Glycerol affects vestibular-evoked myogenic potentials and pure-tone hearing in patients with Ménière’s disease

Conclusion: The pure-tone audiometry results following glycerol administration indicated a positive effect on cochlear endolymphatic hydrops. Glycerol cervical vestibular-evoked myogenic potential (cVEMP) tests are a useful means of diagnosing saccular hydrops. There was no correlation between cVEMP and audiological results. Objective: To document the changes in pure-tone hearing outcomes and cVEMPs in patients with Ménière’s disease (MD) and 10 healthy volunteers before and after oral administration of glycerol. Methods: Twenty-nine study group subjects were chosen with complaints of vertigo. cVEMP testing and pure-tone hearing level testing were performed before and at 1, 2, and 3 h after administration of glycerol. Results: The means of the latencies, amplitudes, and difference ratio in 20 normal subject ears were determined. Based on these values, 9/29 MD-affected (MDA) ears (31%) had a unilaterally absent cVEMP. Compared with difference ratio values of the control groups there were significant differences in both latencies and amplitudes in MDA ears after glycerol administration. Before glycerol administration, there were significant differences between control and MDA ears on mean values of pure-tone hearing outcomes. Twenty patients in the MDA group showed significant pure-tone hearing outcomes after glycerol administration.     

A systematic review and meta-analysis of extratympanic electrocochleography in Ménière’s disease diagnosis

Objective: Determine whether a combination of electrocochleography determined summating/action potential (SP/AP) ratio and other audiological measurements has greater sensitivity and specificity than that achieved with electrocochleography SP/AP ratio alone in diagnosing definite Ménière’s Disease.

Design: Systematic review and meta-analysis.

Study sample: Pubmed, Cochrane Library, and Web of Science were searched using search terms “electrocochleography”, “ECochG, ,“ECoG”, “Ménière’s Disease”, and “Idiopathic Endolymphatic Hydrops”. Inclusion criteria were extratympanic electrocochleography methodology, English language publication between January 2002 and December 2017, and the 1995 American Academy of Otolaryngology and Head and Neck Surgery Ménière’s disease diagnostic criteria. Five articles satisfied inclusion criteria and were sufficiently detailed for aggregate quantitative analysis of SP/AP ratio (315 subjects) and combination audiological measures (113 subjects).

Results: The diagnostic sensitivity and specificity of the SP/AP amplitude ratio was 47.6% and 83.8% and of combination diagnostic measures 63.5% and 89.3%, respectively. Point estimates of sensitivity (p?=?0.248) and specificity (p?=?0.969) and the summary Receiver Operator Characteristic Curve (p?=?0.407) were not statistically significant.

Conclusion: Statistically, combination diagnostic measures do not result in greater accuracy of definite Ménière’s disease diagnosis compared to the SP/AP amplitude ratio alone. However, given the small sample size further studies are recommended to arrive at a definitive conclusion.     

Cervical vestibular evoked myogenic potentials and video head impulse test in Ménière disease

IntroductionMénière's disease is among the most frequent causes of vestibular disorders. Although it is a clinical diagnosis, a better understanding of the pathophysiology and clinical course of the disease through tests would allow improvement in the prognosis and more effective treatments.ObjectivesTo describe the results of the cervical vestibular evoked myogenic and video head impulse test in patients with a defined diagnosis of Ménière's disease and to correlate them with disease duration.MethodsThe sample consisted of 50 participants, of whom 29 comprised the study group and 21 the control group. The individuals were submitted to a questionnaire, otoscopy, audiometry and vestibular function assessment through the cervical vestibular evoked myogenic potential and video head impulse test.ResultsFor the video head impulse test, lateral canal gain values below 0.77 were considered abnormal and for the vertical channels, below 0.61. The percentages of normality were 82.76% for lateral, 89.65% for posterior and 91.37% for anterior canals. For the cervical vestibular evoked myogenic potential, the upper limits of normal for latencies were defined as 18.07 ms for p13 and 28.47 ms for n23; and in the SG, 19.57% showed prolongation of latency of p13 and 4.35% of wave n23, whereas 18.96% did not show biphasic potential.ConclusionsFor the video head impulse test, a decreased gain of the vestibulo-ocular reflex for the lateral canal was observed, with a higher incidence of overt type corrective saccades compared to the control group. For the cervical vestibular evoked myogenic potential, there was a significant difference between the groups for the inter-amplitude parameter, including for asymptomatic ears. There was no correlation between the results of the tests and disease duration.     

