) and 48 h later (T1). The onset of a new vertigo episode during the 2 weeks following the first visit was recorded in each patient's medical record. The sensitivity and specificity of HSNy toward predicting a new vertigo episode were calculated. At T0, an evoked ipsilesional HSNy in 15 (75%) patients was observed; in four of them, the HSNy had a biphasic component. The HSNy was present and persistent at T1 in 8 (42.1%) patients; among these cases, 6 patients had ipsilesional HSNy, and 2 patients a contralesional HSNy. None of the patients presented with a biphasic HSNy at T1. Seven (36.8%) patients experienced the recurrence of a vertigo crisis. Among these, 6 patients had ipsilesional HSNy at T1. Only 8 patients with ipsilesional HSNy at T0 did not have recurrence. The sensitivity of the ipsilesional HSNy in predicting the recurrence of vertigo in patients with MD was 100% at T0 and 85.7% at T1. The specificity was 46.6% and 100% at T0 and T1, respectively. The HST can be a useful test in the early stages of MD to predict a new vertigo attack.

Predicting Development of Bilateral Menière's Disease Based on cVEMP Threshold and Tuning.

To investigate if the cervical vestibular evoked myogenic potential (cVEMP) is predictive for developing bilateral Menière's disease (MD). Retrospective cohort study. Tertiary care center. Records of 71 patients previously diagnosed with unilateral MD at our institution who underwent cVEMP testing between 2002 and 2011 were screened. Patients were contacted to answer a questionnaire to identify which patients had developed bilateral disease. Based on questionnaires and medical charts, 49 patients with a follow-up time of at least 5 years were included. The 49 originally asymptomatic ears are referred to as "study ears." Previously reported cVEMP criteria (original criteria) applied to study-ear cVEMPs separated them into Menière-like and normal-like groups. The main purpose was to determine if previously obtained cVEMP thresholds and tuning ratios of unilateral MD patients could predict who develops bilateral disease. From the 49 included patients, 12 developed bilateral disease (24.5%). The study ears characterized by original cVEMP criteria as Menière-like were significantly more likely to develop bilateral disease compared with the normal-like study ears. The original criteria predicted development of bilateral disease with a positive predictive value (PPV) and negative predictive value (NPV) of 58.3% and 86.5% respectively. ROC curves were used to revise cVEMP criteria for predicting the progression to bilateral disease. A revised criterion combining three cVEMP metrics, reached a PPV and NPV of 85.7% and 93.7%. cVEMP threshold and tuning in unilateral MD patients are predictive of which patients will develop bilateral disease.

Endolymphatic volume in patients with meniere's disease and healthy controls: Three-dimensional analysis with magnetic resonance imaging.

ObjectiveRecently, 3‐Tesla magnetic resonance imaging (MRI) with intravenous gadolinium injection has been used to reveal endolymphatic hydrops (EH). In the present study, we aimed to evaluate EH in patients with Meniere's disease (MD) objectively and quantitatively, and compared the endolymphatic space (ELS) in individuals with MD and healthy controls, to gain understanding of the characteristics of MD.MethodsEighty‐two patients with unilateral MD (uMD), 16 patients with bilateral MD (bMD), and 47 healthy volunteers were enrolled. All participants underwent 3‐T MRI at 4 hours after intravenous gadolinium injection. The volumes of the total fluid space (TFS) and ELS were measured semiautomatically using our workstation, and the percentage of ELS to TFS (ELS percentage) was calculated.ResultsThe ELS percentage was 13.9 in the ears of controls, 18.2 in the contralateral ear of individuals with uMD, 26.1 in the affected ears of these individuals, and 23.0 in both ears of individuals with bMD. The ELS percentages in the affected ear of uMD and the ears of bMD individuals were significantly higher than that in the ears of control individuals (P < .01, one‐way analysis of variance (ANOVA), Tukey's test).ConclusionThe ELS is significantly larger in the affected ears of uMD and in both ears of bMD individuals. Accurate diagnosis of MD can be facilitated by using 3‐T MRI 4 hours after intravenous gadolinium injection and performing volumetric measurements of the ELS.Level of Evidence2b

Cervical VEMP tuning changes by Meniere's disease stages.

