Vestibular evoked myogenic potential (VEMP) in patients with Ménière's disease with drop attacks.
OBJECTIVE
In this retrospective study, we tested the hypothesis that vestibular evoked myogenic potential (VEMP) thresholds are more often elevated or absent in patients with Ménière's disease experiencing Tumarkin drop attacks than in other patients with Ménière's disease.


METHODS
Subjects included normal subjects (n = 14) and patients with unilateral Ménière's disease by AAO-HNS (1995) diagnostic criteria with (n = 12) and without (n = 82) Tumarkin drop attacks at a large specialty hospital otology service. VEMP threshold testing was conducted using 250, 500, and 1,000 Hz tone burst stimuli.


RESULTS
VEMP responses were present in at all frequencies in both ears of all normal subjects. In unaffected ears of patients with unilateral Ménière's disease, VEMPs were undetectable in 13% of measurements attempted. This number rose to 18% in affected ears of patients with unilateral Ménière's disease and to 41% in Meniere ears with Tumarkin drop attacks. Frequency tuning of the VEMP response in normal subjects showed lowest thresholds at 500 Hz. In Meniere ears, the tuning was altered such that the 500-Hz thresholds were higher than the 1,000-Hz thresholds. There was a gradient of threshold elevation and altered tuning that corresponded to the gradient of worsening disease.


CONCLUSIONS
Our findings support the hypothesis that Tumarkin drop attacks arise from advanced disease involving the saccule and that VEMP may be a clinically valuable metric of disease severity or progression in patients with Ménière's disease.
Timmer
Ferdinand C A
FC
Academic Medical Center, Amsterdam, The Netherlands.
Zhou
Guangwei
G
Guinan
John J
JJ
Kujawa
Sharon G
SG
Herrmann
Barbara S
BS
Rauch
Steven D
SD
D000161:Acoustic Stimulation; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D004576:Electromyography; D005072:Evoked Potentials, Auditory; D005260:Female; D006801:Humans; D008297:Male; D008575:Meniere Disease / Q000175:diagnosis*; D008875:Middle Aged; D011336:Probability; D012016:Reference Values; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012684:Sensory Thresholds; D012720:Severity of Illness Index; D013575:Syncope / Q000175:diagnosis*; D014724:Vestibular Function Tests / Q000379:methods