Analysis of wideband tympanometry in Ménière’s disease

IntroductionEndolymphatic hydrops is the pathophysiological substrate of Ménière’s disease. The changes in the inner ear, transmitted to the middle ear through changes in the ossicular chain mobility, can be quantified by wideband tympanometry, through the measurement of the acoustic absorbance at multiple frequencies, represented by the sound energy absorbed by the middle ear, even at its early stages. Studying the behavior of the middle ear through the absorbance in patients with endolymphatic hydrops under ambient pressure and under peak pressure can be useful for detecting Ménière's disease.ObjectiveTo characterize acoustic absorbance behavior in subjects with symptomatic and asymptomatic Ménière's disease compared to controls, in order to verify the ability of wideband tympanometry to detect Ménière's disease.MethodsWe carried out a cross-sectional study with a diagnostic approach comparing the findings of wideband tympanometry at ambient pressure and peak pressure between the ears of the control group (n = 30), the asymptomatic group (n = 21) and the symptomatic group (n = 9).ResultsDifferent peak pressure values were found between the ears of the control group (0 daPa), the asymptomatic group (?11 daPa) and the symptomatic group (?192 daPa), with p < 0.05 by the Kruskal-Wallis test, Mann Whitney test and Bonferroni correction. Different absorbance values were found between the ears of the symptomatic group and the asymptomatic group compared to the control group for low frequencies at ambient pressure and peak pressure, with p < 0.05 by the Kruskal-Wallis test, Mann Whitney test and Bonferroni correction.ConclusionsThe Wideband Tympanometry test was capable of identifying the presence of Ménière´s disease, and to differentiate between asymptomatic and symptomatic patients, when comparing them with healthy individuals.     

Imaging of the endolymphatic space in patients with Ménière’s disease

Objective

To examine endolymphatic hydrops (EH) using magnetic resonance imaging (MRI) in patients with definite Ménière’s disease (MD) and those with nonotological diseases.

Association between Ménière’s disease and vestibular migraine

ObjectiveThe aim of the present study was to evaluate complaints in people with Ménière’s disease (MD) with and without migraine and headache to study the association between MD and Vestibular Migraine (VM). We believe this will help us understand if these two disorders represent a disease continuum in that they may share a common aetiology.MethodsThe study used a retrospective design and included data of 911 patients with MD from the Finnish Ménière Federation database. The study participants had a mean age of 60.2 years, mean duration of disease of 12.6 years, and 78.7% of the participants were females. The questionnaire data comprised of both disease specific and impact related questions. The data were analyzed using the Mann–Whitney U test, the Kruskal Wallis H test, logistic regression analyses, and decision tree analysis.ResultsMigraine and headache was reported by 190 subjects (20.9%) and 391 subjects (42.9%) respectively. We found that patients that could be classified as VM in the study (i.e., those with frequent vertigo spells associated with migraine) more often reported complaints of severe MD symptoms, had reduced health-related quality of life, suffered more from anxiety, had more neurological complaints, and experienced a reduced sense of coherence than the non-migraneous patients with MD. However, neither the decision tree analysis nor the logistic regression analysis could reliably discriminate VM from MD patients.ConclusionOur study results confirm that MD is frequently associated with headache and migraine. In addition, results also indicate that migraine provokes the severity of MD. We suggest that MD and VM may share similar pathophysiological mechanisms. Hence, the future MD classification systems should include a category referred to as ‘MD with migraine’ that will include patients with VM.     

Psychiatric disorders in patients with dizziness and Ménière’s disease

Conclusions: The Self-Rating Depression Score (SDS) is a useful metric for identifying patients with possible psychiatric disorders. Objective: A dilemma commonly encountered by otolaryngologists is how to diagnose and treat depression and anxiety disorders in patients who have dizziness or Ménière’s disease. Methods: We administered the SDS and Hospital Anxiety and Depression Scale (HADS) to patients with dizziness (n = 116) or Ménière’s disease (n = 22). Overall, 31 and 9 patients, respectively, had SDS ≥ 41. We investigated the correlation between the two questionnaire scores and the relationship between scores and a diagnosis of depression by a psychiatrist. Results: We referred 12 patients with dizziness and 4 with Ménière’s disease to a psychiatrist. The most common psychiatric comorbidities were anxiety disorder and major depression. Overall, 7 of the 12 patients who had dizziness and all 4 patients with Ménière’s disease were diagnosed with major depression. Patients with an SDS ≥ 41 and ≥ 11 on the D portion of HADS were likely to be diagnosed with major depression (9 of 11). No psychiatric disorders were diagnosed in patients with an SDS < 41. No specific characteristics were identified by HADS in patients with a psychiatric comorbidity.     