ObjectiveTo determine if changes in cervical vestibular‐evoked myogenic potential (cVEMP) testing reflect the different stages of cochlea‐saccular hydrops in Meniere's disease (MD).MethodsThis is a case‐control retrospective series. Forty‐seven patients with unilateral MD by American Academy of Otolaryngology–Head and Neck Surgery diagnostic and staging criteria, and 30 with non‐MD vertigo as control. Meniere patients were further classified based on symptoms at the time of testing as active or stable. Subsequently, patients underwent cVEMP testing by tone‐burst stimuli at 500 and 1,000 Hz. The main outcome measure was to compare the cVEMP 1,000 and 500 Hz amplitude ratio in ears with MD and non‐MD vertigo, and in active versus stable MD.ResultsThe cVEMP 1,000/500 Hz amplitude ratio was higher in Meniere's ears (mean = 1.14 μV, SD = 0.25) than in non‐Meniere's ears (mean = 0.96 μV, SD = 0.2) (Student's t test, P = .001), and higher in active (mean = 1.22 μV, SD = 0.25) than in stable MD (mean = 1.00 μV, SD = 0.18) (P = .0035). The diagnostic value of cVEMP 1,000/500 Hz amplitude ratio to differentiate MD versus non‐MD vertigo was evaluated with a receiver‐operating characteristics (ROC) curve and the area under the curve (AUC) was 0.716 (95% confidence interval [CI] [0.591, 0.829]). The ideal cutoff point was 0.9435 with sensitivity and specificity values of 83% and 53%, respectively. The sensitivity and specificity values for this test to differentiate active versus stable MD were 68% and 81%, respectively, with AUC 0.746 (95% CI [0.607, 0.885]) and cutoff value of 1.048. In all ears, the 1,000/500 Hz amplitude ratio increased by a decrease of the 500 Hz amplitude with increasing age.ConclusionThe cVEMP 1,000/500 Hz amplitude ratio is elevated in ears with MD but not in those with non‐MD vertigo. After corrected by age, this ratio is higher in active but not in stable MD, probably reflecting dynamic changes in saccular membrane motion mechanics in hydrops, and may be a useful marker of disease progression and the effect of therapy.Level of EvidenceIV

Low-dose intratympanic gentamicin administration for unilateral Meniere's disease using a method based on clinical symptomatology: Preliminary results

There are many therapeutic options for Meniere's disease (MD); intratympanic (IT) gentamicin has been proposed for intractable cases although controversy about dosage and method exists. The purpose of this study was to assess the efficacy and safety of low-dose IT gentamicin on vertigo attacks in MD using a clinical symptomatology-based method in which administration was repeated only if vertigo attacks recurred, with a 2-week interval between injections. Forty-eight patients with unilateral intractable MD were included in the study. All patients received one to five IT injections with 0.5 ml of 10 mg of gentamicin (80 mg/2 ml) with an interval of 2 weeks between injections. Vertigo attacks were evaluated before and after therapy and categorized into classes A-F according to the 2015 Equilibrium Committee criteria. Audiovestibular assessment with pure tone audiometry, vestibular bed-side examination and video head impulse test was performed. Before treatment patients had an average of 4.4 vertigo attacks/month; after treatment the average number decreased to 0.52. The majority of patients (77%) reached Class A vertigo control with 5 or less gentamicin injections. VOR gain was unaffected in the healthy side and significantly reduced in the affected side. No hearing deterioration was found in all treated patients. Low-dose IT gentamicin administration based on clinical symptomatology can produce a satisfactory control of vertigo attacks after treatment; such protocol had an effect mainly on the vestibular function as demonstrated by the significant reduction in VOR gain in the affected side avoiding a cochlear damage.

Evaluation of vestibular evoked myogenic potential, caloric test and cochlear electrogram in the diagnosis of Meniere's disease

