Can you use vestibular evoked myogenic potentials (VEMPs) in the diagnosis of Meniere's disease? Read this article to learn the answer.
Yes VEMPs can be used in a number of ways and, like a number of vestibular diagnostic tests associated with Meniere’s disease, the result and the interpretation depend to a large extent of the point along the disease cycle at which the test is performed. For example, as part of a test battery one use of VEMPs would be to determine the extent of residual otolith function, where reduced VEMP amplitudes or absent VEMPs might be expected as the condition becomes more advanced. However, another interesting application is the VEMP tuning curve, which considers the VEMP amplitude across a range of stimulus frequencies.
In the healthy ear the VEMP (similar concepts apply for both the cervical and ocular VEMP) tuning curve shows a maximal response at around 500 Hz and a progressively reducing amplitude as stimulus frequency increases. However, in a diseased ear the tuning shifts so that the response becomes dominant at around 1000 Hz (Murofushi et al. 2017; Sandhu et al., 2012). The exact mechanism for this shift is unclear but may be attributable to the altered fluid dynamics of the fluid-distended vestibule. Clearly this technique depends on the overall disease stage (e.g. if a VEMP is absent, suggestive of later stages, then a tuning curve cannot be plotted). The postulated mechanism for a tuning curve shift might also suggest that a positive finding should not occur during a remission period even if the patient was a true positive.
To assist you with differentiating Meniere’s disease, see the below tables which suggest expected test results across the test battery in Meniere’s disease patients.
Characterized by an episodic hearing loss affecting the low frequencies
Not present during remission stage
Present if seen during an attack
Nystagmus can reverse immediately after an attack
Gaze-evoked nystagmus not present during remission stage
Gaze-evoked nystagmus present if seen during an attack
Latency: within normal limits
Accuracy: within normal limits
Velocity: within normal limits
Gain: within normal limits
Symmetry: within normal limits
Unilateral weakness: larger than 25% toward affected side
Directional preponderance: less than 30%
Fixation index: less than 50%
Amplitude: reduced on affected ear or absent cVEMP
Amplitude: reduced on affected ear or absent oVEMP
Gain: larger than 0.7 and possibly higher than 1.2
Asymmetry: less than 7% or higher than 7% with increased gain
Catch-up saccades: not present or less than 50%
Phase: within normal limits
Time constant: larger than 10 seconds but less than 60 seconds
Persistent hearing loss affecting the low frequencies
Nystagmus absent or present only at sub-clinical, slow-phase velocities
Gaze-evoked nystagmus absent or present only at sub-clinical, slow-phase velocities
Gain: less than 0.7 on affected side
Asymmetry: larger than 7% toward affected side
Catch-up saccades: generated
Gain: typically reduced, outside of the normative range
Phase: increased phase lead above normal range
Symmetry: asymmetry toward affected ear
Time constant: less than 10 seconds
Murofushi, T., Tsubota. M., Suizu, R. and Yoshimura, E. (2017) Is Alteration of Tuning Property in Cervical Vestibular-Evoked Myogenic Potential Specific for Ménière’s Disease? Front. Neurol. 8 Article 193.
Sandhu, J., Low, R., Rea, P., and Saunders, N. (2012) Altered frequency dynamics of cervical and ocular vestibular evoked myogenic potentials in patients with Ménière’s disease. Otol Neurotol 33. Pages 444-449.
The information in the figures are a resource tool based on the needs of medical professionals and students that allows quick access to the typical assessment findings in a range of common vestibular disorders. The resource was developed to provide fast, easy-to-use, and always available information which can aid in reaching the correct diagnosis. The information contained within is provided as an information resource only, and should not be used as a substitute for professional diagnosis and management.
railCourse details
- Format: Reading
- Clinical area: Evoked Potentials