Meta-analysis of clinical studies with betahistine in Ménière’s disease and vestibular vertigo

We present a meta-analysis of 12 double-blind, randomized, placebo-controlled clinical studies with betahistine in patients suffering from vestibular vertigo or Ménière’s disease, based on both published and unpublished data. The clinical endpoint we used was the investigator’s overall opinion on the response to treatment of the vertigo symptoms, after at least 1 month of treatment. We introduce a new effect parameter, the odds of a favorable treatment outcome, with the odds ratio as measure to compare the responses of betahistine and placebo patients. For each study a separate odds ratio was estimated (the study-specific odds ratio). All but one of the study-specific odds ratios were >1.0, meaning that with the new effect parameter there was evidence of an effect of betahistine on vertigo symptoms in 11 of the 12 studies. Four of the 12 studies showed a statistically significant effect in favor of betahistine compared to placebo. The meta-analytical (i.e., average) odds ratio was 2.58 (95 % confidence interval 1.67–3.99), a statistically significant result. This means that on average, the likelihood of a favorable outcome is almost two times higher for patients treated with betahistine than for placebo-treated patients. Sub-analyses conducted for patients with Ménière’s disease on one hand and with vestibular vertigo on the other hand also yielded statistically significant results. For Ménière’s disease, the meta-analytical odds ratio was 3.37 (95 % CI 2.14–5.29); for vestibular vertigo, the odds ratio was 2.23 (95 % CI 1.20–4.14). Our meta-analysis supports the therapeutic benefit of betahistine on vertiginous symptoms in both Ménière’s disease and vestibular vertigo.     

End-point indicators of low-dose intra-tympanic gentamicin in management of Ménière’s disease

Conclusions: One-shot, low-dose intra-tympanic gentamicin (ITG) treatment was effective and safe for Ménière’s disease (MD) patients. Head thrust test (HTT) and vestibular evoked myogenic potentials (VEMPs) test could be used as endpoint indicators for vertigo control in MD patients.

Objectives: The present study is to explore end-point indicators of ITG injection in MD.

Methods: Patients with MD were reviewed from June 2012 to March 2014. Single-shot ITG at a concentration of 30?mg/ml was administered to patients. The sensitivity and specificity of HTT and VEMPs for vertigo control were measured.

Results: All 37 patients with a median follow-up of 26 months were included. Of those 37 patients, 24 patients (64.9%) obtained class A vertigo control and seven patients (18.9%) obtained class B vertigo control. Only six patients had class C control (16.2%). The sensitivity and specificity of HTT for vertigo control were 74.2% and 50.0%. Meanwhile, the sensitivity and specificity of VEMPs threshold were 83.9% and 33.3%. When combined HTT and VEMPs, sensitivity and specificity were 93.5% and 66.7%. Based on the four-tone average thresholds at 0.5, 1, 2, 3?kHz, 78.4% patients had no significant change in PTA and 16.2% patients experienced significant improvement.     

Mitochondrial ribosome and Ménière’s disease: a pilot study

Ménière’s disease patients experience vestibular disability. When most of medical treatments fail, a chemical labyrinthectomy using aminoglycosides is indicated. However, this process frequently causes hearing damage. Aminoglycosides, interacting with mitochondrial rRNAs, alter mitochondrial protein synthesis and the oxidative phosphorylation system, which provide most of the energy in sensory hair cells. For this reason, we hypothesized that genetic variation in mitochondrial rRNA genes and in two nuclear genes coding for proteins that also modify the susceptibility to aminoglycosides might affect the risk of hearing loss in Ménière’s disease patients suffering chemical labyrinthectomy. However, there were no differences in mitochondrial rRNA, TFB1M or MRPS12 genetic variation between those patients that experienced or did not experience hearing loss. This is only a pilot study and larger studies are required to use this therapeutic approach in a rational way and decrease the risk of hearing damage.     