Objective:The aim of this study is to evaluate the diagnostic value of vestibular-evoked myogenic potential （cVEMP and oVEMP）, caloric test, and cochlear electrogram （EcochG） in patients with Meniere's disease （MD） and non-Meniere's disease. Method:Sixty-four patients （64 ears） with Unilateral Meniere's disease were enrolled in the study group （MD group）, and 127 cases（254 ears） of non-Meniere's disease patients as non-MD group, including vertigo migraine in 40 cases, benign paroxysmal positional vertigo in 48 cases, benign recurrent vertigo in 13 cases, vestibular paroxysmia in 3 cases, vestibular neuritis in 5 cases and other undiagnosed vertigo in 18 cases. Both group undertake cVEMP, oVEMP, caloric test and ECochG. Use Medcale software to draw ROC curve of ECochG and calculate the area under curve（AUC）, Jordan index and optimal diagnostic cut-off points. Make the cut-off point as the point of -SP/AP, then evaluate the sensitivity, specificity, positive predictive value（PPV）, negative predictive value（NPV） and diagnostic accuracy of cVEMP, oVEMP, caloric test and ECochG in MD group and non-MD group. Result:The AUC of ECochG ROC curve was 0.74, the Jordan index was 0.47 and the cut-off point was 0.4. The sensitivity and specificity of cVEMP（62% and 68%）, oVEMP（61% and 53%） and caloric test（53% and 57%） were all below ECochG（65% and 78%）. The positive predictive value and of ECochG was the highest（61.9%）, the negative predictive value of cVEMP was highest（87.5%）. The diagnostic accuracy of ECochG was highest（74%）, followed with cVEMP（67%）, oVEMP（55%） and caloric test（56%）. Conclusion:Compared with the vestibular function tests, the sensitivity, specificity, diagnostic accuracy and NPV were all higher in ECochG, and the diagnostic benefit can be maximized when -SP/AP value>0.4. So the value of single vestibular function examination in the diagnosis of Meniere's disease is limited. The diagnosis of MD still requires a comprehensive evaluation in combination with medical history, audiological tests and vestibular function examinations.

Wideband Tympanometry in Meniere's Disease.

The aim of our study was to obtain wideband tympanometry (WBT) findings in Meniere's disease (MD). It also aimed to evaluate whether the data obtained have diagnostic significance. 21 patients who were followed-up for unilateral Meniere's Disease were evaluated. The ears with Meniere disease were grouped as the MD group and the opposite ears were grouped as the control group. WBT results were recorded as resonance frequency (RF) and frequency-specific absorbance values at 10 different frequencies in the 0.25-8.0kHz range. Statistical analysis was performed with t test and receiver-operating characteristic analysis. Considering the WBT results, RF was significantly lower in the MD group compared to the control group (p < 0.001). Frequency-specific absorbance values at 0.25, 0.5, 0.75 and 1 kHz were significantly lower in the MD group compared to the control group (p < 0.05). No significant difference was found at 1.5 kHz and above (p > 0.05). For the MD, the RF below 598Hz was 85.7% sensitive and 76.2% specific, the absorbance at 0.25kHz below 8% was 66.7% sensitive and 61.9% specific, the absorbance below 17% at 0.5kHz was 71.4% sensitive and 62.1% specific, the absorbance below 36% at 0.75kHz was 81% sensitive and 57.8% specific, and the absorbance below 46% at 1kHz was 71.5% sensitive and 66.7% specific. When MD was compared with intact ears, it was observed that RF was lower, and absorbance decreased in low frequencies. These data is statistically significant, but the sensitivity level is not enough for diagnostic use. Therefore, it is considered as an complementary test for the diagnosis.

Intralabyrinthine Schwannoma: Distinct Features for Differential Diagnosis.

Objectives: The aim of this study was to delineate the clinical and laboratory features suggestive of intralabyrinthine schwannoma (ILS).Methods: We compared the clinical features of 16 patients with ILS, who had been diagnosed at the Seoul National University Bundang Hospital from 2003 to 2018, with those of 18 patients with symptomatic unilateral intracanalicular schwannoma and randomly selected 20 patients with definite or probable unilateral Meniere's disease (MD).Results: Patients with ILS presented with either recurrent spontaneous dizziness/vertigo combined with auditory symptoms (n = 8), isolated auditory symptoms without dizziness/vertigo (n = 7), or recurrent spontaneous dizziness/vertigo without auditory symptoms (n = 1). Most patients reported no improvement (n = 11) or worsening (n = 1) of the symptoms despite medical treatments including intratympanic (n = 5) or intravenous steroids (n = 2). Conventional brain MRIs failed to detect ILS in about a half of the patients (7/16, 44%). However, ILS showed a filling defect on 3-dimensional (3D) heavily T2-weighted MRIs (n = 12), and nodular enhancement on 3D contrast-enhanced T1 (n = 15) or FLAIR MRIs (n = 13) targeted for the inner ear. Compared to MD or intracanalicular schwannoma, ILS showed mostly abnormal head-impulse tests (HITs, p = 0.001). In contrast, the incidence of canal paresis did not differ among the groups (p = 0.513).Conclusion: ILS may mimic MD by presenting recurrent dizziness/vertigo and auditory symptoms. ILS should be suspected in patients with recurrent audiovestibulopathy especially when (1) the duration of the dizziness is not typical for MD, (2) the patients do not respond to medical treatments, or (3) HITs are abnormal.

