Role of audio-vestibular laboratory test in Meniere's disease: Comparative study between caloric test, video head impulse test, VEMP test and audiometry

Results:

In vHIT, the lesion side anterior semicircular canal (ASC) abnormal gain 3/53 (5.2%) patients, horizontal semicircular canal (HSC) 7/58 (12.1%) patients and posterior semicircular canal (PSC) 10/53 (18.8%) patients. In caloric test, 32 patients (55.2%) showed unilateral weakness (> 25%). Unilateral weakness of caloric test is significantly correlated gain of HSC (rho =-0.593, p = 0.0001) and PSC (rho =-0.458, p = 0.001), it was not correlated with ASC (rho =-0.204, p = 0.143).

VEMPs were tested in 22/58 (38%) patients. test. VEMP asymmetry was not correlated with unilateral weakness of caloric test and VOR gains of vHIT. Only 7/11 patients was abnormal response vHIT of them. (ASC-0, HSC-1, PSC-6). Also 7/11 patients was abnormal result caloric test of them. VEMP test's mean 47.6, mode 100, minimum 3.14, maximum 100.

All patients have pure tone audiometry. 31/58 (53.4%) patients were III stage hearing loss. 15/58 (25.9%) patients were II stage hearing loss. 12/58 (20.7%) patients were I stage hearing loss. Hearing loss stage was significantly correlation to age (r = 0.376, p = 0.005) and CP (r = 0.384, p = 0.005). While hearing loss stage was inversely correlation to HSC gain (r =-0.371, p = 0.006 and PSC gain (r =-0.361, p = 0.02).

Conclusions:

In unilateral Meniere's disease, unilateral weakness of caloric test was correlated with vHIT gain of HC and PC with statistical significance. Laboratory tests to evaluate cochleovestibular function were dissociated in many subjects while there was some significant correlation between tests. Audiometry, bithermal caloric test, vHIT and VEMP tests are important diagnostic work-ups for comprehensive understanding of MD patients.

Background:

In Meniere's disease (MD), patients with severe unilateral weakness in bithermal caloric test frequently show normal vestibular ocular reflex (VOR) gain on horizontal video head impulse test (vHIT). Similar observations also frequently noted between audiogram and bithermal caloric test. Differential involvement of the membraneous labyrinth, dynamic nature of this disease entity, different test range of each laboratory test can be speculated to explain these finding.

Objective:

We evaluated the gains of 3 semicircular canals (SCCs) using video head impulse test (vHIT) in unilaterial Meniere's disease (MD), and correlated them with caloric test, cervical vestibular evoked myogenic potential (VEMP) test and pure tone audiometry (PTA).

Materials and methods:

We retrospectively recruited 58 patients (mean age 53 years, 36 females) of definitive MD according to the 1995 AAO-HNS criteria from January through June 2017 who underwent bithermal alternating caloric test, vHIT and pure tone audiometry. Among them, VEMP was tested in 22 patients. Patients who received intratympanic injections or surgery before above evaluation were excluded. Canal paresis (CP) on caloric test, hearing threshold and VEMP asymmetry were correlated with the VOR gain of each SCCs on vHIT. A p value of <.05 was considered significant.

Results:

In vHIT, the lesion side anterior semicircular canal (ASC) abnormal gain 3/53 (5.2%) patients, horizontal semicircular canal (HSC) 7/58 (12.1%) patients and posterior semicircular canal (PSC) 10/53 (18.8%) patients. In caloric test, 32 patients (55.2%) showed unilateral weakness (> 25%). Unilateral weakness of caloric test is significantly correlated gain of HSC (rho =-0.593, p = 0.0001) and PSC (rho =-0.458, p = 0.001), it was not correlated with ASC (rho =-0.204, p = 0.143).<P>VEMPs were tested in 22/58 (38%) patients. test. VEMP asymmetry was not correlated with unilateral weakness of caloric test and VOR gains of vHIT. Only 7/11 patients was abnormal response vHIT of them. (ASC-0, HSC-1, PSC-6). Also 7/11 patients was abnormal result caloric test of them. VEMP test's mean 47.6, mode 100, minimum 3.14, maximum 100.

All patients have pure tone audiometry. 31/58 (53.4%) patients were III stage hearing loss. 15/58 (25.9%) patients were II stage hearing loss. 12/58 (20.7%) patients were I stage hearing loss. Hearing loss stage was significantly correlation to age (r = 0.376, p = 0.005) and CP (r = 0.384, p = 0.005). While hearing loss stage was inversely correlation to HSC gain (r =-0.371, p = 0.006 and PSC gain (r =-0.361, p = 0.02).

Conclusions:

In unilateral Meniere's disease, unilateral weakness of caloric test was correlated with vHIT gain of HC and PC with statistical significance. Laboratory tests to evaluate cochleovestibular function were dissociated in many subjects while there was some significant correlation between tests. Audiometry, bithermal caloric test, vHIT and VEMP tests are important diagnostic work-ups for comprehensive understanding of MD patients.

Key words:

Meniere's disease, caloric test, video head impulse test, vestibular evoked myogenic potential.

Publication History

Publication Date:
18 April 2018 (online)