Video head impulse test and caloric test in definite Ménière’s disease

European Archives of Oto-Rhino-Laryngology - The objective of the study was to compare the results of caloric reflex tests and video head impulse tests (vHITs) of lateral semicircular canals...     

Surgical treatment of the high jugular bulb in patients with Ménière’s disease and pulsatile tinnitus

The aim of this retrospective study was to evaluate the functional results of surgical lowering of the high jugular bulb in the treatment of patients with Ménière’s disease and pulsatile tinnitus. Fifteen patients with disabling Ménière’s disease associated with pulsatile tinnitus and a high and medial jugular bulb were included in this study. As treatment a complete mastoidectomy was performed, after which the jugular bulb was freed by an infralabyrinthine and subfacial approach. The bulb was then displaced downwards with surgical wax. Functional results of surgery were assessed by a questionnaire according to the 1995 guidelines of the United States American Academy Committee on Hearing and Equilibrium, audiometric and vestibular tests, and by magnetic resonance and computed tomographic imaging with vascular sequences. Surgical treatment was contraindicated in two cases: one had hypoplasia of the contralateral sigmoid sinus and the other a small petrous hemangioma located around the jugular bulb that was discovered peroperatively. Among the 13 patients treated by definitive surgery, attacks of vertigo were reported as disabling in 12 cases preoperatively (92%) versus 1 (8%) after surgical treatment. No significant change in hearing was observed after surgery. Tinnitus had been reported in all patients preoperatively and decreased in intensity in four (31%) and disappeared in three (23%) after surgery. Received: 24 April 1998 / Accepted: 13 October 1998     

Vestibular evoked myogenic potentials show altered tuning in patients with Ménière's disease.

OBJECTIVE: Acoustic stimulation of the saccule gives rise to a vestibulocollic reflex, the output of which can be measured in the neck as inhibition of activity in the ipsilateral sternocleidomastoid muscle. This vestibular evoked myogenic potential has been promoted as a means of assessing integrity of saccular function. In this study, we test the hypothesis that the cochleosaccular hydrops of Ménière's syndrome leads to alterations in saccular motion that change the dynamics of the vestibular evoked myogenic potential. STUDY DESIGN: Prospective cohort study. SETTING: Large specialty hospital, department of otolaryngology. SUBJECTS: Fourteen normal adult volunteers and 34 consecutive consenting adult patients with unilateral Ménière's disease by American Academy of Otolaryngology-Head and Neck Surgery diagnostic criteria. INTERVENTIONS: All subjects underwent vestibular evoked myogenic potential testing using ipsilateral broadband click and short tone-burst stimuli at 250, 500, 1,000, 2,000, and 4,000 Hz. MAIN OUTCOME MEASURES: Threshold, amplitude, and latency of vestibular evoked myogenic potential responses in normal and Ménière's affected and unaffected ears. RESULTS: Vestibular evoked myogenic potential was present in all ears tested. Normal subjects show a frequency-dependent vestibular evoked myogenic potential threshold, with best response ("frequency tuning") at 500 Hz. Compared with normal subjects and unaffected ears of Ménière's subjects, affected Ménière's ears had significantly increased vestibular evoked myogenic potential thresholds. Affected Ménière's ears showed threshold shifts at all frequencies and there was less tuning apparent at 500 Hz. Unaffected ears of Ménière's subjects also showed significantly elevated vestibular evoked myogenic potential thresholds compared with normal subjects. Analyses of vestibular evoked myogenic potential thresholds for effects of age, hearing loss, and audiometric configuration showed no significant differences. CONCLUSIONS: Ménière's ears display alterations in vestibular evoked myogenic potential threshold and tuning, supporting our hypothesis of altered saccular motion mechanics arising from hydropic distention. Unaffected ears of unilateral Ménière's subjects show similar changes, though to a lesser degree. This finding may be because of occult saccular hydrops in the asymptomatic ear or binaural interactions in the vestibular evoked myogenic potential otolith-cervical reflex arc.     

Vestibular drop attacks in Ménière’s disease and its association with migraine

European Archives of Oto-Rhino-Laryngology - We explored the association of vestibular drop attacks (VDA) with or without migraine in patients with Ménière’s disease (MD) and...