The prognostic value of glycerol test of electrocochleography on the effects of endolymphatic sac decompression surgery in patients with unilateral Meniere's disease

Objective:To determine whether the preoperative results of glycerol test of electrocochleography and hearing stage have a prognostic value on the effects of endolymphatic sac decompression surgery in patients with unilateral Meniere's disease. Method:A retrospective study was conducted of 58 unilateral Meniere's disease patients who underwent endolymphatic sac decompression surgery. The correlation between the preoperative results of glycerol test of electrocochleography， hearing stage and vertigo control was analyzed by Kendall test. Result:Patients in the positive glycerol test of electrocochleography group had better vertigo control after the decompression of the lymphatic sac than the negative group(P=0.029). Preoperative hearing staging was significantly associated with vertigo control after endolymphatic sac decompression(P=0.028). The better the preoperative hearing, the higher the control rate of vertigo after endolymphatic sac decompression. The stage Ⅰ patients were 91.7%, the stage Ⅱ patients were 78.1%, and the third stage Ⅲ patients were 57.1%, respectively. Conclusion:Our findings suggested that the positive preoperative results of glycerol test of electrocochleography and better hearing stage may indicate a better effects of endolymphatic sac decompression surgery in patients with unilateral Meniere's disease.

P71-F Clinical use of vestibular evoked myogenic potential (VEMP) in unilateral Menière disease (MD)

Background VEMP test averages myogenic responses evoked by sound that stimulates otolithic organs in the inner ear. is an inner ear pathology characterised by episodic attacks of vertigo and fluctuating cochlear symptoThe aim of the study is to describe the VEMP values obtained in patients diagnosed with unilateral MD. Materials and methods VEMP studies performed in patients diagnosed with unilateral younger than 60 years old and done between 2014 and 2017 were analysed. VEMPs were recorded from the ipsilateral sternocleidomastoid muscle (cVEMP) and periocular sites (oVEMP). 500 Hz tone burst at 105 dB nHL was used as stimuli at 5 Hz stimulation rate and averaged for 200 repetitions. Bandpass-filtered between 20 Hz and 2 kHz. Statistical analysis included paired sample test in the SPSS program. We compared latency and amplitude of the affected side (AS) with healthy side (HS). Results We included 9 patients, mean age 48.7 ± 6.8 years old. Patients without bilateral response (1 in cVEMP, 2 in oVEMP), were not included in the statistical analysis of its category. In 87.5% of the cases, p13 latency was longer in AS (13.5–21.1 ms) vs HS (12.9–15.9 ms, p = .017 Wilcoxon test). No statistically significant differences were obtained in the remaining parameter. Conclusion The p13 latency of cVEMP is longer on the affected side with compared to the contralateral healthy side. Since VEMP test clinically evaluates the otolithic function, it is not invasive and is well tolerated, its use should be extended.

Acoustic absorbance characteristics of wideband tympanometry in patients with Meniere's disease

Objective:To study acoustic absorbance characteristics of wideband tympanometry in patients with unilateral Meniere's disease. Method:Acoustic absorbance were detected using wideband tympanometry in 36 patients with unilateral Meniere's disease and 39 control subjects excluding inner ear and middle ear disease. All patients with Meniere's disease underwent electrocochleography, gadolinium contrast internal auditory canal MRI, pure tone test. The integral area formed by the absorbance curve on peak pressure and x-axis(frequency) was calculated. Student's t-test was used to compare integral areas difference of 2 ears in Meniere's disease patients and control group. Result:The integral area of absorbance was greater in affected side than unaffected side and there was no difference in peak values of absorbance between 2 ears in Meniere's disease patients. There was no significant difference in areas between Meniere's disease in different grade(P>0.05). Peak value of absorbance and difference value of absorbance were not significant between Meniere's disease patients and normal control. Only 61.11% Meniere's disease patients showed -SP/AP＞0.4 and 95.24% showed endolymphatic hydrops in affected side. Conclusion:Affected side in patients with Meniere's disease showed higher integral area of absorbance than other side,which is high sensitive but not specific.

The subjective perception of the vertical-a valuable parameter for determination of peripheral vestibular disorder in Menière's disease in the chronic phase?

The perception of verticality is mainly based on utricular afferent signals and central processing of the transmitted signals. However, there are also extracranial receptors that make aconsiderable contribution to the perception of verticality. With the subjective visual vertical (SVV) for the utricle and the subjective trunk vertical (STV), two different parameters are available that are not fully understood in terms of their response to physiologic and pathologic changes. The aim of this work was to determine SVV and STV under certain positions of the head and trunk as well as under the influence of Menière's disease (MD) as achronic vestibular disease. In aprospective clinical study, 26patients with MD and 39healthy volunteers were recruited. Subjects were examined with C‑SVV glasses and with the three-dimensional trunk excursion chair, while head and torso positions were varied. In both groups, SVV determination is clearly more accurate with anearth-vertical head alignment than with alateral head tilt (right: MM and control group: p = 0.001; left: MM p = 0.001, control group p = 0.000). If the torso is deflected laterally and the head is held straight, the SVV is significantly more accurate (left p = 0.003, right p = 0.015). The SRV was not affected by the presence of unilateral MD, while pathologic SVV values, if present, indicated the affected side. The results of our study support the assumption that in addition to SVV, SRV is an independent parameter for verticality perception and differs from the SVV in terms of lateralizing aperipheral vestibular deficit. These results suggest that the STV may depend not only on utricular function but also on extracranial afferent signals, and not be significantly altered by the presence of a hydropic peripheral vestibular lesion.

Long-term Vertigo Control and Vestibular Function After Low-dose On-demand Transtympanic Gentamicin for Refractory Menière's Disease.

To describe the long-term clinical vertigo control along with measured lateral canal vestibular function in patients with unilateral refractory Menière's disease (MD) treated with gentamicin transtympanic injections (TTI). Retrospective analytic study. Tertiary referral center. Thirty-eight patients treated by TTI for medically refractory unilateral MD, defined by the 1995 AAO-HNS criteria, between May 2006 and December 2012. One-year course of treatment with gentamicin TTI following a low dose on-demand protocol. TTI were repeated in new courses of treatment when MD recurrence occurred. AAO-HNS class of control, caloric tests (CalT), recurrence rate. After an average clinical follow-up of 71 months, all patients entered a class of control A (78%) or B (22%), with an average of 2.3 TTI received. The mean maximal obtained deficit was 88.5%, and the mean long-term deficit was 85.5%. Ten (26%) patients had disease recurrence requiring a new course of treatment. A value of the first CalT in the 3 months following the first TTI strictly higher than 78% was significantly associated with disease control and the absence of symptom recurrence (p≤0.01). In the "recurrence" group, four patients had a significantly lower mean value of all CalT performed after the first TTI when compared with other patients (p≤0.001), indicating gentamicin resistance CONCLUSION:: Achieving a sustainable vestibular deficit on caloric testing is key for MD symptom control after gentamicin TTI. Gentamicin resistance must be diagnosed early to adapt therapeutic strategies.

Quantitative evaluation of endolymphatic hydrops with MRI through intravenous gadolinium administration and VEMP in unilateral definite Meniere's disease.

To help clinicians to further understand the significance of vestibular-evoked myogenic potential (VEMP) examinations to diagnose MD and the quantitative relationship between VEMP and MRI in assessing the location and degree of endolymphatic hydrops (EH) in definite Meniere's disease (MD) patients. Fifty-six patients with unilateral definite MD participated in this study, which used MRIs through intravenous gadolinium administration (IV-Gd), audiometry, caloric tests and VEMP tests. The VEMP results of 26 healthy volunteers were used as a normal reference value. The participants were found through MRI to have differing degrees of vestibular and cochlear EH. Quantitative comparison of MRI and VEMP results found that the response rates of oVEMP decreased with cochlear EH increasing; the asymmetry ratio (AR) of oVEMP can be used to find whether cochlear EH or not, and the P1-N1 amplitude was lower in the extreme cochlear EH group (P < 0.01). The AR of cVEMP was larger in severe vestibular EH group than that of the mild or no vestibular EH group (P < 0.01). The correlation between the degree of cochlear EH and the mean PTA threshold was statistically significant (P < 0.05). The duration of MD correlated positively with vestibular EH (P < 0.05). The abnormal rate of caloric tests was higher in severe vestibular EH group than that of the mild or no vestibular EH group (P < 0.05). The advantages of MRIs by IV-Gd administration were obvious in assessing the location and degree of EH. oVEMP and PTA can be indirectly used to evaluate the extent of cochlear EH, cVEMP and caloric tests can be used to assess the extent of vestibular EH on the condition of absent MRIs.

Clinical features and management of Meniere's disease patients with drop attacks.

The aims of the present study are to investigate the variations in clinical features, including medical history, hearing function, vestibular function, and degree of endolymphatic hydrops (EH), in Meniere's disease (MD) patients with and without drop attacks (DAs), and to examine the efficacy of intratympanic gentamicin (ITG) treatment in alleviating DAs. In total, 177 unilateral definite MD patients, including 16 patients with DAs and 161 patients without DAs, were enrolled. The results of hearing test, vestibular-evoked myogenic potentials (VEMPs), and magnetic resonance imaging (MRI) were analyzed. Thirteen patients with DAs received a single ITG treatment and were followed up. The disease course of MD in the DA group was significantly longer than that in the control group (p = 0.007). MD patients with DAs had significantly greater hearing loss and worse EH than MD patients without DAs (p < 0.05). However, there was no between-group difference in vestibular function. In the study, 92.31% of refractory definite MD patients with DAs achieved satisfactory control of DAs after ITG treatment. MD patients with DAs tend to suffer from severe hearing loss and a significant degree of EH in the inner ear. However, the vestibular function of MD patients with DAs may not be completely abolished, but be sensitive to stimulating signals. ITG treatment, which helps to decrease vestibular sensitivity, was an effective treatment to control DAs.

Gadolinium-enhanced MRI reveals dynamic development of endolymphatic hydrops in Ménière's disease

IntroductionMeniere's disease is associated with impaired hearing, tinnitus, vertigo, and aural fullness. Many anatomical studies have suggested idiopathic endolymphatic hydrops as the pathological basis of Meniere's disease, which now can be visualized by using gadolinium -enhanced magnetic resonance imaging of the inner ear. ObjectiveTo investigate the development of endolymphatic hydrops in Meniere's disease by monitoring the vestibules and cochleae of affected patients. MethodsInner ears of 178 patients with definite unilateral Meniere's disease diagnosis were visualized by 3-dimensional fluid-attenuated inversion recovery and three-dimensional real inversion recovery magnetic resonance imaging following bilateral gadolinium intratympanic injection. The scans were used to evaluate the presence and degree of endolymphatic hydrops in the vestibules and cochlear structures, including the cochlear apical turn, the cochlear middle turn, and the cochlear basal turn. The correlation of endolymphatic hydrops occurrence between the various parts of the inner ear was determined. ResultsSymptomatic endolymphatic hydrops was detected on the affected side in all patients, whereas asymptomatic endolymphatic hydrops was detected on the unaffected contra-lateral side in 32 patients (18.0%). On the affected side, the cochlear apical turn and the cochlear middle turn demonstrated significantly higher rates of endolymphatic hydrops than the cochlear basal turn and the vestibule. The severity of endolymphatic hydrops gradually decreased from the cochlear apical turn to the cochlear basal turn. On the contra lateral side, the incidence and degree of the detected asymptomatic endolymphatic hydrops were significantly greater in the cochleae than in the vestibules (p<0.05), with no significant difference detected between the cochlear turns. ConclusionProgression of endolymphatic hydrops appears to be directional, initiated in the cochlea. The order of endolymphatic hydrops severity gradually decreases from the cochlear apical turn to the cochlear basal turn and then to the vestibule. Endolymphatic hydrops in the vestibule is associated with symptomatic Meniere's disease.